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CBIC Section 4

Employee/ Occupational Health

QuestionAnswer
You have been notified by the Director of the Emergency Department that several employees were exposed to a patient confirmed to have pulmonary TB. After you confirm that the employees were exposed what should be done next? Administer the TB skin test & repeat skin test in 12 weeks. Look for possible converters. Chest radio graphs are performed only on those with prior positive TST & who are currently symptomatic.
Incident report: ped RN exposure. The report is incomplete. It states the RN was scratched by a “needle” in a pt's room, while spiking an IV bag. Can't tell at what point the exposure occurred or type of “needle” involved. Your 1st action should be: Determine if a Blood or Body fluid exposure actually occurred.
A new employee to your facility is foreign-born and received the bacillus Calmette-Guérin (BCG) vaccine as a child. Her pre-employment assessment for tuberculosis (TB) should include: Two-step PPD as any other employee would receive
During an in-service program for new employees, the IP describes how hepatitis B and HIV are transmitted. A major difference in the epidemiology of the two diseases is: The ease of transmission through needle punctures Hepatitis B is transmitted easier through needles then HIV
During educational in-service to pediatric nurses, the IP is asked how to manage a patient with cytomegalovirus (CMV). The correct precautions include: Following Standard Precautions.
Elements of an occupational health program surveillance, education, immunization, and injury prevention and response.
Conjunctivitis Work Restriction & Duration Work Restriction: Restrict from Pt contact & contact w/ pt environment. Duration: Until discharge ceases
CMV Work Restriction & Duration No restrictions
Diarrheal diseases Work Restriction & Duration Acute stage (diarrhea w/ other s/s) WR: Restrict from pt contact, contact w/ the environment & food handling. Duration: Until S/S resolve.
Diphtheria Work Restriction & Duration Work Restriction: Exclude from duty Duration: Until ABX completed & 2 cultures obtained 24 hrs apart are -
Enteroviral infections Work Restriction & Duration Work Restriction: Restrict from care of infants, neonates & immuno compromised pts & their environments. Duration: Until symptoms resolve
Hep A Work Restriction & Duration Work Restriction: Restrict from pt contact, contact w/ pt's environment & food handling. Duration: until 7 days after onset of jaundice
Hep B Work Restriction & Duration Acute or C\hr hep B surface antigen who do not perform exposure prone procedures Work Restriction: No Restrictions; refer to state regs; SP should always be observed Duration; NA
Hep B Work Restriction & Duration Acute or Chr Hep Be Antigen who perform exposure-prone procedures Work Restriction: Don't t perform exposure prone invasive procedures until reviewed by expert panel and state regs are reviewed Duration: Until hep be antigen is negative
Hep C Work Restriction & Duration Work Restriction: No recommendation Duration: Until lesions heal
Herpes simplex Work Restriction & Duration Genital Work Restriction: No restriction Duration: NA
Herpes simplex Work Restriction & Duration Hands (Herpetic whitlow) Work Restriction: Restrict from pt contact & contact w/ the pt's environment Duration: Until symptoms resolve
Herpes simplex Work Restriction & Duration Orofacial Work Restriction: Evaluate for need to restrict from care of high-risk pts Duration : Until symptoms resolve
HIV Work Restriction & Duration do not perform exposure prone invasive procedures. Seek expert panel review; Standard precautions should always be observed; State regs reviewed
Measles Work Restriction & Duration Active Work Restriction: Exclude from duty Duration: 7 days after the rash appears Post Duration: from 5th day after 1st exposure through 21st day after last exposure &/or 4 days after rash appears
Meningococcal infections Work Restriction & Duration Work Restriction: Exclude from Duty Duration: until 24 hrs after start of effective therapy
Mumps Work Restriction & Duration Active Work Restriction: Exclude from duty for both Active Duration: Until 9 days after onset of parotitis Post exposure duration: from 9th day after 1st exposure through 26th day after last exposure or until 9 days after onset of parotitis
Pediculosis Work Restriction & Duration Work Restriction: Restrict from pt contact Duration: Until treated & observed to be free of adult & immature lice
Pertussis Work Restriction & Duration Active Work Restriction: Exclude from duty; Duration: From beginning of catarrhal stage - 3rd wk after onset of paroxysms or until 5 days after start of effective abx.
Pertussis Work Restriction & Duration Post exposure (asymptomatic) Work Restriction No restrictions, prophylaxis recommended Duration: NA
Pertussis Work Restriction & Duration Post exposure (symptomatic) Work Restriction: Exclude from duty: Duration: 5 days after start of effective ABX
Rubella Work Restriction & Duration Active Work Restriction: Exclude from duty Duration: Until 5 days after rash appears
Rubella Work Restriction & Duration Post exposure (susceptible) Work Restriction : Exclude from Duty Duration: from 7th day after 1st exposure through 21st day after last exposure
Scabies Work Restriction & Duration Work Restriction: Restrict from pt contact Duration: until cleared by medical evaluation
S. Aureus infection Work Restriction & Duration Active: draining skin lesions Work Restriction: Restrict from contact w/ pt's, their environment and/or food Duration: Until lesions have resolved
S. Aureus infection Work Restriction & Duration Carrier state Work Restriction: No restriction, unless personnel are epidemiologically linked tor transmission of the organism. Duration: NA
Streptococcal infection, group A Work Restriction & Duration Work Restriction: Restrict from contact w/ pt's, their environment and/or food Duration: Until 24 hrs after adequate tx started
TB Active Disease Work Restriction & Duration Work Restriction: Exclude from duty Duration: Until proved noninfectious
TB PPD converter Work Restriction & Duration Work Restriction: no restrictions Duration: NA
Varicella Active Work Restriction & Duration Work Restriction: Exclude from duty Duration: Until all lesions dry and crust
Varicella Post exposure (susceptible personnel) Work Restriction & Duration Work Restriction: Exclude from duty Duration: from 10th day after 1st exposure through 21st day (28th day if VZIG given) after last exposure
Zoster Work Restriction & Duration Localized, in healthy person Work Restriction: Cover lesions; restrict from care of high-risk pt Duration: Until all lesions dry & crust
Zoster Work Restriction & Duration Generalized or localized in immuno-suppressed person Work Restriction: Restrict from pt contact Duration: Until all lesions dry & crust
Zoster Work Restriction & Duration POst exposure (susceptible personnel) Work Restriction: Restrict from pt contact Duration: From 10th day after 1st exposure through 21st day (28th day if VZIG given) after last exposure or, if varicella occurs, until all lesions dry & crust
Viral respiratory infections, acute febrile Work Restriction & Duration Work Restriction: Consider excluding from the care of high-risk pts or contact w/ their environment during community outbreak of RSV & Influenza Duration: Until acute symptoms resolve
Personnel who have laryngeal or pulmonary TB are excluded from work until they are receiving adequate therapy, the cough has resolved, and there have been two consecutive sputum smears negative for acid-fast bacilli. T/F False - 3 consecutive sputum smears
The generally accepted respiratory protection that is used to protect personnel from a person with suspected or confirmed TB is a particulate N95 respirator, a requirement identified in CDC's respiratory protection standard. False -OSHA standard
A X is one that results in a pass or fail fit test and one that assesses the adequacy of respirator fit that relies on the individual's response to the test agent. Qualitative fit test (QLFT)
A X is an assessment of the adequacy of respirator fit by numerically measuring the amount of leakage into the respirator. A user seal check is an action conducted by the respirator user to determine if the respirator is properly seated to the face. Quantitative fit test (QNFT)
What action is indicated when the IP is asked to help determine if a worker has experienced occupational acquisition of an infectious agent or disease in order to receive workers’ compensation benefit? C. Review the workers’ compensation system in place
Which U.S. agency requires a respiratory program for HCP? A. Food and Drug Administration (FDA) B. The Joint Commission (TJC) C. Centers for Disease Control and Prevention (CDC) D. Occupational Safety and Health Administration (OSHA) OSHA requires that the employer have a RT protection program w/ a qualified administrator who oversees it , evaluating the effectiveness. Also requires that each HCW who wear a respirator receive a fit test before & perform a seal check with each use.
A technician finds out after obtaining an EKG on a pt that the pt may have (shingles) on a dermatome on the upper body. OCH RN checks the employee’s records and realizes that they were never tested for varicella on hire. First thing thet should do : A. Determine if the pt actually has an active case of shingles by involving the IP or checking with the pts doc to verify the dx.
Diarrheal diseases Work Restriction & Duration Convalescent stage Work Restriction: Restrict from care of high-risk pts . Duration Until S/S resolve; consult w/ PH regarding need for - STC
Measles Work Restriction & Duration Post exposure (susceptible personnel) Work Restriction: Exclude from duty Post Duration: from 5th day after 1st exposure through 21st day after last exposure &/or 4 days after rash appears
Mumps Work Restriction & Duration Post exposure (susceptible personnel) Work Restriction: Exclude from duty Duration: from 9th day after 1st exposure through 26th day after last exposure or until 9 days after onset of parotitis
The Avg risk of seroconversion after a percutaneous injury involving blood infected w/ HCV is... 1.8%
The Avg risk of seroconversion after a percutaneous injury involving blood infected w/ HBVis... 23 to 64%
The Avg risk of seroconversion after a percutaneous injury involving blood infected w/ HIVis... 0.3%
The Centers for Disease Control and Prevention (CDC) defines the term HCP as all paid and unpaid persons working in healthcare settings who have the potential for exposure to infectious materials, including body substances, contaminated medical supplies and equipment, contaminated environmental surfaces, or contaminated air.
HAI Possible & prevented by Pre-expoisure Vaccine Anthrax*, HAVa, HBV, Influenza, N. Meningitis *, Pertussis, Rubella, Rubeola, Varicella, Tetanus, Diptheria, Small pox
HAI unlikely HSV; Toxoplasmosis
IP precautions are the only preventitive measures CMV, HCV, Parvovirus B19, TB
Post exposure Chemoprophylaxis HIV, N. Meningitis, Syphilis
Vaccination for Pregnant HCW Hep A, Hep B, Influenza-inactivated, Meningococcal (MCV4/MenACWY), Polio (if needed), Tdap
Vaccinations contraindicated for Pregnant HCW HPV, Influenza-live virus, MMR, Varicella, Zoster (shingles)
Vaccinations for Pregnant HCW unknown Pneumococcal Conjugate (PCV 13) ; Pneumococcal Polysacccharide (PPSV23)
There's an outbreak of Bordetella pertussis. Several employees have contacted the IP at their for info on the Tdap vaccine. They q the need for the vaccine because they received it as a child. The IP should inform them that the ACIP recommends that: All adults aged 19 and older should receive at least one dose of Tdap
A pregnant HCW is concerned because she has been assigned to take care of a pt who has cytomegalovirus (CMV) infection. How should an IP respond to this concern? Advise following SP while caring for the pt will prevent transmission. CMV is transmitted through saliva, urine, and blood products and organs. CDC recommends using SP when caring for pts w/ CMV, w/ no additional precautions recommended for pregnant HCP.
pregnant EVS , who is nonimmune, enters the room of a pt w/ confirmed varicella who is not wearing a mask before an isolation sign is posted. This happened on 1/11. After giving VZIG, she should be excluded from work. What day can she return to work? Feb 9 The HCW was given VZIG. Normal time off would be from day 10 through day 21 after exposure, but bc VZIG was given, it is recommended to keep the employee off through day 28 (able to return on the 29th day after the exposure).
A hospital has admitted an immunocompetent pt w/ localized herpes zoster. During unit rounds, the IP notes a sign on the door that says “No pregnant women.” How should the IP best respond to this? Remove the sign from the door and ensure that all lesions are completely covered; Standard Precautions are sufficient to prevent the spread of the virus
Pt w/ a confirmed Dx of varicella is seen in ED. He is immediately masked until could be moved to a - airflow room, where the mask is removed. A pregnant EVS , nonimmune, enters the room before a sign is posted. Most appropriate postexposure response? Give the EVS employee VZIG and place off work from day 10 through day 28
Precautions for Variola Major (small pox) Airborne
Precautions for N. Meningitidis Droplet
Precautions for Influenza Droplet
Precautions for VRE Contact
Precautions for MRSA Contact
Precautions for C. Diff Contact
Precautions for Bordetella pertussis Droplet
Precautions for Cytomegalovirus Standard
Precautions for Measles Airborne
Precautions for TB Airborne
Precautions for Parvovirus Droplet
Urine Refrigerate vs Room Temp Refrigerate
Vaginal/Genital Sample Refrigerate vs Room Temp Room Temp
Occular Sample Refrigerate vs Room Temp Room Temp
Stool Sample Refrigerate vs Room Temp Refrigerate
Immunobiologic Antigenic substance or antibody containing preparation used to induce immunity and prevent infectious disease.
Active immunization Use of an antigenic substance to induce immunity by stimulating an immune response.
Vaccine Active immunization A suspension of live (usually attenuated) or inactivated microorganisms, or fractions thereof.
Toxoid Active immunization A modified (nontoxic) bacterial toxin that is capable of stimulating antitoxin formation.
Passive immunization Use of an antibody-containing preparation to enhance or restore immunity. (Ig): A sterile solution containing antibodies from human blood. Antitoxin: A solution of antibodies derived from the serum of animals immunized with specific antigens.
Vaccine Monovalent A vaccine consisting of a single strain or type of organism.
Vaccine Trivalent A vaccine consisting of three types or strains of a single organism (e.g., influenza vaccine), or three different organisms (e.g., diphtheria-pertussis-tetanus vaccine).
Vaccine Quadrivalent An influenza vaccine consisting of four influenza strains (e.g., two A virus strains, two B virus strains).
Vaccine Polyvalent Multiple strains or types of organisms in the vaccine (e.g., 23-valent pneumococcal vaccine).
Misconceptions concerning contraindications to immunization Previous local reaction or fever after Td vaccine. Egg intolerance or allergy to feathers. PCN or other non specific allergy. Mild acute illness w/ low grade fever. Recent exposure to infectious disease. Breastfeeding
Sputum Refrigerate vs Room Temp Refrigerate
Spinal Fluid Refrigerate vs Room Temp Room Temp
Created by: JRWeidenaar