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Occupational Health
&
Infection Control
Dr Faisal Al Haddad
Consultant of Family Medicine
& Occupational Health
PSMMC
Outlines


Occupational Health (OH)



Role of OH in Infection Control



Prevention of Blood-borne virus infections in...
?What is occupational health
The promotion and maintenance of the highest
degree of physical, mental and social wellbeing ...
?Why Occupational Health

To prevent occurrence of occupational injury or illness
and their costs on workers and employers
Costs on workers



Pain and suffering of the injury or illness



Possible loss of income



Possible loss of a job

...
Costs on employers


Payment for work not performed



Medical and compensation payments



Possible reduction in the q...
Occupational Health Services


Risk assessment and risk control



Pre-employment assessments



Periodic medical exami...
Occupational Health Services


Health education and counseling



Treatment of occupational injury or illness



Advice...
Occupational Hazards in healthcare


Physical



Chemical



Microbiological



Ergonomic



Psychosocial
Role of OH in Infection Control


Microbial Risk Assessment



Microbial Risk Control



Education of Health Care Worke...
Microbial Risk Assessment
Steps:


Identification of microbiological hazards in workplace



Assessment of the risk of e...
Microbial Risk Control
Microbial Risk control is the eradication or minimization of the risk
of exposure to microbiologica...
Control measures to prevent exposure to or
infection with disease

1) Engineering Controls
2) Administrative Controls
3) O...
OH Work Practices


Regular workplace microbial risk assessment



Pre-employment and periodic screening



Vaccination...
Routine vaccination for HCWs


HBV: 3 doses given at 0, 1, and 6 months



DTP: primary series of 3 doses and booster do...
Control measures to manage HCWs exposed to
or infected with disease
1. Assessment of the incident:





The method of ...
Management of HCWs exposed to or
infected with disease



Post-exposure prophylaxis



Treatment of infected HCW



Cou...
Education of HCWs



Prevention and management of exposure to and
infection with disease



Universal and additional pre...
Prevention of Blood-borne virus
infections in healthcare setting

Dr. Faisal Al Hadad
Outlines


BBV-specific exposure definition



Occupations at increased risk of exposure



Risk of transmission



Pr...
Occupational infections in Healthcare
1. Airborne Transmission:
 Adenovirus
 Diphtheria
 Influenza
 Measles
 Meningoc...
(Exposure definition (CCDR
A percutaneous injury from equipment contaminated with blood or
body fluids, or mucous membrane...
Occupations at risk of exposure to BBVs


Healthcare workers



Laboratory staff



Staff of residential for those with...
The risk of transmission after exposure


After parenteral exposure to infected blood:
HIV
Hepatitis C

3%-10%

Hepatitis...
Prevention of exposure to BBVs



Reduction in the number of blood samples taken from a patient



Safer-needle devices
...
Bloodborne pathogen precautions



Wear gloves



Wash hands



Cover existing wounds and skin lesions



Avoid sharps...
;Contd



Avoid wearing open footwear



Clean up spillage of blood and disinfect surfaces



Protect mucus membrane of...
Action recommended following potential
exposure to blood


Encourage bleeding



Wash the site of bleeding



Cover the...
Employment implications


Restriction from EEP



Sickness absence



Discrimination



Loss of skilled workers



St...
Hepatitis B virus
Vaccination


Strongly recommended before employment.



Hepatitis B vaccines are not 100% effective i...
Hepatitis B virus
Post-exposure management
Hepatitis B vaccine + hepatitis IG within 24 hours of exposure.


HBsAg status...
Hepatitis B virus
Fitness of HBsAg-positive HCWs for work
HBeAg-positive HCWs
 Not allowed to carry out exposure-prone pr...
(Exposure-Prone Procedures (EPP



Insertion of hands or fingers inside the body cavity



Hands or fingers may disappea...
Hepatitis C virus
Vaccination
No vaccine available

Post-exposure management


IG and antiviral agents are not recommende...
Hepatitis C virus
Fitness to work


HCV RNA-positive HCWs should not be allowed to perform
EPP



HCV RNA-positive HCWs ...
HIV
Vaccination
No vaccine available

Post exposure management
Prophylaxis
 300mg zidovudine + 150mg lamivudine (one Comb...
(HIV (indications of PEP
1. Type of injury:
 Percutaneous injury (recommended)
 Exposure of mucus membrane or non-intact...
HIV-positive HCWs


HIV-positive HCWs must not undertake EPP and they must
receive appropriate guidance from an occupatio...
Testing source patients


It is considered unethical to test a source patient for BBV infection
without their fully infor...
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Occupational health & infection control

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Occupational health & infection control

  1. 1. Occupational Health & Infection Control Dr Faisal Al Haddad Consultant of Family Medicine & Occupational Health PSMMC
  2. 2. Outlines  Occupational Health (OH)  Role of OH in Infection Control  Prevention of Blood-borne virus infections in Healthcare setting
  3. 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. 4. ?Why Occupational Health To prevent occurrence of occupational injury or illness and their costs on workers and employers
  5. 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. 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. 7. Occupational Health Services  Risk assessment and risk control  Pre-employment assessments  Periodic medical examinations including HS  Post-sickness absence review  Immunization
  8. 8. Occupational Health Services  Health education and counseling  Treatment of occupational injury or illness  Advice on compensation  Advice on environmental issues
  9. 9. Occupational Hazards in healthcare  Physical  Chemical  Microbiological  Ergonomic  Psychosocial
  10. 10. Role of OH in Infection Control  Microbial Risk Assessment  Microbial Risk Control  Education of Health Care Workers (HCWs)
  11. 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. 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. 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. 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. 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. 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. 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. 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
  19. 19. Prevention of Blood-borne virus infections in healthcare setting Dr. Faisal Al Hadad
  20. 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. 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. 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. 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. 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. 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. 26. Bloodborne pathogen precautions  Wear gloves  Wash hands  Cover existing wounds and skin lesions  Avoid sharps  Safe handling and disposal of contaminated waste
  27. 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. 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
  29. 29. Employment implications  Restriction from EEP  Sickness absence  Discrimination  Loss of skilled workers  Staff shortage
  30. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. .
  40. 40. Thank You

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