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OCC HEALTH Flashcards

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1
Q

Which elements are included in OCC HEALTH program?

A
  • surveillance
  • education
  • immunization
  • injury prevention
  • response
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2
Q

When should a TST be performed on staff after exposure to TB?

A

At time of exposure and again in 12 wks

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3
Q

What is the major difference between Hep B and HIV with the epidemiology and how it’s transmitted?

A

The ease of transmission through needle punctures.
The risk of HBV seroconversion after a per cutaneous injury ranges from 23% to 64%
HIV risk is 0.3%
HCV is 1.8%We

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4
Q

What precautions are used for CMV?

A

Standard Precautions
Groups at high risk for serious complications include infants infected in utero or during delivery and immunocompromised persons

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5
Q

How does CDC define HCP?

A

All paid and unpaid persons working in healthcare settings who have potential for exposure to infectious materials, including body substances, contaminated medical supplies and equipment, contaminated environmental surfaces or contaminated air

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6
Q

How important are maintenance of employee records?

A

Major requirements.
Computerized database preferred

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7
Q

What are the IP&C objectives of an OCC HEALTH program?

A
  • Educate HCP about IP&C and individual responsibility.
  • Collaborate with IP&C to monitor/investigate exposures/outbreaks
  • provide care to those for work related illnesses or exposures
  • ID work related infection risks and institute appropriate preventive measures
  • Contain costs by preventing infectious diseases that result in absenteeism and disability
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8
Q

Make sure to look at OESH immunization table for basics

Hep A
Hep B

Influenza
MMR

POLIO
Td
Tdap

Varicella

A

Hep A - lab and primate worker
Hep B - occupational exposure

Influenza - everyone in contact with high risk pts
MMR - adults born after 1957 without hx of measles, serological immunity or 2 doses of vaccine

POLIO - lab who come in contact
Td - > 10 years since last dose
Tdap - those with direct patient contact, healthy adults 19 to 64
- pregnant HCWs need Tdap during each pregnancy

Varicella - those nonimmune

Meningococcal- those routinely exposed to N. Meningitidis should get one dose

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9
Q

Work restriction for conjunctivitis?

A

Restrict pt contact until discharge ceases

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10
Q

Work restriction for CMV?

A

None

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11
Q

Work restriction for diarrheal illness?

A

Restrict from patients and food handling until sxs resolve

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12
Q

Restriction from acute stage (diarrhea)?

A

Restrict from high risk pts until sxs resolve. Consult re: negative stools

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13
Q

Restrictions for diphtheria?

A

Exclude from
Duty until anti microbial therapy completed and 2 cultures obtained 24 hrs apart and negative

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14
Q

Restrictions for enteroviral infections?

A

Restrict from care of infants, neonates and immunocompromised until sxs resolve

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15
Q

Restrictions for Hep A?

A

Restrict from patient contact, contact with patients environment and food handling until 7 days after onset of jaundice

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16
Q

Restriction for Hep B?

A

If acute or chronic HBV and perform exposure prone procedures, restriction is
Until Hep B e antigen is negative!

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17
Q

Restrictions for acute or chronic Hep B?

A

Do not perform exposure prone invasive procedures until counsel from expert received

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18
Q

Restrictions for Hep C?

A

No recommendation until lesion healed as unresolved issue

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19
Q

Restrictions for herpes simplex?
Genital?
Hands (herpetic whitlow)?

A

HSV- No restriction
Genital - restrict from pt contact
Hands- evaluate need to restrict from high risk pts until lesions heal

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20
Q

Restrictions for HIV?

A

Do not perform exposure prone invasive procedures until counsel from expert received

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21
Q

Restrictions for measles?

Susceptible contact?

A

Exclude from duty until 7 days after rash appears

Contact? - from 5th day after exposure to Day 21and/or 4 days after rash appears

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22
Q

Restrictions for meningococcal infections?

A

Exclude from duty until 24 hrs after start of effective therapy

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23
Q

Restrictions for mumps?

A

Exclude from duty until 9 days after onset of parotitis

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24
Q

Restrictions for susceptible contact mumps?

A

Exclude from duty after 12 days from exposure to Day 26 or until day 9 after onset of parotitis

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25
Restrictions for pediculosis?
Restrict from patient contact until treated and observed to be free of adult and immature lice
26
Restrictions for pertussis? Asymptomatic? Symptomatic?
Asymptomatic?Exclude from duty from beginning of catarrhal stage through 3rd week after onset of paroxysms or until 5 days after start of effective antimicrobial therapy completed Symptomatic? Until 5 days after start of effective antimicrobial therapy completed
27
Asymptomatic?Exclude from duty from beginning of catarrhal stage through 3rd week after onset of paroxysms or until 5 days after start of effective antimicrobial therapy completed Symptomatic? Until 5 days after start of effective antimicrobial therapy
28
Restrictions for rubella? Susceptible contact?
Exclude from duty until 5 days after rash appears Exclude from 7th day after first exposure to Day 21
29
Restrictions for scabies?
Restrict from patient contact until cleared by medical evaluation
30
Restrictions for staph aureus infection? (Active draining skin lesions) Carrier state?
Restrict from contact with patients and patient environment or food handling until lesions have resolved Carrier state? No restriction unless linked to transmission
31
Restrictions for GAS?
Restrict from pt care, contact with pt environment or food handling until 24 hrs of tx
32
Restrictions for TB active disease?
Exclude from duty until proved no infectious
33
Restrictions for TB PPD converter?
No restriction
34
Restrictions for varicella (active)?
Exclude from duty until all lesions dry and crusted
35
Restrictions for varicella susceptible contact?
Exclude from duty from 10th day after first exposure to Day 21 (28 if VZIG given)
36
Restrictions for (herpes) zoster?
Cover lesions; restrict from care of high risk patients until all lesions dry and crusted
37
Restrictions for localized in immunosuppressed person?
Exclude from pt contact from 10th day after first exposure to Day 21 (28 if VZIG given)
38
What are the 3 TB screening risk classifications?
Low risk Medium risk Potential ongoing transmission
39
What HCPs should be included in a TB screening program?
PT, temporary, contract and full time HCPs.
40
What are other HCPs who should be included in a TB Screeninf program?
-Face to face contact with suspected/confirmed pts -HCPs who enter pt rooms/tx rooms whether or not pt present -Participate in AGMPs -Participate in MTB specimen processing -installing, maintaining replacing environmental control in areas in which persons with TB encountered
41
Define Latent TB
Condition that occurs after initial infection, the immune response limits additional multiplication of the tubercle bacilli and test results for M, tuberculosis infection become positive. Certain bacilli remain in the body and viable for multiple years. These persons are asymptomatic and not infectious.
42
Compare latent vs Active TB table in OCC HEALTH chapter
Later
43
What is used to diagnose LTBI?
PPD TST
44
What is used to detect M. Tuberculosis?
In vitro cytokine based immunoassays - tests measure cell mediated immune responses to peptides from two M. Tuberculosis proteins that are not present in any bacille Calmette-Guerin (BCG) vaccine strain and are absent from majority of nontuberculosis Mycobacteria - one such blood assay for M. tuberculosis (BAMT) is the Quantiferon - TB Gold test (QFT-G)
45
When and how should TST be administered?
Given by trained personnel. Tine texts should not be used. Baseline screening should be done at time of hire.
46
Should those with history of having BCG be included?
Yes. Unless they have documentation of a previous positive reaction - a two step TST should be done when initial is negative and no documented TST in preceding 12 months
47
What is considered a positive result for TST?
- If baseline and > 10 mm - if serial testing without known exposure and increase > 10 mm is considered a positive result (TST conversion) - known exposure (close contact) and > 5 mm if they have baseline of 0 mm
48
What is considered positive for QuantiFERON TB Test?
- Baseline and positive (only one step) - for serial testing without known exposure change from negative to positive (QFT conversion) - for known exposure (close contact) change to positive
49
50
What should be done if HCP has positive TST?
A CXR to check for active disease. Obtain history to determine if community or occupational related. Ask person to report symptoms. CXR does not need to be repeated unless Symptomatic
51
What type of test is one that results in a pass or fail fit test and assesses adequacy of respirator fit?
Qualitative fit test
52
What test is an assessment of the adequacy of respirator fit by numerically measuring leakage into respirator?
Quantitative fit test (QNFT)
53
** know percentage risks for HIV/Hep B/ Hep C What is the exposure risk % for transmission of HIV by: - percutaneous - mucous membrane contact - non intact skin contact
- percutaneous is 0.3 - mucous membrane contact 0.1 - non intact skin contact 0.1
54
When must an employ have an exposure plan for Hep B vaccine when they begin employment?
Within 10 days of employment
55
What percent is the risk of Hep B virus seroconversion after a percutaneous injury dependent on the Hep B e antigen status?
23 to 62 %
56
What is diagnosis for this re: Hep B? HBsAg+, total Anti-HBc+, IgM Anti-HBC-, and Anti-HBs-
Chronic infection
57
What is temp for flash steam sterilization?
132C/270F
58
In a probable food outbreak a febrile patients develop severe bloody diarrhea and abdominal cramps in one to 10 days (peaking at 3 to 4 days) after eating at a country fair. The most likely pathogenic organism is
E. Coli (enterohemorrhagic)
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60
When should the Hep A vaccine be administered and what are seroconversion rates?
Two dose schedule (0, 6 to 18 months later). For HAVRIX it’s 0, 6, 12 months later. Seroconversion rates > 90% routinely observed
61
When should anti-HBs antibody titers be checked?
No sooner than 30 days after last dose of vaccine and no later than 6 months after last dose
62
How many doses should adults receive for HBV immunization?
Three doses
63
What year is important for MMR vaccine?
1957
64
For those born in 1957 or later what is required for MMR vaccination?
Two doses of MMR 4 weeks apart
65
What is the recommendation for Tdap (tetanus-diptheria-acellular pertussis 11 years and older?
Adults should receive a single dose of Tdap to replace a single dose of tetanus-diptheria (Td) for booster immunization against tetanus diphtheria and pertussis if they received the most recent tetanus containing toxins 10 or more years previously
66
What should HCP get for vaccinations if not previously received Tdap?
Single dose of Tdap if direct care provider
67
What should adults receive for Tdap if wanting to protect infants aged < 12 months?
Single dose of Tdap
68
What should pregnant women receive for Tdap?
Tdap recommended for all Women in third trimester (ideally 27 through 36th week of pregnancy) even if previously received
69
70
When should varicella vaccine be administered if no evidence of immunity to varicella?
Two 0.5 mL doses 4 to 8 wks apart
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74
The average risk for transmission of HIV by exposure type is what for: - percutaneous - mucous membrane contact - non intact skin contact
- percutaneous is 0.3% - mucous membrane contact is 0.1% - non intact skin contact is less than 0.1%
75
What infectious agents are we concerned with when we have pregnant HCPs?
- CMV - Parvovirus B19 - HSV - Syphillis - Rubeola - Rubella - Varicella ** don’t forget the exposure to the ribavirin aerosol for treatment of RSV concerns!
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