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Transcript
EMPLOYEE HEALTH PROGRAM REQUIREMENTS FOR ASCs Mary T. Post, RN, MS, CNS, CIC Infection Prevention Specialist Oregon Patient Safety Commission 1 http://www.youtube.com/watch?v=3ZEZa_8m98 c&feature=related http://www.youtube.com/watch?v=4P1EToToHE U&feature=related 2 Objectives • List three elements of an employee health (EH) program that should be included in your Infection Prevention Program (IPP) Plan • Describe two recently published guideline changes for immunization and screening of healthcare workers • Identify three post-exposure interventions to follow after an occupational exposure to potential bloodborne pathogen viruses and TB 3 CMS Requirement: ASC Identifies Risks for Acquiring & Transmitting Infections Include employee related data in your analysis: • Percentage of individuals compliant with TB screening policy • If applicable, number of TB employee conversions • Number of unprotected communicable disease exposures • Blood and body fluid exposure/sharps injury rates • Employee compliance rates with immunizations and screenings 4 Set Goals Based on Identified Risks • Limit unprotected exposure to pathogens (PPE, hand hygiene) • Limit the transmission of infections associated with the use of medical equipment, devices (sharp safety), and supplies 5 CMS Requirement: ASC Has an Infection Prevention Plan • Include employee infection prevention data and goals • Include employee exposures/potential source for possible disease outbreaks • Occupational health programs may assist with communication of responsibilities to licensed independent practitioners (LIPs) and staff; if service is contracted, be certain contractor’s role is well defined 6 CMS Requirement: ASC Prepares to Respond to Influx of Potentially Infectious Patients Emergency Management • Role of employee health programs in pandemics: • • • • Exposure management Employee illness tracking/evaluations Vaccinations Respiratory protection (N95 masks) 7 Implementing IPP Plan • Communicate responsibilities to LIPs and staff; include hand and respiratory hygiene • Report, share employee infection prevention data with LIPs and staff 8 ASC Infection Prevention Policies The ASC has policies and procedures to prevent the transmission of infectious disease among patients, licensed independent practitioners, and staff. 9 Immunizations and Screening Screening for exposure and/or immunity to infectious diseases should be available to LIPs and staff • Tuberculosis screening • Screening for vaccine preventable diseases 10 Ill Provider Policies If suspected of having an infectious disease that places others at risk, must have a system to provide or refer LIPs/staff for assessment, potential testing, prophylaxis/treatment, or counseling 11 Exposure Follow-up and Treatment Refer or provide assessment and potential testing, prophylaxis/treatment, or counseling to staff or LIPs with occupational exposures 12 Influenza Vaccination The ASC offers vaccination against influenza to licensed independent practitioners and staff 13 Influenza Vaccination Program • Educates LIPs and staff • Influenza vaccine • Non-vaccine control and prevention measures • Diagnosis, transmission, impact • • • • Accessible sites Evaluates rates and reports to state Declination reasons Improves vaccination rates 14 Post-occupational Exposure INTERVENTIONS FOR SELECT COMMUNICABLE DISEASES 15 Exposure Determination • Verify the diagnosis and patient infectivity • Determine if PPE worn by healthcare workers (HCWs) • Identify the exposed HCWs • Determine if the individual is susceptible • Determine appropriate disease specific postexposure follow-up • Always use as a “teachable moment” • Promote your program and resource needs 16 What to do if You Have a Blood or Body Fluid Exposure 1. Wash the area well with soap and water 2. Flush eyes well with water if splashed 3. Immediately report accident according to your facility’s policy 4. Encourage employee to bring patient name, medical record number, and any known HIV risk factors for post-exposure prophylaxis (PEP) consideration Employers are required to provide confidential and free baseline and follow up lab testing and counseling 17 Blood & Body Fluid Exposures Lab Work Exposed employee • Hepatitis B surface antibody • HIV Elisa/EIA • Hepatitis C antibody • Repeat at 6 and 12 weeks and 6 months based on source patient lab results Source patient • Hepatitis B surface antigen • HIV ELISA/EIA standard • Rapid HIV (consider) • Hepatitis C antibody 18 HIV Post-exposure Prophylaxis • If indicated, start PEP (drugs) as soon as possible • Reevaluate 72 hours after exposure • Be familiar with agents, their side effects, contraindications, and the management of toxicity • Anticipate toxicity labs for renal/hepatic failure, complete blood count • Counsel employee on risks and symptoms of bloodborne pathogens 19 Tuberculosis (TB) Exposures • Unprotected exposures: initial testing at time of exposure; repeat 10-12 weeks post-exposure • Employees should monitor for symptom onset • Usually have “teachable moments” with possible TB exposures • Two-step testing for baseline on employment has shed light on conversions 20 MMWR January 14, 2011 Recommended Adult Immunization Schedule, United States IMMUNIZATIONS FOR HEALTHCARE WORKERS 21 Contraindications As always, check the vaccinations for age exclusions, allergy exclusions, underlying medical condition exclusions, and other possible vaccination contraindications 22 Tetanus, Diptheria, and Acellular Pertussis (Td/Tdap) • Tdap should replace a single dose of Td for adults who have not received Tdap (can now be given if > 64) • Tdap for unvaccinated pregnant women (preferably during the third or late second trimester), close contacts of infants aged < 12 months, HCWs • Direct patient care HCWs: interval = 2 years since Td suggested, but can be shorter 23 Varicella Vaccination • Adults without immunity should have 2 doses total • HCWs have contact with persons at high risk of disease and should be immune 24 Varicella Documentation of Immunity (HCWs) • Documentation of two doses of varicella at least four weeks apart • Laboratory evidence of immunity or confirmation of disease • History of varicella or zoster based on diagnosis or verification of varicella by a healthcare provider • Atypical or mild case of varicella, seek epidemiologic link 25 Measles, Mumps, Rubella (MMR) Adults born after 1957 and HCWs born before 1957 without immunity: • Should consider vaccinating personnel with 2 doses of MMR at the appropriate interval (Measles, Mumps) and 1 dose Rubella • During outbreaks, healthcare facilities should recommend workers receive 2 doses of MMR (Measles, Mumps) and 1 dose Rubella Measles Mumps Rubella 26 MMR Documentation • Second dose of MMR recommended for HCWs • Documentation of vaccination(2 dose mumps and measles, 1 dose rubella) • Laboratory evidence of immunity • Documentation of physician-diagnosed measles or mumps 27 Seasonal Influenza Vaccination • Occupational: all healthcare personnel (including those employed by long term care and assisted living facilities) and caregivers of children aged < 5 years should receive annual influenza vaccinations • New high-dose vaccine approved for > 65 years 28 Influenza Vaccine • HCWs may receive either inactivated influenza vaccine (IIV) or live attenuated influenza vaccine (LAIV) • Restrict HCWs from care of patients in protective environments for 7 days postLAIV 29 Hepatitis B Vaccination • HCWs who are exposed to blood or other potentially infectious body fluids per OSHA • Recommended for all adults in many ambulatory practice areas • Safe vaccine • No booster doses are currently recommended 30 Hepatitis B Vaccine • Series of three immunizations (two doses four weeks apart; third dose five months after second) • Titers post-completion of series 1-2 months later • Non-responders repeat 31 Oregon ASC Employee Health Program Findings Evidence in personnel records of new employee TB screening and Hepatitis B immunization within 30 days of employment was not present 32 Toolkit Contents • Screening and Immunizations for Vaccinepreventable Diseases and Tuberculosis Policy (6.01) • Declination of Influenza and Hepatitis B Forms (6.02a-b) • Tuberculosis Screening Documentation Form (6.03) • HCW Communicable Disease Illness Policy (6.04) • Occupational Exposure to Communicable Diseases Policy and Procedure (6.05) • Blood & Body Fluid Exposure Policy (6.06) • Blood & Body Fluid Exposure Documentation Form (6.07) 33 Conclusion The ASC’s employee health program: • Plays an important role in assuring patient safety and a safe work environment • Is an essential component of the Infection Prevention Program (IPP) and should be reflected in the organization’s IPP Plan 34