This document outlines an occupational safety and employee health program for healthcare workers. It defines occupational safety, identifies those at risk like healthcare providers and administrators, and discusses factors that determine risk of occupational transmission. It recommends protective measures like immunizations, training in safety precautions, and management of exposures. Guidelines are provided for work restrictions for infectious diseases. The program should monitor injuries, exposures, and infectious diseases in healthcare personnel to improve safety.

1. Occupational Safety
and Employee
Health
By/
Mahmoud Shaqria
Out lines :-
 Definition of Occupational Safety
 The target caring for (at risk)
 Factors that determine the risk for occupational transmission of blood
borne pathogen include
 Protective measures
 Elements of the program for occupational safety and Employee Health
 Guidelines for work restrictions for HCPwith infectious diseases
 Training in Personal Health and Safety Precautions
 Immunization of Health Care Personnel
 Management of Occupational Exposure
 Examples of Strategies for Health Care Facility Sharp Injury Prevention
Program
Definition :

2. It is standard measures done for health care workers for prevention of exposed
hazards during their work activity at health care centers
Safety against what diseases?
According to the variety of the hospitals:
General hospital Fever hospital
Hepatitis B Tuberculosis
Hepatitis C Meningitis
HIV Influenza
Avian flu
Rubella
Skin disease: scabies
Who are the target caring for (at risk)?
All health care providers and helpers
Administrators (some diseases)
Opportunity of exposure:
Dealing with patient:
 Taking a sample
 Dressing
 Taking care
 Filing the record
 Cleaning the room
Factors that determine the risk for occupational transmission of
blood borne pathogen include:
 The nature and type of sharps injury
 The prevalence of blood borne infection in the patient population
 Concentration of blood borne pathogen circulating in the patient who is the
source of the sharps injury (may be higher during acute or later stages of
disease)
 The number of blood exposure to which a health care worker is exposed
(new personnel or personnel in training may be less familiar with medical
devices and experience greater frequency of injuries).
Protective measures:

3. Environment:
a- Sanitary, clean, hospital environment include:
 Sanitary collection & incineration of particular forms of hospital refuse
 Disinfection of air of operating theaters, premature units and certain
laboratories and wards when necessary by ultraviolet radiation
b- sanitation of surrounding area: a suitable area, all around hospital or medical
center must be clean & free of breeding places of insects.
Regulation:
Any occupational health program should include:
 Pre-employment screening and employee health screening of staff.
 Training in personal health and safety precautions.
 Immunization of health care personnel.
 Management of occupational exposures.
 Monitoring of injuries and of infectious diseases among HCP.
The health of all personnel should be supported by policies
that address the following elements of the program:
1- Maintenance of records related to occupationally acquired infections,
needle sticks and/or sharps injuries and notification of the designated
occupational health infection control personnel
2- Clinical & laboratory evaluation of HCP who report work related
injuries or illness
3- Evaluation of personnel who report to work with communicable
diseases for fitness to work
4- Clearance of employees to resume work assignments after reporting
an episode of a communicable disease to their supervisor
Guidelines for work restrictions for HCP with infectious diseases
Disease problem
Relieve from direct
patient contact
Partial work restriction Duration
Conjunctivitis Yes
Until discharge from eye
ceases
Diarrhea
Yes; include restriction of
food handlers
Until symptoms resolve
Group A Strep Yes
Until 24 hours after adequate
treatment is started
Hepatitis A Yes
Until 7 days after onset
(jaundice)
Hepatitis B or C (chronic) No
Strict adherence to standard
precautions

4. Disease problem
Relieve from direct
patient contact
Partial work restriction Duration
Herpes on the hands
(herpetic whitlow)
Yes Until lesions heal
Measles/Rubella Yes
Until 7 days after the rash
appears
Staphylococcal skin
infection
Yes; include restriction of
food handlers
Until treated
Tuberculosis, pulmonary Yes
Until receiving adequate
therapy including proof w ith 3
negative sputum smears and
resolved cough
Upper respiratory tract
infection
No
Personnel w ith a upper
respiratory tract infection
should not take care of high
risk patients (i.e., intensive
care unit, immuno-
compromised patients, or
patients w ith chronic lung
disease)
Until acute symptoms are
resolved HCP should stay
aw ay from high-risk patients
Varicella, active Yes Until all lesions dry and crust
Varicella, post exposure Yes
From the 10th through the
21st day after exposure or if
varicella occurs, until all
lesions dry and crust
HIV/Aids
Relieve from contact w ith
highly infectious patients
Strict adherence to standard
precautions
Training in Personal Health and Safety Precautions
All health care facilities should provide training to personnel who are at risk of occupational
exposure to blood and to infectious body fluids.
This training should include the use of standard precautions for personal protection.
All health care personnel should be trained in the following essential health and safety
precautions:
 Hand hygiene;
 Use of gloves and protective clothing during contact with patients’ blood or body fluids;
 Proper disposal (do not recap needles) of sharps and infectious waste;
 Reporting of sharps/needle stick injuries;
 Reporting of certain conditions such as jaundice, rash-like illness, skin infections that are
vesicular or pustular, and illnesses that do not resolve within a designated period (fever
more than 2 days, cough > 2 weeks, diarrheal disease).
Immunization of Health Care Personnel:
Occupational health programs should maintain immunization records on all employees.
HCP may be exposed to infectious disease agents that may be transmitted through the
airborne route, through direct contact with patients and through the blood-borne route by way
of sharps/needle stick injuries.
For example:

5.  Airborne: Many airborne infectious agents are vaccine preventable (e.g., rubella,
chickenpox), and determining HCP immunization status for such infections is an essential
element in the employee health program.
 Blood-borne: Hepatitis B is one of the three major blood-borne pathogens of concern to
HCP that can be prevented by immunization.
 All medical, nursing, and ancillary staff who have potential for exposure to patient blood
and body fluids as part of their assigned tasks should be offered hepatitis B vaccine.
 It is critically important to ensure that they are protected through immunization and as
early as possible, prior to potential blood exposures or sharps injuries.
Table of Vaccines that are recommended for HCP
Vaccine Indication Vaccine/Route/Schedule Booster dose
Hepatitis B
All Health care
workers
3 doses i.m.
0, 1 month, 6 months;
Not
recommended
Td (Tetanus)
Persons without a
history or an
unknown history
3 doses i.m.
0, 1-2 months, 6 months
Every 10 years
If exposed to a
dirty wound and
last boosterdose is
> 5 years, give
booster
Rubella
Un-immunized
women of child-
bearing age
Single dose i.m. or s.c.
Tips about hepatitis B vaccination of HCP:
 All Health care staff should be offered hepatitis B vaccine prior to beginning assigned
tasks.
 Ensure that all students and trainees are vaccinated.
 There is no need to provide booster doses or to revaccinate HCP who have previously
received hepatitis B vaccine.
 If a HCP has not completed the series, do not restart the series but do complete the
series.*
 If the vaccine supply is limited, then offer the vaccine to HCP who are exposed to blood
or who have potential for sharps or needle stick injuries as part of their routine duties.
 Do not perform serologic testing before vaccination.
 Perform serologic testing 2 months after the 3rd dose to ensure adequate immune
response (HbsAb +ve). Non-responders should repeat the vaccination schedule again (3
doses).
 Provide hepatitis B vaccine according to a routine schedule as post-exposure prophylaxis
for unvaccinated HCPs who receive needle stick injuries.
 Seroconversion (Hbs Ab +ve) occurs 1-2 months after the 3rd dose.
Management of Occupational Exposure
 HCP in contact with patients may be exposed to infectious agents.

6.  Pregnant HCP are not at greater risk that other HCP from acquiring infections from
patients, but if they do, the infection could affect their newborn.
 Infection control programs should have written procedures to monitor and to manage
exposures to health care staff.
 Preventative measures include routine precautions to prevent exposure and post-
exposure prophylaxis in the event of needle stick or other sharp injuries.
Management of needle stick injuries
1. Immediately following an exposure to blood or body fluids with visible blood:
 Wash needle sticks/sharps injury site and cuts with soap and water.
 Irrigate eyes with clean water, saline, or sterile irrigates.
 There is no scientific evidence that using antiseptics prevents infection or
that by squeezing the injured site can remove contaminants.
2. Report to a designated person (e.g., supervisor).
3. Procedures should describe where the injured HCP should seek initial
assessment and counseling for follow-up testing and appropriate treatment.
4. The occupational safety program should provide post-exposure prophylaxis
based on the hepatitis B vaccination status of the HCP and on the serology status of
the source patient according the following table.
HB Post Exposure Prophylaxis
Source patient
Hepatitis B vaccination
status of HCP
Treatment
HBs Ag +
Not vaccinated
1 dose vaccine
2 doses vaccine
3 doses vaccine
Start vaccine immediately*
Complete series*
Complete series*
No treatment
HBsAg negative
Not vaccinated Vaccinate
Vaccinated No treatment
Unknown
Not vaccinated Vaccinate**
Vaccinated No treatment
Anti-HCV positive No vaccine for HCV No treatment***
HIV-positive
No vaccine for HIV 1.Four week course of 3
antiretroviral drug therapy (e.g.,
zidovudine and lamivudine) ***
2. Start treatment immediately
(within hours)**
* If available, unvaccinated persons exposed to a HBsAg-positive patient should receive a
dose of hepatitis B immune globulin (HBIG) within 24 hours of exposure in addition to
hepatitis B vaccine.
** All HCPs exposed to a needlestick injury should be offered hepatitis B vaccine.
*** Consult with an infection control specialist for further assessment.
Note

7.  There is no vaccine against HIV and post exposure treatment is only recommended for
exposures that may cause a greater risk for transmitting HIV.
 There is no vaccine against HCV and no treatment after an exposure that will prevent
infection. Immune globulin is not recommended.
Tips on prevention of needle stick injuries in HCPs
 Educate HCP on the proper disposal of needles.
 Place needle without manipulation into MOHP-approved sharps container.
 Do not recap/bend/break used needles.
 Do not overfill sharps containers.
 Ensure availability of sharps containers in all settings where injections are provided.
Monitoring Injuries among Health Care Personnel
One of the most important ways that infection control programs can help maintain the safety
of the facility environment is by reporting incidents and by monitoring disease occurrences
that have the potential for disseminating infections to staff or to patients.
All injuries or conditions that predispose HCP to injuries should be reported to the infection
control program including:
 Needlestick and sharps injuries;
 Conditions that exist in the facility that increase the risk of disease transmission
such as a shortage of needles for injections (which may increase likelihood of
reuse);
 Shortage of sharps boxes and hazardous waste containers;
 Conditions that exist in the facility that increase the risk of injury to the community
at large such as improper disposal of waste.
 Based upon the analysis of these reports, the infection control team should
implement appropriate measures to minimize the risk to the clinician, to fellow
staff, to patients, to visitors, and to the community at large.
Sharps Injury Prevention Program
Needlestick injuries have been related to certain work practices such as:
 Recapping.
 Transferring a body fluid between containers.
 Failing to properly dispose of used needles in puncture-resistant sharps
containers.

8. Examples of Strategies for Health Care Facility Sharp Injury Prevention
Program
Some interventions that facilities should consider based on available
resources include:
 Eliminate the use of needles where safe and effective alternatives are available.
 Implement the use of devices with safety features and evaluate their use to determine
which are most effective and acceptable.
 Sharps injuries can best be reduced when the use of improved engineering controls
(modifications in devices needed for patient care that protect the sharp once used
from potential contact with personnel) is incorporated into a comprehensive program
involving personnel.
 Examples of engineering controls include a sheath that can slide over a needle once
an injection is given, an angio-catheter which offers a retractable needle once the
catheter is in the vein, and needleless connectors for IV systems.
Health care facilities should also consider implementation of the following
prevention program elements:
 Analyze needle stick and other sharps-related injuries in the facility to identify hazards
and injury trends.
 Set priorities and strategies for prevention by examining local, national, and
international information about risk factors for sharps injuries and successful
intervention efforts.
 Ensure that health care personnel are properly trained in the safe use and disposal of
needles. This is particularly important for less experienced or new personnel as the
frequency of injuries tend to be higher when learning to use invasive devices.
 Modify work practices that pose a needle stick injury hazard to make them safer.
 Promote safety awareness in the work environment.
 Establish procedures for and encourage the reporting and timely follow-up of all
needle stick and other sharps-related injuries.
 Evaluate the effectiveness of prevention efforts and provide feedback on performance
to personnel.