73 Questions
Which of the following groups should be offered Hepatitis B immunisation?
Trainee health care workers
What is the typical incubation period for Hepatitis C?
6-9 weeks
Which route of infection is associated with Hepatitis C?
Parenteral (IVDU / blood products prior to 1991)
What percentage of individuals spontaneously clear Hepatitis C due to immunosuppression?
15-20%
Which occupational group is NOT recommended for Hepatitis B immunisation?
Teachers and educators
When should the delegate start their revision for Part 2?
3-4 months before June/July
What information should the delegate learn for each biological agent?
Description, exposure industry, health effects
What types of exams are mentioned in the text?
MCQ, MEQ & Hygiene exam
Where can the delegate find specific usage rights for the images in the presentation?
On the final slide
What is the aim of the presentation?
To give an overview of biological hazards for MFOM
Which test replaced the Heaf test in the UK in 2005?
Mantoux Intradermal injection of purified protein derivative (PPD)
What is the treatment duration for latent tuberculosis with isoniazid and rifampicin?
3 months
How is HIV transmitted vertically?
Mother to baby
What are the factors considered in the risk assessment for lab staff exposed to engineered Mycobacterium tuberculosis?
Nature of the project and potential exposure risks
What percentage of cases does Hepatitis B immunization provide immunity in?
$90%$
What are the routine vaccinations recommended for healthcare workers?
DTP (5 doses), MMR (2 doses), and varicella immunity
What are the symptoms of measles?
High fever, rash, pneumonia, and encephalitis
How is tuberculosis transmitted?
Through inhaled droplets and close contact with sputum positive cases
Why are healthcare workers at risk of tuberculosis?
Aerosol generating procedures and close contact with infected individuals
What factors determine immunity requirements for healthcare workers?
Local epidemiology of disease, frequency of patient contact, and severity of the disease
What should be contained in a closed system within a containment area for biological agents?
Viable micro-organisms
What additional measures are required for Group 3 or 4 biological agents?
Showering before leaving containment area
When should effective vaccines for biological agents be offered to workers?
If there is a risk of exposure
Under what reporting requirement must diseases caused by work exposure to a biological agent be reported?
RIDDOR reporting of occupational diseases
What should employers assess and mitigate in compliance with HASAWA and COSHH regulations?
Risk of biological hazards
Which of the following is NOT considered a biological agent according to COSHH 2002?
Viruses
What is the size range of viruses, and how can they be transmitted?
$20-450$nm, through airborne or blood-borne routes
What are the factors considered in the classification of occupational biological hazards?
Pathogenicity to humans, employee hazard level, spread to the community, and availability of treatments/vaccines
Which of the following biological agents is associated with Q fever?
Coxiella burnetii
What limitation does the COSHH Hazard Group system have?
It does not consider vulnerable staff such as those with underlying medical conditions or immunosuppression
What is the typical onset time for metal fume fever following exposure to welding fumes?
Within 10-12 hours
Which mineral is usually associated with fibrotic disease in asbestos exposure?
Amphibole
What is the most common site affected by musculoskeletal symptoms in decompression illness?
Shoulder
Which of the following statements about chrome salts is true?
They can be a skin sensitizer and skin irritant.
Which condition is more common in divers and linked to obesity, alcohol, and steroid use?
Dysbaric osteonecrosis
Which substance is classified as a group 1 carcinogen for lung, skin, and bladder cancers?
Arsenic
Leptospirosis is a zoonosis occurring predominantly in which regions?
Asia and the Caribbean
Which condition is known as Caplan’s syndrome?
Rheumatoid nodules in the lungs with pneumoconiosis
What is a group 1 carcinogen for nasal cancer?
Wood dust
Which condition is caused by exposure to gaseous oxides of nitrogen?
Silo filler’s disease
Which type of radiation is more dangerous for skin damage and cancer?
UVB radiation
Which of the following can cause neurotoxicity and an increased risk of coronary artery disease?
Carbon disulphide
Which bacterium causes Q fever?
Coxiella burnetii
Which group of compounds are organochlorine compounds with toxic effects?
Organochlorine compounds
Which type of emissions are group 1 carcinogens, linked to lung inflammation and cancer?
Diesel engine exhaust emissions
Which metal is classified as an IARC group 1 carcinogen?
$Cd$ (Cadmium)
Which chemical can trigger de novo occupational asthma at low exposure levels?
Toluene diisocyanate
What is the resistant state formed by Coxiella burnetii in the environment?
Cyst state
What is the maximum metabolic rate used to minimize heat stress in a given environment?
Thermal work limit (TWL)
Which type of asbestos cannot be distinguished by the naked eye?
All types can be distinguished
What increases the risk of occupational voice loss?
Room dryness
What can cause gastrointestinal necrosis?
Ingestion of mercuric salts
Which of the following is true about trivalent chromium (Cr III)?
It is an essential nutritional supplement to humans and is involved in glucose metabolism.
What is the average recommendation for illuminance in workplaces where perception of detail is important?
500 lux
What is the highest weighting factor for alpha particles?
20
Which of the following statements about Legionnaire’s disease is true?
90% of Legionnaire’s disease is caused by Legionella pneumophila with the remainder caused by other Legionella serotypes.
What are zoonoses?
Diseases acquired through direct contact with infected animal materials or via arthropod vectors.
What percentage of cases does Hepatitis B immunization provide immunity in?
95%
What does hypothermia refer to?
Core body temperature below normal.
Which of the following substances can weaken the irritant effects of skin irritants?
Dilution
What level of pressure is equivalent to 1 ATA?
100 kPa
What causes Itai-itai disease?
Cadmium exposure
What type of threshold shift results in loss of cochlear hair cells?
Permanent threshold shift
What is the term for sudden death due to overwork, recognized in Japan and neighboring countries?
Karoshi
Which workplace intervention is most effective for reducing disability in those out of work due to musculoskeletal disorders?
Ergonomic adjustments
What is the term for the condition more common in those with diabetes, tending to last 12-18 months and resistant to treatment?
Frozen shoulder (adhesive capsulitis)
What condition may occur due to occupational exposure to benzene, chlorates, or chromates, with treatment using methylene blue?
Methaemoglobinaemia
What does job strain, defined by high psychological demands and low decision latitude, increase the risk of?
Depressive symptoms
What is the term for the condition potentially associated with Parkinsonism after 6 months exposure in young individuals?
Manganese madness
What is the term for the resistance to treatment and tendency to last 12-18 months in those with diabetes?
Adhesive capsulitis (frozen shoulder)
What is the term for sudden death due to overwork recognized in Japan and neighboring countries?
Karoshi
What may occur due to occupational exposure to benzene, chlorates, or chromates with treatment using methylene blue?
Methaemoglobinaemia
What does job strain defined by high psychological demands and low decision latitude increase the risk of?
Depressive symptoms
Study Notes
Pre-commencement Immunity Requirements and Vaccination Programmes
- Pre-employment health assessment is mandatory for all staff.
- Immunity requirements are determined based on factors such as pathogens staff may be exposed to, local epidemiology of disease, and frequency of patient contact.
- The benefits of a pre-commencement vaccination programme for workers include meeting statutory obligations, protecting against communicable diseases, and ensuring efficient running of services.
- Routine vaccinations include DTP (5 doses), MMR (2 doses), and varicella immunity.
- Measles is caused by the paramyxovirus and infects 90% of non-immune contacts, with symptoms including high fever, rash, pneumonia, and encephalitis.
- Close contacts of TB patients should be clinically assessed for pulmonary TB and offered standard screening for latent TB.
- Tuberculosis is a notifiable disease with symptoms such as cough, weight loss, and night sweats, and it is transmitted through inhaled droplets and close contact with sputum positive cases.
- Healthcare workers are at risk of TB due to aerosol generating procedures and close contact with infected individuals.
- The most common cause of tuberculosis in UK healthcare workers is unprotected occupational exposure during aerosol generating procedures on a patient known to be infected.
- The Employee Safety Representative contacts regarding the benefits of a pre-commencement vaccination programme for workers.
- The employer benefits from meeting statutory obligations and ensuring efficient running of services, while employees are protected against communicable diseases.
- The immunity requirements are based on local epidemiology, frequency of patient contact, and severity of the disease, and the vaccination program benefits both employees and employers.
Biological Hazard Control and Classification
- Key topics include zoonoses, tropical parasites and diseases, travel medicine, tuberculosis, blood borne viruses, food borne diseases, food handlers fitness standards, and COSHH principles in relation to biological hazards.
- Cordell Health's recent papers cover various topics such as body fluid exposure, malaria, hydatidosis, Q fever, rabies, and vaccinations by occupation.
- Biological agents include micro-organisms like bacteria, viruses, fungi, and parasites that live inside their host, and can cause health effects beyond infection.
- According to COSHH 2002, ticks and mosquitos are considered biological agents because they have the capacity to cause disease in humans.
- Ticks and mosquitoes are not biological agents, but their bite may be the route by which a parasite or pathogen can infect a human.
- Viruses are 20-450nm in size and can be transmitted through airborne or blood-borne routes.
- Bacteria come in various forms and fungi may produce mycotoxins, posing occupational health risks.
- The classification of occupational biological hazards is based on the pathogenicity to humans, employee hazard level, spread to the community, and availability of treatments/vaccines.
- Examples of biological agents include Borrelia burgdorferi, measles virus, Legionella sp., Bacillus anthracis, rabies virus, Mycobacterium tuberculosis, SARS-CoV-2, Ebola virus, and others.
- The COSHH Hazard Group system has limitations as it does not consider vulnerable staff, such as those with underlying medical conditions, immunosuppression, breastfeeding, or pregnancy.
- Risk assessment for biological hazards involves considering the work activity, control measures, potential health effects, exposed population, and type/extent of exposure.
- Anyone working with Hazard Group 2, 3, or 4 biological agents must undergo a risk assessment, and COSHH specifies containment levels for activities involving these agents.
Occupational Medicine Key Points
- "Healthy worker effect" refers to the selection bias in comparing worker health to general population in studies
- Karoshi is sudden death due to overwork, recognized in Japan and neighboring countries
- Workplace interventions are most effective for reducing disability in those out of work due to musculoskeletal disorders
- Young individuals are more susceptible to "manganese madness" after 6 months exposure, potentially associated with Parkinsonism
- Job strain, defined by high psychological demands and low decision latitude, increases risk of depressive symptoms
- Humans are trichromatic, with infants having good color vision by two months of age
- No good evidence supports workplace interventions reducing low back pain risk
- Frozen shoulder (adhesive capsulitis) tends to last 12-18 months and is resistant to treatment, more common in those with diabetes
- Limited evidence for association between computer use and wrist tendinitis, tension neck pain
- Studies suggest up to 90% return to work post-operatively, earlier for lighter work after hip arthroplasty
- Noise-induced hearing loss may cause tinnitus, vertigo, and social isolation, typically bilateral
- Methaemoglobinaemia may occur due to occupational exposure to benzene, chlorates, or chromates, with treatment using methylene blue
Learn about the factors that should be considered when determining the immunity requirements at the precommencement health assessment for staff. Understand the impact of pathogens, local epidemiology of diseases, frequency of contact with infected material, and nature of patient interaction on immunity requirements.
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