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1 OSHA/Infection Control Annual Update Training - 2014 IC/EC, Inc.

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Presentation on theme: "1 OSHA/Infection Control Annual Update Training - 2014 IC/EC, Inc."— Presentation transcript:

1 1 OSHA/Infection Control Annual Update Training IC/EC, Inc.

2 2 ∗ Update disease information ∗ List new training responsibilities ∗ Conduct refresher training on key department issues of compliance ∗ Understand the use of surgical masks ∗ Clarify use of declination forms ∗ Review new flu vaccines Objectives

3 3 Disease Numbers ∗ 2012 ∗ HIV Dx – 35,361 ∗ HBV – 2,895 ∗ HCV – 1,782 ∗ Syphilis – 15,667 ∗ TB – 9,945 ∗ ∗ 2013 ∗ HIV – ∗ HBV – 2,666 ∗ HCV – 1,655 ∗ Syphilis – 15,639 ∗ TB – 8,080 CDC, MMWR, Jan.3, 2014 – provisional

4 4 Other Diseases ∗ Measles ∗ Mumps ∗ Rubella ∗ Chickenpox ∗ Pertussis (whooping cough) ∗ 184 ∗ 438 ∗ 9 ∗ 9,987 ∗ 24,231 CDC, MMWR, 1/3/14- provisional

5 5 County Disease Numbers ∗ HIV Dx (down from previous year) ∗ HBV – 6 new 48 chronic (up from previous year) ∗ HCV – 6 new 528 chronic (same as previous year) ∗ Syphilis - 16 (up from previous year) ∗ TB - 8 (same as previous year)

6 6 ∗ This means that medical facilities have expanded notification responsibilities ∗ This means that departments have extended vaccine/immunization responsibilities Ryan White Notification - Update

7 7 Education & Training to Include ∗ Bloodborne ∗ HCV ∗ HBV ∗ HIV ∗ Vaccinia virus ∗ Cutaneous Anthrax ∗ Rabies ∗ Viral hemorrhagic fevers ∗ ∗ Airborne ∗ Measles (Rubeola) ∗ Chickenpox ∗ Tuberculosis Federal Register, 11/2/11

8 8 ∗ Droplet Transmitted ∗ N. Meningitis ∗ Diphtheria ∗ Mumps ∗ Pertussis ∗ Plague ∗ Rubella ∗ SARS-CoV ∗ Novel Influenza A viruses List Published Federal Register, 11/2/11

9 9 Prevention ∗ Travel history on patient assessment especially with respiratory symptoms

10 10 ∗ Place surgical mask on patient ∗ If can not, place surgical mask on yourself ∗ Good handwashing ∗ Use good airflow in vehicle Prevention IOM meeting June 3, 2010/ CDC

11 11 ∗ Surgical mask and droplet precautions even if H1N1 ∗ CDC reverted to this in 2010 ∗ N95s for hospital use for aerosol-generating procedures Masks & Influenza Personal communication, Dr. Uyeki, CDC July 19, 2012

12 12 ∗ Hepatitis B vaccine ∗ Tdap booster x1 ∗ MMR ∗ Chickenpox ∗ Flu vaccine ∗ TB Testing Immunizations/Vaccinations CDC,1997, 2011

13 13 ∗ HICPAC and CDC have recommended that secure, preferably computerized, systems should be used to manage vaccination records for HCP so records can be retrieved easily as needed ∗ Each record should reflect immunity status for indicated vaccine-preventable diseases, as well as vaccinations administered during employment CDC Statement on Records CDC, November, 2011

14 14 ∗ From – ∗ Your schools ∗ High school ∗ College ∗ Training programs ∗ Previous employer Did You -Obtain Your Records

15 15 ∗ If you do not wish to give your medical information, you must sign a declination form Declination Forms

16 ∗ If received between 1963 – 1967 ∗ Revaccinate with 2 doses one month apart MMR Vaccine

17 17 ∗ No need to titer ∗ Just vaccinate Measles Status Unknown CDC, 11/25/12

18 18 ∗ Unable to document immunity ∗ Just vaccinate Chickenpox Vaccine CDC, Nov. 25, 2011

19 19 ∗ Recommended for persons 50 and older ∗ Can take if you have had an outbreak of shingles ∗ Employer does not need to offer Shingles Vaccine - Clarification CDC

20 20 ∗ To protect patients from infection ∗ To protect yourself ∗ To protect co-workers Healthcare Worker Duty

21 21 ∗ Declination Forms ∗ Document that the employer met his/her obligation to offer ∗ Does not eliminate employee rights Clarification

22 22 ∗ Bloodborne - 0 ∗ Airborne/droplet - 0 Department Exposures

23 23 ∗ Universal vaccination ∗ occupational infections decreased by 95% ∗ Healthcare worker infection infrequent HBV Infection Rate- US CDC, September, 2009, Nov

24 ∗ Need to complete all 3 shots ∗ 1 dose = 30% - 55% protection ∗ 2 dose = 75% protection ∗ 3 dose = >90% protection Vaccine - HBV CDC, MMWR, Nov. 2011

25 25 ∗ Due to improper infection control practices ∗ Outbreaks ∗ Ambulatory care clinics ∗ Free dental clinic ∗ Dialysis centers ∗ Dental Practices HCV Increased

26 26 ∗ Since 2001, over 157,000 persons have been called back for testing for HIV,HBV and HCV due to breaks in basic infection control practices HCV Outbreaks CDC, 2012

27 27 ∗ All persons born between should have a one time screening for HCV infection CDC- Baby Boomers

28 28 ∗ OraQuick ®HCV ∗ FDA approved ∗ Takes 20 mins. ∗ No lab equipment required ∗ Very accurate- 99.8% ∗ Waiver granted 11/28/11** ∗ Screens for multiple genotypes New Rapid HCV Test FDA. June 25, 2010

29 29 ∗ A positive test for HCV by antibody testing does NOT mean current infection ∗ Source patient to have viral load test for confirmation ∗ (HCV-RNA) Remember CDC, Hep C Symposium Dec..,2011

30 30 ∗ If you are exposed to a hepatitis C positive patient, you should have a blood test in 2 weeks ∗ HCV-RNA (blood test) ∗ Cost - $ $ Reminder - Am. Assoc. for the Study of Liver Disease, Practice Guidelines, 2009

31 31 Hepatitis C – Early Treatment ∗ HCV-RNA positive begin treatment ∗ weeks –

32 32 New Treatment Drug Telaprevir- Vertex “cured 75%-79% of patients with Genotype 1 HCV in 24 weeks of treatment” FDA approval granted – April 2011 Boceprevir – Merck ∗ FDA approved 5/13/11 ∗ Given as 3 drug cocktail

33 33 Newer Drugs Olysio ∗ Treatment Genotype 1 Solvadi ∗ Treatment Genotype 1 & 4 Cure more often and in less time 0 12 weeks 80% - 95+% 2014

34 34 ∗ Treatment Genotype 2 & 3 ∗ Given with Ribavirin ∗ NO interferon Solvadi 2014

35 35 ∗ 1978 – December, 2010 ∗ 57* documented cases ∗ 0 in fire/EMS personnel ∗ 49 were sharps related exposures Infected Healthcare Workers- Occupational Infection-HIV CDC, May, 2012(CDC), NIOSH

36 36 ∗ CDC reported that – ∗ “More than 90% of healthcare personnel infected with HIV have non-occupational risk factors reported for acquiring their infection.” CDC Surveillance of Occupationally Acquired HIV CDC, 2012 Report

37 37 No new cases since 1999

38 38 ∗ Cases increase in ages ∗ ,000 infected ∗ 1,000 per month Risk group – HIV infection CDC, 2012

39 39 ∗ Aids “cocktail” drugs = 96% unable to transmit the disease ∗ HIV/AIDS – living 50 years Update Dr. Fauci, NIH, May 2011

40 40 ∗ Atripla – 84%- 0 HIV virus in blood in 48 weeks ∗ Stribild – 88% - 90% in 48 weeks ∗ Truvada – 87% in 48 weeks Result 3 Drug Cocktail= 0 virus CDC, Oct. 2012

41 41 Rapid HIV Tests- Post Exposure Rapid HIV Test - currently available – using blood OraQuick Reveal Uni-Gold Multispot Clearview 41 CDC January 2007

42 42 ∗ If source patient is negative with rapid testing = no further testing of health-care worker ∗ Use of rapid testing will prevent staff from being placed on toxic drugs for even a short period of time Reminder - Testing Issues - Post Exposure CDC, May, 1998, CDC June 29, 2001, September 2005

43 43 ∗ Updated CDC Guidelines – September, 2013 ∗ If source is HIV positive and has viral load= ∗ Baseline, 6 weeks and rapid test at 4 months using rapid test Change in Post Exposure to HIV

44 44 ∗ Since rapid tests are waivered, they can be performed in the ED ∗ Point of Care Testing is the current standard of care Point of Care Testing - POCT

45 45 Point of Care Testing ∗ HIV ∗ HCV ∗ Syphilis ∗ Lyme disease ∗ Herpes Simplex ∗ Influenza A&B ∗ Strep A

46 46 Syphilis Cases ∗ Part of post exposure testing ∗ Post exposure follow up if source is HIV positive or Hepatitis C positive ∗ More testing under new Sexually transmitted disease (STD) guidelines ∗ (2010) ∗ Part of point of care testing

47 47 Highest States for cases ∗ California ∗ Texas ∗ New York City ∗ Florida ∗ CDC, MMWR, 2013

48 48 CDC - Plan ∗ Update plan to eliminate syphilis by 2015? ∗ Not looking good!

49 49 Tuberculosis

50 50 ∗ 2012 lowest case number since 1953 ∗ 10,528 in now 8,080 for 2013 ∗ Goal to eliminate by worldwide Tuberculosis CDC, MMWR, 2012;61:

51 51 ∗ MDR-TB – 84% in foreign-born persons ∗ 109 cases in 2010 ∗ XDR-TB – 2 cases reported in 2007 ∗ XDR-TB = 83 cases reported ∗ 2008 = 0 ∗ 2009 = 0 ∗ 2011= 4 cases in foreign-born persons ∗ Both are treatable ! Multi-drug Resistant TB

52 52 ∗ New 12 Dose Regimen for latent TB infection ∗ (positive test) ∗ Rifapentine and INH once a week for 12 weeks ∗ No alcohol Short Term Course of Treatment CDC, 2012

53 53 ∗ National and global decrease due to - ∗ Direct Observed Therapy- DOT Decrease in TB Cases

54 54 Risk Assessment - CDC ∗ Based on number of active-untreated TB patients transported in the past year CDC, 2005

55 55 Risk Assessment - TB ∗ Low Risk ∗ Transported less than 3 TB patients ∗ Medium Risk ∗ Transported more than 3 TB patients CDC TB Guidelines, 2005, pg. 134

56 56 ∗ 2013 – 0 Department TB Risk Assessment

57 57 ∗ QFT-T (In-tube) ∗ FDA approved – October 2007 ∗ Less time consuming to perform ∗ More accurate ∗ Cost effective - $33.67 New Version TB Blood Test

58 58 ∗ Second blood test available for TB testing ∗ FDA approved ∗ Cost – approximately $45.59 T-Spot

59 59 ∗ Currently there is a national shortage ∗ Use the Blood test for new hires TST Testing Solution

60 60 ∗ “ TB is generally not spread by casual contact, but typically requires relatively prolonged contact in shared air space. The environment on long flights in commercial aircraft, particularly those of 8 or more hours in length, has been previously implicated in TB transmission, especially to passengers seated in close proximity ” Reminder -Transmission - Plane Dr. Cetron, US Public Health, July,2007

61 61 Flu Vaccine - Annual ∗ “Direct patient care” ∗ All healthcare workers

62 62 CDC Flu Vaccine Program ∗ Employers must offer ∗ Employers must pay ∗ Employees who decline - sign a declination form CDC, February 24, 2006/- current NFPA 1581

63 63 ∗ Percent = 41% Department Flu Vaccine Participation

64 64 ∗ Used to identify which new vaccines may be offered to increase compliance ∗ Currently lowest rate of compliance is in EMS groups Why Important

65 65 New Influenza Vaccines

66 66 Vaccine for 2013/14 ∗ ∗ A- California/H1N1 ∗ A- H3N1 ∗ B - Massachusetts CDC, March. 28, 2013

67 67 ∗ 2 B Strains ∗ A/ H1N1 ∗ A/H3N2 ∗ B/Yamagata ∗ B/Victoria Quadrivalent Flu Mist or Injection 2013 MedImmune/CDC

68 68 ∗ 4 times higher antigen level Over 65 Vaccine

69 ∗ New ∗ Flucelvax ∗ No thimerosal or antibiotics ∗ Not egg based Vaccine –

70 70 ∗ Flublok ∗ No virus ∗ No eggs used in production ∗ No antibiotics/mercury ∗ DNA technology New Flu Vaccine FDA, 1/16/13

71 Employee with allergies ∗ Accommodation with new vaccine

72 72 Flushot.healthmap.org

73 73 ∗ New antibody identified inhibits many strains of influenza ∗ CH65 Universal Vaccine? Infectious Disease News, Aug. 24,2011

74 74 ∗ Lower than any other HCW group in 3 studies Flu Vaccine EMS Participation

75 75 Work Restriction ∗ Restrict ill workers from the workplace ∗ use sick time ∗ protect co-workers ∗ protect patients

76 ENFORCEMENT ∗ General Duty Clause – OSHA ∗ Employee with a communicable disease poses a direct threat ∗ Can require reporting ∗ Maintain confidentiality SHRM, 2013

77 77 MDRO’s – Update Issues

78 78 ∗ There is NO recommended follow up or treatment needed for exposure to MRSA, VRE MRSA/VRE Exposure CDC, 2010

79 79 ∗ For C-diff and Norovirus a chlorine –based cleaning agent is needed ∗ Handwashing post care of patient with C-diff is warm soap & water ∗ waterless agent not effective Reminder

80 ∗ High mortality rate ∗ Difficult to treat ∗ 15 cases in US in 2013 ∗ Contact Precautions ∗ Not acquired by healthy people CRE – New Resistant Organism

81 81 Travel History & CRE

82 82 Compliance Monitoring Check for compliance

83 83 ∗ What issues need to be addressed in your department Compliance Monitoring

84 84 ∗ Single patient use only ∗ HIV testing of patients in NY VA Hospital Insulin Pens CDC, January 5, 2010

85 85 ∗ Need to be cleaned after each patient use ∗ Recently implicated in outbreak investigation Glucose Monitors

86 86 ∗ There is no disease that requires airing of a vehicle or putting a vehicle out of service ∗ Focus high touch items! ∗ Non-critical items ∗ Clean and go! Cleaning Issues

87 87 ∗ Only need a 1 min. contact time ∗ Very effective Pre-Mixed Cleaning Wipes CDC, 2010 COCA Conference/ CDC Guidelines for Disinfection and Sterilization, 2008

88 88 Handwashing

89 89 ∗ No antibacterials ∗ Use hand sanitizers ! ∗ No artificial nails ! Handwashing - CDC

90 90 ∗ Study from Robert Woods Johnson University Hospital ∗ 1,500 EMS providers surveyed ∗ 13% compliance ∗ First responders ∗ EMS providers ∗ Paramedics Handwash Study - EMS 11/12/13

91 91 ∗ Soap & water – removes dirt from hands; associated with skin irritation after repeated use ∗ Alcohol based solutions: active against gram- and gram + bacteria, but not against spores ∗ Quaternary Ammonium Compounds: weak activity against gram- bacteria- not recommended in healthcare ∗ Triclosan: broad range of activity but relatively non – effective against gram- bacteria- not recommended in healthcare Hand Hygiene Agents

92 92 OSHA Most Common BBP Citations ∗ Not having a compliant Exposure Control Plan ∗ No initial or annual training offered to staff and at no cost to staff ∗ No annual update of Plan ∗ Hepatitis B vaccine not offered within 10 days of hire and after education & training ∗ No effective engineering controls ∗ Not offering HBV vaccine to unprotected staff at risk and not offering post exposure evaluation & follow up ∗ No employee input to selection of needlesafe devices ∗ Not having declination forms ∗ Not maintaining a sharps injury log ∗ Not offering annual update training within 1 year of previous training OSHA Jan.,2014

93 93 ∗ Program Goal ∗ Protect the patient ∗ Protect the care provider ∗ Accomplish in a cost effective manner whenever possible using evidence-based practice Reminder -

94 94 Questions & Answers 94


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