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HEALTH CARE FACILITY INFECTION CONTROL PROGRAM A N E MPLOYEE H EALTH P ERSPECTIVE Kenneth R. Keller, DO Employee Health Physician Medical Director Occupational.

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Presentation on theme: "HEALTH CARE FACILITY INFECTION CONTROL PROGRAM A N E MPLOYEE H EALTH P ERSPECTIVE Kenneth R. Keller, DO Employee Health Physician Medical Director Occupational."— Presentation transcript:

1 HEALTH CARE FACILITY INFECTION CONTROL PROGRAM A N E MPLOYEE H EALTH P ERSPECTIVE Kenneth R. Keller, DO Employee Health Physician Medical Director Occupational Health Services McCullough-Hyde Memorial Hospital kkeller@mhmh.org

2 E MPLOYEE H EALTH & I NFECTION C ONTROL O BJECTIVES Minimize communicable disease transmission from employee to patient and patient to employee. Reduce the need for treatment and absenteeism containing costs Review immunization program Review major risks of occupational exposure to Infectious Disease Review counseling, follow up, and work restriction recommendations for communicable diseases and following exposure Review strategies to accomplish these function s

3 I MMUNIZATION P ROGRAM Begin with thorough pre-placement evaluation Assure immunity to minimize employee to patient and patient to employee communicable disease transmission Must be consistent with the most current ACIP guidelines Barriers to success

4 P RE - PLACEMENT E VALUATION Immunization record review Health history review ( pregnancy, current health status, hepatitis, skin condition, TB/ exposure/ skin test conversion, immune deficient conditions ) Physical examination ( less important than history for infection control purposes ) Lab tests ( other than immune titres) and x-ray are generally of no value ) One of our best opportunities to individually explain the benefits of our immunization program, not just for patients, but for the employee, as well.

5 CDC/ACIP H EALTHCARE P ERSONNEL V ACCINATION R ECOMMENDATIONS Hepatitis B – 3 dose series ( now, 1 month, 6 months) IM. Obtain anti- HBs serology 1-2 months after dose 3. (SAFE in pregnancy) Influenza - 1 dose annually. Inactivated influenza injection IM ( SAFE in pregnancy),Live attenuated vaccine ( LAIV) intranasaly (NOT SAFE in pregnancy) MMR (measles, mumps, rubella) - without serologic evidence of immunity or prior vaccination, 2 doses, 4 weeks apart SC. NOT SAFE in pregnancy- recommend protected intercourse 4 weeks post vaccination. Varicella (chickenpox) - no serologic proof of immunity, prior vaccination or PROVIDER documented disease, 2 doses, 4 weeks apart, SC (NOT SAFE in pregnancy ) Tdap ( tetanus, diphtheria, pertussis) - if not previously given, IM ( SAFE in pregnancy) Meningococcal – one dose to microbiologists routinely exposed to N. meningitidis, IM, SC. TB skin test ( PPD) - 2 step ( 7-10 days apart), ID, SAFE in pregnancy. Chest x-ray NOT routinely recommended for prior converters- only if symptomatic ( cough, hemoptysis, fevers, weight loss, other constitutional symptoms ).

6 M AJOR O CCUPATIONAL I NFECTIOUS D ISEASE E XPOSURE R ISKS Bloodborne Pathogens Tuberculosis Meningococcus Selected disease risk to and from patients (Handout) Selected disease risk from patients to providers (Handout) Special populations ( pregnancy, immunosuppression ) (Handout) Ensure your notification follows your policy and any applicable Local or State Health Department Reporting Requirements. For unusual non-major, as well as major, ID concerns - immediately involve Infection Control, Employee Health Officer, Local and State Health Departments.

7 B LOODBORNE P ATHOGENS 29 CFR 1910.1030 – OSHA Bloodborne Pathogen Standard Limits occupational Exposure to blood and other potentially infectious material (OPIM) Protect workers against exposure that can lead to disease and death

8 K EY E LEMENTS OF THE S TANDARD Record Keeping Multi-Employer Worksites Who is covered under the standard Exposure Control Plan Compliance HBV Vaccination, Post-Exposure Evaluation & Follow-Up Employee Information & Training

9 R ECORD K EEPING Bloodborne Pathogen Exposure is an Injury Usually recorded in the OSHA 300 Log Healthcare Employers must Establish a Separate Sharps Log ( incident description, location, type and brand of device – at minimum)

10 M ULTI -E MPLOYER W ORKSITES Agency Contractors (Non-Employees) cannot be Cited in an Exposure The Contracting Facility (Hospital, etc) is Cited in an Exposure. Home Health cannot be Cited for Site-Specific Hazards

11 W HO IS C OVERED U NDER THE S TANDARD ? Any employee ( full time, part, time, temporary) with potential for blood or OPIM exposure Excluding: students, state, county, municipal, and construction workers. Also Excluding: “Good Samaritan” ( helping co-worker with a nose bleed, etc )

12 E XPOSURE C ONTROL P LAN Always reviewed by Compliance Officers Sample Bloodborne Pathogen Standard Model Exposure Control Plan available on the OSHA Website Required for any Employer with one ore Employees wit Potential for Exposure Required Yearly Update Facility Specific Must Solicit Input From Non-Management Must be Readily Available to Employees Must contain Procedures for Investigation/Evaluation of Exposure Incidents

13 COMPLIANCE Universal Precautions Engineering Controls: Sharps Protection Hand Washing Facilities: Present & Effective No Cost PPE Proper Disposal of Contaminated Waste & Sharps

14 HBV V ACCINE, P OST -E XPOSURE E VALUATION & F OLLOW -U P HBV vaccine ( three shot series ) provided at no cost and outlined in the exposure control plan ( ECP) Obtained signed declination if refused, vaccine remains available to them at any time Beware of current CDC vaccination guidelines No need to vaccinate if proof of prior vaccination or immunity ( positive titer ) Any unvaccinated employee has vaccine availability to them within 24 hours of exposure incident Every effort should be made ( and documented ) to test the exposure source

15 E MPLOYEE I NFORMATION & T RAINING Initial & Annual Training on Blood & OPIM Exposure & Protective Measures Training Conducted & Recorded by Qualified Instructor Appropriate Biohazard Labeling of Containers & Refrigerators

16 T RAINING E LEMENTS Copy & Explanation of BBP Standard Epidemiology & Symptoms Modes of Transmission Employer & Site-Specific ECP Exposure Determination Hazard Recognition/Risk Identification Engineering Controls, Word Practices & PPE Hepatitis B Vaccine Emergency Reporting & Response Exposure Incident Post-Exposure Evaluation & Follow-Up Signs & Labels Live Question & Answer

17 M AIN C ONCERNS Hepatitis B Virus Hepatitis C Virus HIV Virus

18 H EPATITIS B Potentially Fatal & Preventable by Effective Vaccination Over 1 Million Americans are Chronically Infected with Hepatitis B 5,000- 6,000 Deaths Annually due to Liver Disease or Cancer Related to Hepatitis B At Risk: IV Drug Users, Multiple Sex Partners ( A Sexually Transmitted Disease) Hemodialysis Patients Hearty Virus: Can Live in Dried Blood for up to 2 Weeks High Transmission Risk 1/3 of Patients have No Symptoms CDC Reports 60,000 New HBV Cases a Year

19 HEPATITIS C Most Common Chronic Bloodborne Infection in the U.S., Nearly 3,000,000 Active Infections Chronic Infection may not have Symptoms for up to 2 Decades Symptoms Similar to Hepatitis B Chronic Liver Disease Occurs in 70% with 8,000-10,000 Deaths Annually Not as Hearty a Virus as Hepatitis B Lower Transmission Risk, but No Vaccine

20 HIV V IRUS Development of AIDS may take Years from Actual Infection with HIV 40,000 New Cases of HIV / Year per CDC Virus is Not Hearty & Does Not Survive Well Outside the Body with Lower Transmission Risk Less than 100 Reported Cases of Infection due to Occupational Exposure ( Nearly all deep needle sticks) Risk of Transmission even from Needlestick only 1:300

21 E XPOSURE I NCIDENT D EFINITION Contact of Blood or other Potentially Infectious Material (OPIM) by Sharps Stick, Mucous Membrane Exposure or Non-Intact Skin Exposure

22 W HAT IS OPIM? Practical Definition: All Bodily Fluids Universal Precautions Refers to Protection from All Bodily Fluids

23 W HAT TO D O IF AN E XPOSURE O CCURS ? Wash with Soap & Water Report Incident to Superior Medical Evaluation & Arrangement of Follow-Up ASAP

24 W HAT H APPENS IN THE P OST -E XPOSURE P ERIOD ? Documentation of the exposure type Attempt to obtain source testing if applicable Testing of exposed employees if applicable Risk counseling of the exposed employee in prophylactic treatment as indicated per USPHS and CDC guidelines

25 E XPOSURE R ECORD -K EEPING R EQUIREMENT Employee Name & SS# Hepatitis B Immune Status Applicable Test Results & Post-Exposure Follow-Up Healthcare Provider Written Opinion Maintain Confidential Records for Duration of Employment & 30 years

26 T HE B EST W AY TO M ANAGE BP E XPOSURE IN THE W ORK P LACE ? PREVENTION!

27 P ERSONAL P ROTECTIVE E QUIPMENT Non Latex Gloves Clothing/Footwear Eye Protection / Faceshield

28 FIRST AID PRECAUTION Gloves Eye/Faceshield if Splash/Spray Hazard Universal Precautions – Consider all Bodily Fluids OPIM Wash Hands!

29 H OUSEKEEPING P RECAUTIONS Gloves for Any Contaminated Object – Including Laundry Wash Hands ASAP After Removing Gloves Collect broken Glass, Any Sharp Contaminant with Broom/Dust Pan Do Not Touch other Surfaces with Contaminated Gloves No Food/Drink in Contaminated Area No Smoking Wash Hands!

30 D ISPOSAL & D ECONTAMINATION Gloves! Disinfect with ¾ Cup Bleach to 1 Gallon Water Spill Clean-Up: Soak Up with Paper Towel, Disinfectant Wipe Down, Red Bag all Wipes Wash Hands!

31 S UMMARY An Exposure is Blood or OPIM Contact by Sharps Stick, Mucous membrane or Non-Intact Skin Contact The Most Important Bloodborne Pathogen is Hepatitis B – Potentially Fatal & Preventable by Effective Vaccine, Hearty Organism with High Transmission Risk & the Only Pathogen Specifically Included in the OSHA ECP Universal Precautions Requires Considering All Blood & Body Fluids as OPIM & Taking the Appropriate First Aid & Housekeeping Precautions Personal Protective Equipment is Needed for any Potential Exposure

32 T UBERCULOSIS At Risk Population Annual Facility Risk Assessment Surveillance/Screening Annual Training Steps in Exposure Managing TB Skin Test (TST) Positives/Conversion Counseling/Treatment

33 A T R ISK P OPULATION FOR TB Patient Populations: Foreign Nationals from High Risk Areas, Alcoholic, IV Drug use, Prison Inmates, Homeless, Immunosuppression, HIV History Healthcare Workers ( Especially Respiratory Care, those who Intubate) Staff Training to Identify those At Risk on Admission for Triage to Negative Pressure Room in the ED or on a Medical Floor

34 A NNUAL F ACILITY TB R ISK A SSESSMENT Moderate or High Risk will Require Annual Surveillance May have up to 3 Year Surveillance Interval if Low Risk

35 S URVEILLANCE / S CREENING OSHA Requirement Must Include Employees, Volunteers, Students & Physicians New Hire: 2 Step TST Mantoux Technique ( 0.1 ML -5 Tuberculin Units – of Purified Protein Derivative Intermediate Intradermal ) – 2 Step Required to Prevent Misinterpretation of a Boosted Response from Recent Infection If 1 Step 0-9 MM Induration, can Proceed to 2 nd Step 1-3 Weeks After If Negative TST in Last 3 Months, Only Need 1 Step If Positive TST ( >= to 10 MM Inuration ), Obtain Chest X-Ray If Prior Positive TST, Do Not Do TST, Chest X-Ray only if Symptomatic

36 TB A NNUAL T RAINING OSHA Required Epidemiology of TB Difference Between Latent TB Infection & Disease Signs, Symptoms & Recognition Purpose & Interpretation of TST Multi-Drug Resistant TB & Treatment Problems PPE & Respiratory Isolation Review ( N95, FIT Test, PAPR)

37 S TEPS T AKEN IN E XPOSURE Unprotected Exposure ( Other than Initial Encounter ) Should be Rare Baseline PPD ASAP After Exposure unless One in Previous 3 Months 2 nd Step at 10 Weeks Post-Exposure Referral for TB Evaluation if Positive TST Response or Symptoms

38 TB C OUNSELING & T REATMENT New TST Converters will Get a Chest X-Ray & Referral ( PCP, Pulmonologist, Health Department ) for Evaluation They may not Return to Patient Care Until Cleared by this Evaluation

39 M ENINGITIS E XPOSURE Neisseria Meningitidis is Spread by Droplet, not Aerosol Close Contact – Intubation or Nasotracheal Suctioning – Required for Occupational Transmission Ceftriaxone 125 MG IM X 1 or Rifampin 600 mg every 12 Hours for 4 Doses Consider No Patient Contact for 24 Hours After Treatment

40 S TRATEGIES FOR S UCCESSFUL I MPLEMENTATION Annual Training : OSHA required (hand washing, standard/universal precautions, PPE, safe sharps handling, spills, biohazard ) but also employee responsibility with communicable disease and any other evolving issues Cross Talk : Between Employee Health, Infection Control, Health and Safety, Physician Services ( Bylaws, Rules and Regulations) and Volunteer Services committees and policies Reporting & Real Time Action Structure : For TB surveillance, employee or patient communicable or reportable disease. Secure Employee Health Records : With access on as needed basis. Preplacement Evaluation : Immunization review Plan for all Associate Compliance : Thousand mile journey begins with first step Remember the Primary Objective : You will need it.

41 Q UESTIONS


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