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1. OCCUPATIONAL HEALTH
& IMMUNIZATION OF HCP
Dr. Faisal Al Haddad
Consultant Family Medicine &
Occupational Health
Director of Saudi Board Program
CBAHI Surveyor

2. Immunization Schedule for HCP
Vaccine Indication Schedule
Hepatitis A Laboratory & primate worker 2
doses of 1 mL IM at 0,
6 months
Hepatitis B Occupational exposure to
blood, blood products, or
bodily secretions
3
doses of 1 mL IM at 0,
1 & 6-12 months
Influenza Persons attending high-risk
patients (e.g. elderly
(
Inactivated vaccine
:
1
dose of 0.5 mL IM
annually
Live attenuated vaccine
:
Intranasal dose of 0.2 ml
annually

3. Immunization Schedule for HCP
Vaccine Indication Schedule
MMR Adults born after 1957 with no proof of
immunity
:
•documented vaccination with 2 doses
•laboratory evidence of immunity
•laboratory confirmation of disease
2
doses of 0.5 mL SC
at 0 & at least 1 month
later
Polio Laboratory and other HCP who come in
contact with live virus
3
doses of 0.5 mL SC
:
•1st
two doses 4-8
weeks apart
•3rd
dose 6-12 months
after the 2nd
dose.

4. Immunization Schedule for HCP
Vaccine Indication Schedule
Varicella Adults with no proof of immunity:
•laboratory evidence of immunity
•HX of clinically diagnosed or
verified varicella/zoster
•documentation of vaccination
2
doses of 0.5 mL SC
at time 0 weeks & 4-8
weeks later
Tdap HCP with direct patient contact 0.5
mL IM one-time
dose

5. Influenza Vaccination
 HCP must receive the vaccine or sign a declination after
reading the benefits of receiving vaccine versus risks to self,
patients and others by not receiving the vaccine.
 If HCP refuses the influenza vaccine, it is mandatory that HCP
wear a barrier mask during influenza season when providing
direct patient care.
 Methods increasing vaccination rates:
– Monetary incentive to receive the vaccine.
– Providing the vaccine at convenient times and locations.
– Receiving the vaccine as a condition of employment.

6. Influenza Vaccination
 Vaccination against influenza is recommended for all HCP.
 It takes about 2 weeks after vaccination for antibodies to
develop that protect against influenza virus infection.
 Vaccines can be offered from September to March.
 Inactivated trivalent vaccine (TIV(:
– > 6 months old (healthy people, chronic medical conditions(
– One dose of 0.5 mL IM annually

7. Influenza Vaccination
 Live attenuated influenza vaccine (LAIV(:
– Healthy people 2 to 49 years of age who are not pregnant
– Intranasal dose of 0.2 ml annually
 Avoid use of LAIV among HCP or other close contacts of
severely immunocompromised persons.
 HCP who receive LAIV should not provide care for severely
immune-suppressed patients for 7 days after vaccination.

8. Influenza Vaccination
If influenza outbreak occurs, unvaccinated staff should be re-
offered influenza vaccinations
If an outbreak is caused by a strain of influenza virus that is not
well matched by the vaccine for that season, chemoprophylaxis
should be considered for all employees, regardless of their
vaccination status.

9. Work Restrictions for HCP with
Infectious Diseases
Disease/Problem Work Restriction Duration
Conjunctivitis Restrict from patient
contact & contact with the
patient's environment
Until discharge ceases
CMV infections No restriction
Diarrheal diseases
Acute stage Restrict from patient
contact, contact with the
patient's environment, or
food handling
Until symptoms resolve
Convalescent stage Restrict from care of high-
risk patients
Until symptoms resolve

10. Work Restrictions for HCP With
Infectious Diseases
Disease/Problem Work Restriction Duration
Diphtheria Exclude from duty Until antimicrobial
therapy completed & 2
cultures obtained 24 hrs
apart are negative
Enteroviral
infections
Restrict from care of
infants, neonates, and
immunocompromised
patients and their
environments
Until symptoms resolve
Hepatitis A Restrict from patient
contact, contact with
patient's environment &
food handling
Until 7 days after onset
of jaundice

11. Work Restrictions for HCP With
Infectious Diseases
Disease/Problem Work Restriction Duration
Hepatitis B
Personnel with
HBsAg who do not
perform EPP
No restriction; Standard
Precautions should always be
observed
Personnel with
HBeAg who perform
EPP
Do not perform EPP until expert
review panel recommend
procedures the worker can perform
Until HBe Ag
is negative
Hepatitis C No recommendation

12. Work Restrictions for HCP With
Infectious Diseases
Disease/Problem Work Restriction Duration
Herpes simplex
Genital No restriction
Hands (herpetic
whitlow
(
Restrict from patient
contact and contact with
the patient's environment
Until lesions heal
Orofacial Evaluate for need to restrict
from care of high-risk
patients
HIV Do not perform EPP until expert review panel
recommend procedures the worker can perform

13. Work Restrictions for HCP With
Infectious Diseases
Disease/Problem Work
Restriction
Duration
Meningococcal
infections
Exclude from
duty
Until 24 hours after start of
effective therapy
Pediculosis Restrict from
patient contact
Until treated and observed to be
free of adult and immature lice
Pertussis Exclude from duty From beginning of catarrhal stage
through 3rd
week after onset of
paroxysms or until 5 days after start
of effective antimicrobial therapy
Scabies Restrict from
patient contact
Until cleared by medical evaluation

14. Work Restrictions for HCP With
Infectious Diseases
Disease Work Restriction Duration
Staphylococcus
aureus infection
Active (draining
skin lesions
(
Restrict from contact with
patients and patients'
environment or food handling
Until lesions have
resolved
Carrier state No restriction, unless personnel
are epidemiologically linked to
transmission of the organism
Streptococcal
infection, group A
Restrict from patient care,
contact with patient's
environment, or food handling
Until 24 hours
after adequate
treatment started

15. Work Restrictions for HCP With
Infectious Diseases
Disease Work Restriction Duration
Measles Exclude from duty Until 7 days after the rash
appears
Mumps Exclude from duty Until 9 days after onset of
parotitis
Rubella Exclude from duty Until 5 days after rash
appears
Varicella Exclude from duty Until all lesions dry and crust
TB Exclude from duty Until proved noninfectious

16. WHERE
?

17. Post Exposure Management
 Varicella
 Meningococcal Disease
 MMR
 Pertussis
 TB
 Blood borne pathogens

18. Varicella Post Exposure Management
Unvaccinated susceptible personnel exposed to varicella:
Exclude the person from duty from the 10th day after exposure
through the 21st day after exposure or until all lesions are dry and
crusted if varicella occurs.
Vaccinated personnel exposed to varicella:
Serological testing immediately after exposure to assess the
presence of antibody.
If seronegative, exclude the person from duty from day 10 through day
21 postexposure.
If fever, URT symptoms, or rash develop, then exclude the person from
duty until all lesions are dry and crusted

19. Varicella Post Exposure Management
 Consider administering the vaccination for exposed
unvaccinated personnel without documented immunity. The
efficacy of postexposure vaccination is unknown.
 VZIG use is considered for immunocompromised or pregnant
workers postexposure.
 If VZIG is used, extend the time that the worker is excluded
from duty from 21 days to 28 days postexposure.

20. Meningococcal Disease Post Exposure
Management
 Exposed personnel do not need to be excluded from duty.
 PEP is advised for persons who have had intensive, unprotected
contact with infected patients.
 Unprotected means without wearing a mask
 Intensive contact include:
– mouth-to-mouth resuscitation
– endotracheal intubation
– endotracheal tube management or
– close examination of the oropharynx

21. Meningococcal Disease Post Exposure
Management
 Prophylactic therapy should be administered immediately after
the unprotected exposure.
 Current recommended regimens:
– Rifampin 600 mg PO BID for 2 days
– Single dose of ciprofloxacin 500 mg PO or
– Single dose of ceftriaxone 250 mg IM.
 Rifampin & ciprofloxacin are not recommended for pregnant
women.

22. MMR Post Exposure Management
Measles vaccine should be administered to susceptible HCP
who have had contact with a measles patient within 3 days of the
exposure (or IG within 6 days of exposure) to modify severity of
infection
Mumps vaccine and IG are not proven to prevent infection after
exposure.
Rubella vaccine and IG are not proven to prevent infection after
exposure.

23. MMR Post Exposure Management
 Susceptible personnel who are exposed to measles need to be
excluded from duty 5 days after the first exposure to 21 days
after the last exposure.
 Susceptible personnel who are exposed to mumps need to be
excluded from duty the 9th
day after the first exposure to the 26th
day after the last exposure.
 Susceptible personnel who are exposed to rubella need to be
excluded from duty from the 7th
day after the first exposure
through the 21st
day after the last exposure.

24. Pertussis Post Exposure Management
 PEP is indicated for personnel exposed to pertussis.
 The regimen used is either:
– Erythromycin 500 mg QID 14 days
– One tab of trimethoprim-sulfamethoxazole BID 14 days
 Exposed personnel do not need to be excluded from duty.
 Personnel in whom symptoms develop should be excluded until
5 days after the start of appropriate therapy.

25. Practice
A food service worker is diagnosed with Hepatitis A. How long
should this employee be on work restrictions
?
a. Until 14 days after symptoms resolve
b. Until 7 days after onset of jaundice
c. Until 14 days after onset of jaundice
d. Until 10 days after symptoms resolve

26. Practice
ACIP recommends all of the following immunizations be provided
to healthcare personnel except
:
a. Hepatitis A and B vaccines
b. Influenza vaccine
c. Measles, mumps, and rubella (MMR) and varicella-zoster
vaccines (if not immune
)
d. BCG

27. Practice
An employee who is not immune to varicella-zoster was exposed
to a patient with active chickenpox. How long must the employee
remain on work restrictions
?
a. Until evaluated by a physician
b. From day 10 after exposure to day 21 after exposure
c. No work restriction is necessary if no signs and symptoms are
present
d. At the discretion of the hospital infectious disease physician

28. Practice
The IP is reviewing the immunization records of healthcare personnel at their
facility and discovers that employees born before 1957 do not have any
record of receiving MMR vaccine. What should she recommend to the
Human Resources Director regarding employees born before 1957
?
a. They are considered immune and do not require follow-up
b. They should receive two doses of the vaccine 4 weeks apart
c. They are only required to provide proof of immunity to measles
d. They are required to provide proof of immunity mumps, measles & rubella

29. Practice
A patient in the Emergency Room is diagnosed with bacterial
meningitis due to Neisseria meningitidis. The patient was not
properly isolated, and a number of employees entered her room
without wearing a mask. Which employee should receive PEP
?
a. The phlebotomist who drew blood on the patient
b. The respiratory therapist who intubated the patient
c. The radiology technician that performed the chest radiograph
d. The employee from admissions that registered the patient

30. Practice
OSHA mandates that which of the following vaccines be provided
at no cost to healthcare providers and others at risk for blood and
body fluid exposure
?
a. Hepatitis A
b. Hepatitis B
c. BCG
d. Meningococcal

31. Practice
Which of the following is not proof of measles immunity for
healthcare personnel
?
a. Documentation of vaccination with two doses of live measles
virus-containing vaccine
b. Laboratory evidence of immunity
C. Born after 1957
d. Laboratory confirmation of disease

32. Thank you