Download employee/occupational health

Chapter 6
EMPLOYEE/OCCUPATIONAL HEALTH
The CIC® exam will have a total of ten (10) questions
addressing Employee/Occupational Health. The content
will test knowledge of the following:
A. Review and/or develop screening and immunization programs
B. Provide counseling, follow-up, and work restriction
recommendations related to communicable diseases
or following exposures
C. Assist with analysis and trending of occupational exposure
incidents and information exchange between Occupational Health
and Infection Prevention and Control departments
D. Assess risk of occupational exposure to infectious diseases
(e.g., tuberculosis, bloodborne pathogens)
KEY CONCEPTS
• Healthcare personnel face a wide range of hazards on the job
including needlestick injuries, back injuries, latex allergy, violence,
and stress.
• According to the U.S. Centers for Disease Control and Prevention,
cases of nonfatal occupational injury and illness in healthcare
personnel are among the highest of any industry sector.
• An occupational health program is an essential and corner¬stone
element in efforts to provide a safe environment for patients and
healthcare personnel.
• Elements of an occupational health program include surveillance,
education, immunization, and injury prevention and response.
NOTES
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CHAPTER 6: EMPLOYEE/OCCUPATIONAL HEALTH
NOTES
RESOURCES FOR STUDY
Nearly all questions on Employee/Occupational Health are based
on chapters in the primary references, but secondary references
may be useful to help clarify more detailed issues.
Primary Reference:
1. Grota P, ed. APIC Text of Infection Control and Epidemiology,
4th edition. Washington, DC: Association for Professionals in
Infection Control and Epidemiology, 2014. Also available online
at http://text.apic.org [subscription required].
Notable Chapters
71
Bordetella pertussis
80
Herpes Virus
81
HIV/AIDS
82
Influenza
86
Measles, Mumps, Rubella
87
Neisseria meningitidis
95
Tuberculosis and Other Mycobacteria
97
Viral Hepatitis
100
Occupational Health
101
Occupational Exposure to Bloodborne Pathogens
102Volunteers, Contract Workers, and Other Nonemployees
Who Interact with Patients
103
Immunization of Healthcare Personnel
104
Pregnant Healthcare Personnel
105
Minimizing Exposure to Blood and Body Fluids
Certification Study Guide
CHAPTER 6: EMPLOYEE/OCCUPATIONAL HEALTH
2. Brooks K. Ready Reference for Microbes, 3rd edition. Washington,
DC: Association for Professionals in Infection Control and
Epidemiology, 2012.
NOTES
3. Heymann D, ed. Control of Communicable Diseases Manual,
19th edition. Washington, DC: American Public Health
Association, 2008.
4. Kulich P, Taylor D, eds. The Infection Preventionist’s Guide to the
Lab. Washington, DC: Association for Professionals in Infection
Control and Epidemiology, 2012.
Secondary Reference:
1. Advisory Committee on Immunization Practices (ACIP). Vaccine
Recommendations of the ACIP. Available at: http://www.cdc.gov/
vaccines/acip/.
2. Current guidelines, standards, and recommendations from
Centers for Disease Control and Prevention (CDC), Association
for Professionals in Infection Control and Epidemiology (APIC),
Society for Healthcare Epidemiology of America (SHEA), and
Public Health Agency of Canada.
CDC: http://www.cdc.gov/hicpac/pubs.html
APIC: www.apic.org
SHEA: http://www.shea-online.org/PriorityTopics/
CompendiumofStrategiestoPreventHAIs.aspx
Public Health Agency of Canada: http://www.phac-aspc.gc.ca/
dpg-eng.php
3. Pickering LK, ed. Red Book: Report of the Committee on
Infectious Diseases, 29th edition. Elk Grove Village, IL: American
Academy of Pediatrics, 2012.
5th edition
135
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CHAPTER 6: EMPLOYEE/OCCUPATIONAL HEALTH
NOTES
PRACTICE QUESTIONS
1.
The infection preventionist (IP) is assisting Employee Health with
personnel tuberculosis (TB) skin testing. Which of the following
represents a known tuberculin skin test (TST) conversion in a
healthcare worker?
a. P
rior tuberculin test results are not available, but the current
result is 16 mm after 48 hours
b. T
uberculin reaction 1 year ago was 9 mm, and the current
results are 13 mm
c. A
prior tuberculin reaction was not measured, but the
employee states it was dime-sized. The current result is 11 mm
d. T
uberculin reaction 1 year ago was 3 mm, and the current
result is 18 mm
2.
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
3.
Because there is no vaccine for Hepatitis C, there have been
national recommendations for prevention and control of
Hepatitis C virus (HCV) infections. These include all but which
recommendation?
a. Screening and testing of blood donors
b. R
isk-reduction counseling and screening of persons at risk
for Hepatitis C infection
c. A
national registry for all healthcare personnel known to
be Hepatitis C antibody positive
d. A
dherence to Standard Precautions and safe work practices
in healthcare settings
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CHAPTER 6: EMPLOYEE/OCCUPATIONAL HEALTH
NOTES
ANSWERS AND RATIONALES
1.
uberculin reaction 1 year ago was 3 mm, and the current result
D T
is 18 mm
Rationale: Interpretation of the TST depends on measured TST induration in
millimeters, the person’s risk for being infected with M. tuberculosis, and risk
for progression to active TB if infected. The TST test should be interpreted
according to the CDC guidelines. A healthcare worker without known
exposure who demonstrates an increase of ≥10 mm is considered a positive
result. (See Table 6-1)
Table 6-1. Interpretations of TST and QFT Results According to the Purpose of Testing
for M. tuberculosis Infection in Healthcare Setting
Purpose of Testing
TST
QFT
Baseline
≥10 mm is considered a positive result
(either first or second step)
Positive
(only one-step)
Serial testing without
known exposure
Increase of ≥10 mm is considered a
positive result (TST conversion)
Change from
negative to positive
(QFT conversion)
Known exposure
(close contact)
≥5 mm is considered a positive result
in persons who have a baseline TST
result of 0 mm; an increase of ≥10 mm is
considered a positive result in persons
with a negative baseline TST result or
previous follow-up screening TST result
of ≥0 mm
Change to positive
Source: Jensen PA, Lambert LA, Iademarco MF, et al. Guidelines for preventing the
transmission of Mycobacterium tuberculosis in health-care settings, 2005. MMWR
Recomm Rep 2005 Dec 30;54(RR-17):47.
References: APIC Text, 4th edition, Chapter 95 – Tuberculosis and Other
Mycobacteria; APIC Text, 4th edition, Chapter 100 – Occupational Health;
Jensen PA, Lambert LA, Iademarco MF, et al. Guidelines for preventing the
transmission of Mycobacterium tuberculosis in health-care settings, 2005.
MMWR Recomm Rep 2005 Dec 30;54(RR-17):1-141.
2.
B Until 7 days after onset of jaundice
Rationale: According to the ACIP, food service workers who are diagnosed
with Hepatitis A must be restricted from food handling until 7 days after the
onset of jaundice.
References: APIC Text, 4th edition, Chapter 100 – Occupational
Health; Advisory Committee on Immunization Practices (ACIP). ACIP
Recommendations. ACIP Website. Available at: http://www.cdc.gov/vaccines/
acip/recs/index.html
Certification Study Guide