This document discusses occupational health and infection control as it relates to preventing blood-borne virus infections in healthcare settings. It defines occupational health and outlines its key services like risk assessment and medical examinations. Healthcare workers are at risk of exposure to various occupational hazards including microbiological ones. The role of occupational health includes microbial risk assessment, control through education and policies, and managing exposed or infected workers. The document focuses on preventing exposure to and transmission of blood-borne viruses like HIV, hepatitis B, and hepatitis C through vaccination, post-exposure prophylaxis, safe practices, and managing infected healthcare workers and their work duties.
3. ?What is occupational health
The promotion and maintenance of the highest
degree of physical, mental and social wellbeing of
workers in all occupations.
(ILO/WHO, 1950)
4. ?Why Occupational Health
To prevent occurrence of occupational injury or illness
and their costs on workers and employers
5. Costs on workers
Pain and suffering of the injury or illness
Possible loss of income
Possible loss of a job
Health-care costs
6. Costs on employers
Payment for work not performed
Medical and compensation payments
Possible reduction in the quality of work
Replacement of the injured/ill worker
Time
Concern of fellow workers
Poor public relations
7. Occupational Health Services
Risk assessment and risk control
Pre-employment assessments
Periodic medical examinations including HS
Post-sickness absence review
Immunization
8. Occupational Health Services
Health education and counseling
Treatment of occupational injury or illness
Advice on compensation
Advice on environmental issues
9. Occupational Hazards in healthcare
Physical
Chemical
Microbiological
Ergonomic
Psychosocial
10. Role of OH in Infection Control
Microbial Risk Assessment
Microbial Risk Control
Education of Health Care Workers (HCWs)
11. Microbial Risk Assessment
Steps:
Identification of microbiological hazards in workplace
Assessment of the risk of exposure to the microbiological hazards
Information:
Workplace surveillance (walk-through visit)
Pre-employment assessment (history, testing)
Ongoing interactions between OH and the HCW
12. Microbial Risk Control
Microbial Risk control is the eradication or minimization of the risk
of exposure to microbiological hazards .
Includes:
Risk control measures to prevent HCW exposure to or infection
with disease
Risk control measures to manage HCWs exposed to or infected
with disease
13. Control measures to prevent exposure to or
infection with disease
1) Engineering Controls
2) Administrative Controls
3) OH Work Practices
4) Personal Protective Equipment (PPE)
14. OH Work Practices
Regular workplace microbial risk assessment
Pre-employment and periodic screening
Vaccination and post-exposure prophylaxis
Managing HCWs (infected, immunocompromised, dermatitis)
*OH should establish and maintain communication with appropriate
departments (Admin, IC, Lab, Operation and Maintenance, Safety..)
15. Routine vaccination for HCWs
HBV: 3 doses given at 0, 1, and 6 months
DTP: primary series of 3 doses and booster doses of Td/10 y
MMR: 2 doses one month apart
Varicella: 2 doses on month apart
BCG: one dose
Meningococcal: one dose /3 y
Influenza: one dose annually
16. Control measures to manage HCWs exposed to
or infected with disease
1. Assessment of the incident:
The method of transmission
Type of exposure
Use of PPE
Compliance with precautions
2. Assessment of the source of exposure:
Communicability
Diagnosis of infection
3. Assessment of the HCW exposed to or infected with disease:
Determining immune status of HCW
Diagnosis of infection
17. Management of HCWs exposed to or
infected with disease
Post-exposure prophylaxis
Treatment of infected HCW
Counseling
Work restriction/reassignment/return to work
Tracing close contacts
Assessing worker for fitness to work
18. Education of HCWs
Prevention and management of exposure to and
infection with disease
Universal and additional precautions
Action recommended following potential exposure
The consequences of non-compliance
20. Outlines
BBV-specific exposure definition
Occupations at increased risk of exposure
Risk of transmission
Prevention of exposure/transmission
Employment implications
HIV, HBV, HCV
- Vaccination
- Post-exposure prophylaxis
- Fitness for work
21. Occupational infections in Healthcare
1. Airborne Transmission:
Adenovirus
Diphtheria
Influenza
Measles
Meningococcus
Mumps
Mycoplasma infection
Parvorvirus
Pertussis
Rubella
SARS
Tuberculosis
Varicella
2. Bloodborne Transmission
AIDS
Hepatitis B
Hepatitis C
Cytomegalovirus
Hepatitis D virus
Human parvovirus
Human T-cell lymphotropic virus
3. Oral-Fecal Transmission
Hepatitis A
Typhoid fever
4. Direct-contact
Herpes simplex
Scabies and pediculosis
22. (Exposure definition (CCDR
A percutaneous injury from equipment contaminated with blood or
body fluids, or mucous membrane or non-intact skin contact with
.blood or body fluids. Blood on intact skin is not an exposure
The types of body fluids capable of transmitting BBVs:
Blood, serum, plasma, and all biologic fluids visibly contaminated with
blood.
Lab specimens, samples or cultures that contain concentrated BBVs.
Organ and tissue transplants.
Pleural, amniotic, pericardial, peritoneal, synovial, and CS fluids.
Uterine/vaginal secretions or semen (HCV unlikely)
Saliva for HBV only, unless contaminated with blood.
23. Occupations at risk of exposure to BBVs
Healthcare workers
Laboratory staff
Staff of residential for those with learning difficulties
Those handling human remains
Prison service staff in regular contact with inmates
Emergency frontline responders
24. The risk of transmission after exposure
After parenteral exposure to infected blood:
HIV
Hepatitis C
3%-10%
Hepatitis B
0.3%
30%
Transmission is more likely where the worker has been exposed to
infected blood through NSI injury than through exposure of MM.
25. Prevention of exposure to BBVs
Reduction in the number of blood samples taken from a patient
Safer-needle devices
Needleless drug administration
Reduce work duration and night work
Advice on bloodborne pathogen precautions and action
recommended following potential exposure to blood
26. Bloodborne pathogen precautions
Wear gloves
Wash hands
Cover existing wounds and skin lesions
Avoid sharps
Safe handling and disposal of contaminated waste
27. ;Contd
Avoid wearing open footwear
Clean up spillage of blood and disinfect surfaces
Protect mucus membrane of eyes with protective eyewear
Never resheath needles and never put hands in a used sharps
box.
28. Action recommended following potential
exposure to blood
Encourage bleeding
Wash the site of bleeding
Cover the bleeding site
If splashed in eye, nose or mouth wash immediately
Note the name and location of the patient concerned
Contact occupational health department
Report the accident and complete an incident-report form
30. Hepatitis B virus
Vaccination
Strongly recommended before employment.
Hepatitis B vaccines are not 100% effective in all workers.
The normal course of vaccination comprises 3 doses of vaccine over a 6month period.
HCWs with postvaccinal anti-HBs levels, one to two months after vaccine completion, ≥10 mIU/ml
are considered as responders and immune against HBV infection.
In responders, booster doses of vaccine or periodic antibody concentration testing are not
recommended
Non- responders can be given another course of vaccines followed by retesting. If the HCW fail to
respond they need to be informed of the implications of this.
Non-responding HCWs involved in a high risk incident should be offered PEP with IG.
31. Hepatitis B virus
Post-exposure management
Hepatitis B vaccine + hepatitis IG within 24 hours of exposure.
HBsAg status of the source (HBsAg-positive)
Immune status of exposed person (non-immune)
32. Hepatitis B virus
Fitness of HBsAg-positive HCWs for work
HBeAg-positive HCWs
Not allowed to carry out exposure-prone procedures (EPP)
Undergoing antiviral treatment have to show that their viral load
has been reduced to <1000 GEq/ml 1 year after finishing their
therapy.
HBeAg-negative HCWs
Viral load >1000 GEq/ml are restricted from performing EPP
Viral load <1000 GEq/ml need not have their working practices
restricted
33. (Exposure-Prone Procedures (EPP
Insertion of hands or fingers inside the body cavity
Hands or fingers may disappear from view
Hands or fingers may come into contact with a sharp
instrument or tissue
The operator may bleed into the patient
34. Hepatitis C virus
Vaccination
No vaccine available
Post-exposure management
IG and antiviral agents are not recommended for PEP after
exposure to HCV-positive blood.
HCWs exposed should be tested for HCV-Ab at baseline and after
6 months.
35. Hepatitis C virus
Fitness to work
HCV RNA-positive HCWs should not be allowed to perform
EPP
HCV RNA-positive HCWs who have responded successfully to
treatment with antiviral therapy should be allowed to resume
EPP
Successful response is defined as remaining HCV RNA
negative six months after cessation of treatment.
36. HIV
Vaccination
No vaccine available
Post exposure management
Prophylaxis
300mg zidovudine + 150mg lamivudine (one Combivir tab) 28 days
200mg lopinavir + 50mg ritonavir (two Kaletra tab) 28 days
HIV testing
at baseline
at 6-8 weeks
at least 6 months post exposure
37. (HIV (indications of PEP
1. Type of injury:
Percutaneous injury (recommended)
Exposure of mucus membrane or non-intact skin (considered)
Exposure of intact skin (discouraged)
2. Type of source material:
Blood, body fluid containing visible blood, CSF, concentrated virus in a lab
setting (recommended)
Semen, vaginal secretions, synovial, pleural, peritoneal, amniotic fluids and
tissues (considered)
Urine, vomit, saliva, tears, faeces, sweats, sputum (discouraged)
3. Source patient:
Known to be HIV-positive (recommended)
HIV status unknown, consent refused or unavailable (considered)
HIV-negative (discouraged)
38. HIV-positive HCWs
HIV-positive HCWs must not undertake EPP and they must
receive appropriate guidance from an occupational physician.
There is little evidence of HCWs passing HIV to their patients
through normal medical procedures.
Efficient and confidential reporting channels are required to
ensure that HCWs who know or suspect that they could be
HIV-positive can report to the OH department.
39. Testing source patients
It is considered unethical to test a source patient for BBV infection
without their fully informed consent.
The clinician who has received the needlestick injury should never
seek the consent from the source patient.
Source patients should be counseled on the implications of the test
and results including possible need to discuss any positive test with
his/her sexual partner.
It is unacceptable to seek preoperative consent for source-patient
testing in order to guard against an exposure incident occurring during
surgery.
.