Download Infectious Contagious Disease and TB

Progress Industries
Standard Procedures
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Infections and Contagious Diseases and
Tuberculosis (TB) Testing Requirements
G: Procedures – Health
G: Policies – Health
President & CEO
1-93
1-94, 5-94, 8-94, 12-94, 4-95, 4-98, 5-00, 4-02, 6-03, 5-04, 3-05,
3-11, 3-12, 1-14, 3-15, 3-16, 1-17
7-06, 7-07, 6-11, 3-13
1. Progress Industries (P.I.) will support, where feasible and practical, educational
programs to enhance employee awareness and understanding of serious disease.
2. Employees with a serious disease are to be treated the same as any other employee. In
addition, if the serious disease affects their ability to perform their assigned duties,
such employees are to be treated like other employees who have disabilities that limit
their job performance.
3. Employees who have a serious disease are to provide the Human Resource
Department with any pertinent medical records needed to make decisions regarding
job assignments, ability to continue working, or ability to return to work. P.I. may
require a doctor’s certification of an employee’s ability to perform job duties.
4. The Human Resource Department will review with the employee, P.I.’s policy on
such issues as assistance, leaves, disability, infection control, and available benefits.
5. P.I. will attempt to maintain the confidentiality of the diagnosis and medical records
of employees with serious diseases, unless required otherwise by law. Information
relating to an employee's serious disease will not be disclosed to other employees
unless the information is, in the opinion of P.I., necessary to protect the health or
safety of the employee, co-workers, or others.
6. P.I. will attempt to identify employees who are at risk of exposure to blood-borne
diseases and, when required, will develop a system of “Standard and Transmission
Based Precautions” to limit the spread of infections in the work place. Supervisors
should instruct employees about any special precautions needed in individual work
areas. A system of precautions is to include elements such as:
a. The use of protective barriers, such as gloves and goggles, by employees who are
exposed to blood or bodily fluids or who are required to handle contaminated
items and to clean contaminated areas.
b. Procedures for handling and disposing of potentially infectious materials,
clothing, and other items;
c. Provisions for the cleaning and disinfecting of work areas or equipment
contaminated with blood or bodily fluids with a suitable disinfectant;
d. Procedures for the treatment of open wounds, lesions, inflammations, and other
skin problems; and
e. Basic provisions to monitor environmental conditions surrounding all work,
housekeeping, and sanitation functions.
7. Employees concerned about being infected with a serious disease by a co-worker,
customer, or other person should convey this concern to their supervisor.
8. Employees who refuse to work with or perform services for a person known or
suspected to have a serious disease, without first discussing their concern with a
supervisor, will be subject to discipline, up to and including termination.
TUBERCULOSIS (TB) TESTING REQUIREMENTS
This is an airborne communicable disease caused by the tubercle bacillus. It is spread by
tiny airborne particles expelled by a person who has infectious TB. If another person
inhales the droplet nuclei, transmission may occur. Symptoms may be weight loss,
fatigue, loss of appetite, night sweats, a low-grade fever and chronic cough.
Employees
1. New employees will need to have a required 2 stick TB test upon employment with a
purified protein derivative and have test read in 48 - 72 hours. 2 stick testing
meaning the employee will receive a TB test upon hire and receive a 2nd TB test 1-4
weeks after initial test. (If person can show proof of a TB test done within that year,
that result may be used as the 2nd test.)
2. Yearly TB tests will be done on all other employees. Results of TB tests will be read
in 48-72 hours and be documented and kept in employees personnel file.
3. Negative TB tests will be repeated yearly.
4. Positive reaction to TB tests (a TB test shows signs of swelling, redness, in duration
or raised area) will be referred to physician for further evaluation and treatment.
If an employee has a reaction to a TB test they will be referred to Occupational
Medicine. They will determine if it is .10mm or above. At this time a Chest x-ray will
be completed. If the CXR is questionable then a Quantum Gold Test for TB may be
completed , this is a more accurate measurement of testing for determining if they
have TB and need treatment. If the test is negative then the employee would be
required to complete the TB questionnaire annually. If the employee completing the
questionnaire indicates that they are symptomatic then a Quantum Gold test would be
completed. No further CXR are indicated unless specifically requested by
Occupational Medicine or the Physician
5. Documentation will need to be obtained from physical and placed in employee’s
personnel file of present TB status.
6. TB Status:
a. Known Reactor:
This person has a history of a positive TB skis test, but has proven negative to
actual disease. These people will do a yearly TB questionnaire screen with the
Health Care Coordinator. If the person shows signs or symptoms of TB,
employee will be referred to a physician for treatment and follow up. Upon
returning to work, employee will need written documentation of present TB
status.
b. Convertor:
A positive skin test with a past negative test. These people will do a yearly TB
questionnaire screen with the Health Care Coordinator. If the person shows signs
or symptoms of TB, upon returning to work, employee will need written
documentation of present TB status.
c. Positive Diagnostic Findings:
Confirmation of TB, the employee will be restricted immediately from working in
any capacity at Progress Industries during the infectious stage. Drug therapy will
begin immediately upon receipt of the medications. Three weeks following the
initiation of drug therapy, the employee may return to work with a doctor’s
permission. Documentation of proof of treatment will be kept in personnel file.
Any employee who refuses treatment or stops taking their medications will be
subject to disciplinary actions. All persons having exposure to the infected person
will need to have testing done immediately.
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Person Served
1. All persons served, upon admission to Progress Industries will be required to have a
physical and TB skin test done with a purified protein derivative.
2. ICF-ID persons served are required to have a physical examination completed
annually. All other persons served should see a physician, as needed, and are
encouraged to have a physical examination on an annual or regular basis. Person
served case files should contain documentation of the person served physical or
medical examination. Exceptions to an annual or regularly scheduled physical should
be rare and the reasons for the exception should be documented in the person served
case file.
3. Yearly TB tests will be done on all persons served by their physician. (Results of TB
test will need to be read by the administering doctor’s office with in 48-72 hours after
skin test administration. Documentation will be kept in the person served case file.)
4. Negative TB tests will be repeated yearly.
5. Positive reaction to TB test (a TB test that shows signs of swelling, redness, in
duration (greater than .10mm) or raised area will be checked by doctor and further
evaluation ordered, if needed. For positive reaction of TB skin test measuring greater
than .15mm will be treated as positive. If a person served has a reaction to a TB test
they will be referred to their primary care provider. They will determine if it is .10mm
or above. At this time a Chest x-ray will be completed. If the CXR is questionable
then a Quantum Gold Test for TB may be completed , this is a more accurate
measurement of testing for determining if they have TB and need treatment. If the test
is negative then the person served would be required to complete the TB
questionnaire annually. If there are indicators that the person served is symptomatic
then a Quantum Gold test would be completed. No further CXR are indicated unless
specifically requested by the Physician.
6. Documentation will need to be obtained from physician and placed in persons served
case file regarding present TB status.
7. TB Status:
Positive Reaction
This person has a history of a positive TB skin test, but has proven negative to the
actual disease. These people will need to be evaluated for TB signs and symptoms at
their annual physical by their physician. They will need to have written
documentation of present TB status that will be kept in their case file.
Convertor
A positive skin test with a past negative test. The physician will need to provide
documentation of current TB status. Drug therapy may be initiated if prescribed by
the doctor. If drug therapy is prescribed, documentation that meds are being taken
must be kept in the person served case file.
Positive Diagnostic Findings
The person served with TB infectious stage will be restricted from work and the
residential site. Drug therapy will be initiated as ordered by the physician. Three weeks
following the initiation of drug therapy, the persons served may return to work and the
residential site with doctor’s permission. Documentation of proof of treatment will be
kept in the persons served case file.
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RESPIRATORY INFECTIONS
This includes all infections involving the respiratory tract including the lungs which may
cause pneumonia.
1. Obvious runny nose, cough producing droplet sprays are considered contagious.
2. Flu shots will be offered to all employees of P.I. on a yearly basis.
3. Flu shots for person served will be done at their local doctor’s office or Flu Shot
Clinics in the community.
4. Control Guidelines:
a. If febrile temperature is over 100.5, the persons should avoid contact with others.
b. See doctor if cold symptoms progress into a high fever or does not go away in 1014 days.
c. Good health practices are important to good health (proper rest, diet,
exercise, and decreasing stress) increase the resistance to respiratory
infections.
d. Frequent hand washing to decrease spread of respiratory infections.
RUBELLA
This is a contagious viral disease resulting in a rash, fever, enlarged lymph glands, and
respiratory symptoms. Complications may cause joint and arthritic pains. Rubella is
spread via airborne droplets.
1. Rubella’s course is approximately 7-10 days.
2. Avoid pregnant women
3. Control Guidelines:
a. Bed rest - isolate to bedroom.
b. Encourage proper nutrition especially fluids
c. Monitor condition and follow directions from the doctor
STAPHYLOCOCCAL INFECTIONS:
This is the bacteria which may develop from any contaminated object, infecting an open
area on the skin causing purulent drainage.
1. All purulent drainage from skin lesions is considered infectious.
2. Direct contact with the drainage is the mode of transmission.
3. Control guidelines:
a. All persons with open areas will keep those areas covered at all times until areas
are scabbed over.
b. Use Standard and Transmission Based Precautions when dealing with any open
area.
c. Frequent hand washing to prevent spread of infections.
HEPATITIS A (Infectious Hepatitis)
This is a disease that is spread by the fecal-oral route where improper personal hygiene
methods are used or by eating contaminated foods. Symptoms are: flu like symptoms
(abdominal pain, nausea, vomiting and fever). Occasionally a person may have
1. Control Guidelines
a. Frequent hand washing to prevent spread of disease
b. Wash hands after each toileting
c. Hepatitis A immunization is available
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MRSA - Methicillin Resistant Staphylococcus Aureus
Due to the widespread use of antibiotics, strains of Staphylococcus Aureus have
developed which are unaffected by Methicillin type drugs. These strains are referred to
as MRSA. MRSA is resistant to a wide variety of antibiotics.
1. Transmission is frequently spread from one person to another via hands on contact.
MRSA is also spread via airborne transmission especially when a person has a lower
respiratory infection and coughs with out covering mouth.
2. MRSA is seen in people in very poor health or in a person with open pressure sores or
any type of internal catheters.
3. Treatment of MRSA infection is Penicillinase - resistant Penicillin and first and
second generation cephalosporin, erythromycin and Clindamycin. Vancomycin is
considered to be the antibiotic for treating severe MRSA infections. If vancomycin resistant MRSA develops, there is no antibiotic therapy available to treat such an
infection.
4. Control Guidelines
1. Treatment with proper prescribed antibiotics
2. Avoid over use of antibiotics to prevent resistance from developing
3. Hand washing is the most important measure for controlling the spread of
MRSA.
Vancomycin Resistant Enterococci
VRE, caused by strep infections and usually seen in the urinary tract, surgical sites or
blood stream, is due to the widespread over use of antibiotics. There is a higher risk of
patients to be diagnosed with VRE in those that are critically ill or those with severe
underlying diseases, or those with long-term internal type catheters.
1. Education of staff regarding the problem of VRE (over use of antibiotics).
2. Proper infection control measures to prevent transmission from person to person.
3. Avoid over use of vancomycin
4. Those people diagnosed with VRE need to be kept isolated from others. Keep all
contaminated items in the person’s room to prevent contamination to other areas.
HEPATITIS C VIRUS
The Hepatitis C virus (HVC) can also cause inflammation of the liver which leads to
chronic liver disease and death. It is less common than (HBV) Hepatitis B virus and its
signs and symptoms are similar to HBV. Currently, there is no vaccine to prevent HCB
infection; but, with prompt and proper treatment, most cases can be treated successfully.
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