Occupational Safety And Management Of Occupational Exposures PDF

Occupational Safety And Management Of Occupational Exposures Reem Hamdan Albalawi Outline ❑What is Occupational Health ❑Pre- employment assessment and management ❑Vaccination ❑Post exposure management  Introduction Occupational expos...

Occupational Safety And Management Of Occupational Exposures Reem Hamdan Albalawi Outline ❑What is Occupational Health ❑Pre- employment assessment and management ❑Vaccination ❑Post exposure management  Introduction Occupational exposure means reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or OPIM that may result from the performance of an employee's duties. Healthcare personnel face occupational exposure to bloodborne pathogens, such as HBV and HIV, through needlesticks, cuts, or contact with infected patient's blood, posing a risk to their health and potentially causing disease. N.B: Most exposures do not cause infection, but it is crucial to have the person evaluated by a healthcare professional immediately if necessary for treatment. Pre-Employment Assessment And Management Standard Pre-Employment Examinations ❑Physical Exam ❑TB Screening ❑Documentation of Immunizations  TB Screening ALL new HCWs need to be screened for latent tuberculosis infection (LTBI) either by: Interferon Gamma Release Assay (IGRA) “preferred if available” Two-Step Tuberculosis Skin Testing (TST) or (2 Step purified protein derivative PPD) Tuberculosis Skin Testing The Mantoux test is the recommended TST. It is administered intradermally by injecting 0.1 ml containing 5 tuberculin units (TU) of purified protein derivative (PPD) solution. The HCW must return within 48 to 72 hours to look for a reaction on the arm. The Reaction is a raised, hard area or swelling, and if present, measure its size using a ruler. Redness by itself is not considered part of the reaction. Result: Positive skin test: This means the person’s body was infected with TB bacteria. Additional tests are needed to determine if the person has a latent TB infection or TB disease. Negative skin test: This means the person’s body did not react to the test, and that latent TB infection or TB disease is not likely.  Interferon Gamma Release Assays (IGRAs) An IGRA is a blood test that can determine if a person has been infected with TB bacteria. Two IGRAs Approved by the United States Food and Drug Administration (FDA) 1. QuantiFeron-TB Gold In-Tube test (QFT-GIT) 2. T-spot TB test (T-Spot) Result: Positive IGRA: This means that the person has been infected with MTB bacteria. ✓ Additional tests are needed to determine if the person has LTBI or MTB disease. ✓ A healthcare provider will then provide treatment as needed. Negative IGRA: This means that the person’s blood did not react to the test and that LTBI of MTB disease is not likely. Immunization Of Healthcare Personnel  Documentation of Immunizations All employees shall have repeat testing HIV Hepatitis B (HBV) Hepatitis C (HCV) Hepatitis A (HAV) All employees shall have testing for Immunoglobulin G (IgG) for : Rubella(IgG) measles (IgG) varicella (IgG) Pre-Employment Immunizations As Recommended  HBV Vaccination Schedule Vaccine given in 3 doses over 6 months ✓ 1st on the initial assignment ✓ 2nd one month later ✓ 3rd 6 months after 2nd dose Immune response to HBV vaccine is assessed by measuring antibody level after 6–8 weeks of completion of 3 doses. If anti-hbs is at least 10 miu/ml (positive), ✓ The vaccine is immune. (No further serologic testing or vaccination). If anti-hbs is less than 10 miu/ml (negative) should be considered susceptible to HBV infection ✓ Hcw is not protected from hepatitis b virus (HBV) infection ✓ Should receive another 2-dose or 3-dose series Meningococcal Vaccine HCWs participating in Hajj, HCWs work in Clinical research Microbiologists who are routinely exposed to isolates of N. meningitides Single dose Repeated every 3 years if polysaccharide type Or Repeated every 5 years if conjugate type Occupational Exposure Incidents Occupational exposure means reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or OPIM that may result from the performance of an employee's duties. If an Exposure Occurs 1.Immediate measures:- Soap and water to wash exposed areas Flush exposed mucous membranes with water Flush exposed eyes with water or saline solution Do NOT apply caustic agents or inject antiseptics or disinfectants into the wound 2.Report and Document incident 3.Seek “immediate” medical evaluation 4. Follow the employer’s exposure control plan Reporting an Incident Minimal Information to Report ⚫Date and time of incident ⚫Job classification ⚫Location in the worksite where incident occurred ⚫Work practice being followed ⚫Engineering controls in use ⚫Procedure being performed ⚫PPE in use Management Of Occupational Exposure To Biological Hazards  Exposure to Blood Borne Pathogens Bloodborne pathogens Microorganisms present in human blood that can infect and cause disease in people who are exposed to blood containing the pathogen. In addition to blood, other fluids may also present an infection risk. OSHA defines these as “Other Potentially Infectious Materials” or OPIM. These are listed below: synovial Fluid Pleural Fluid Peritoneal Fluid Saliva in Dental Procedures Cerebrospinal Fluid HIV or HBV Cultures Bloody Body Fluids Unfixed Tissue Modes of Transmission 1- Puncture wounds or cuts 2- Contact (touch, splash, or spray) with blood or OPIM on: ✓Mucous membrane ✓Non-intact skin(Cuts, abrasions, burnsAcne, rashesHangnails) ✓Contaminated sharps Specific Bloodborne Pathogens ▪ Hepatitis B virus (HBV) ▪ Hepatitis C virus (HCV) ▪ Human immunodeficiency virus (HIV) Hepatitis B Virus ( HBV) It affects the liver Prevalence of HBV infection among healthcare workers is 10 times greater than HCV infection Hepatitis B virus (HBV) is transmitted by direct exposure to blood and other infected body fluids. HBV is a relatively hardy virus capable of surviving on environmental surfaces and fomites. Hepatitis B Virus ( HBV) Incubation period averages 12 weeks Most cases of HBV resolve without complications Chronic liver disease may occur in 6 to 7% of those infected with HBV Symptoms (weeks-~6months) – Fever, Jaundice, fatigue, abdominal pain, loss of appetite, nausea, vomiting, joint pain, dark urine Complications - Cirrhosis (scarring) of the liver, liver cancer, liver failure, and death Hepatitis B Virus ( HBV) Healthcare workers who have received hepatitis B vaccine and have developed immunity to the virus are at virtually no risk for infection. For an unvaccinated person, the risk from a single needle stick or a cut exposure to HBV- infected blood ranges from 6%–30% and depends on the hepatitis B e antigen (HBeAg) status of the source individual. Interpretation of Hepatitis B Serologic Test Results Hepatitis B serologic testing involves the measurement of several hepatitis B virus (HBV)-specific antigens and antibodies to identify different phases of HBV infection:- ❑Acute or chronic HBV infection, ❑ Differentiate between immunity to HBV as a result of prior infection or vaccination, ❑ Susceptibility to infection. Interpretation of Hepatitis B Serologic Test Results Hepatitis markers:- HB surface Ag (HBsAg) and antibody to hepatitis B surface antigen (anti-HBs); Hepatitis B core antigen (HBcAg) and anti-HBc; and Hepatitis B e antigen (HBeAg) and antibody to HBeAg (anti-HBe). Interpretation of Hepatitis B Serologic Test Results Hepatitis B surface antigen (HBsAg): A protein on the surface of hepatitis B virus; it can be detected in high levels in serum during acute or chronic hepatitis B virus infection. The presence of HBsAg indicates that the person is infectious. Interpretation of Hepatitis B Serologic Test Results Hepatitis B surface antibody (anti-HBs): The presence of anti-HBs is generally interpreted as indicating recovery and immunity from hepatitis B virus infection. Anti-HBs also develop in a person who has been successfully vaccinated against hepatitis B. Interpretation of Hepatitis B Serologic Test Results Total hepatitis B core antibody (anti-HBc): Appears at the onset of symptoms in acute hepatitis B and persists for life. The presence of anti-HBc indicates previous or ongoing infection with hepatitis B virus in an undefined time frame. Interpretation of Hepatitis B Serologic Test Results IgM antibody to hepatitis B core antigen (IgM anti-HBc): Positivity indicates recent infection with hepatitis B virus ( < 6 months) Its presence indicates acute infection. Interpretation of Hepatitis B Serologic Test Results Hepatitis e antigen (HBeAg):- can be detected in the serum of persons with acute or chronic HBV infection. The presence of HBeAg correlates with viral replication and high levels of virus (i.e., high infectivity). Anti-Hbe:- correlates with the loss of replicating virus and with lower levels of virus. Hepatitis C Virus (HCV) It is most common chronic bloodborne infection in US. The Hepatitis C virus can survive outside the body at room temperature, on environmental surfaces, for at least 16 hours but no longer than 4 days. Needle stick injury is only occupational risk factor associated with HCV Risk of HCV infection after exposure to HCV infected blood is 1.8% 70 to 75% of those with acute HCV infection have no symptoms Signs & Symptoms of HCV The incubation period averages 7 weeks Chronic liver disease may occur in 70% of those infected with HCV S&S includes:- Jaundice - yellow color to skin and whites of eyes, Fatigue , Headache, Abdominal Pain, Loss of appetite, Nausea and vomiting Diagnosis of Different Stages of Hepatitis C HCV RNA: tests will report whether the hepatitis C virus is present in the blood or not Anti-HCV EIA: detect the presence of hepatitis C antibodies in serum. Human Immunodeficiency Virus (HIV) HIV is the virus that causes AIDS. HIV does not spread through tears, saliva, sweat, urine, feces (bowel movements) or vomit that is free from blood. It is not transmitted through casual contact with someone who is HIV positive. HIV does not live outside the body for more than a few hours. The virus's ability to infect is reduced by 90 to 99 percent when the exposed surface is dry Risk for HIV infection The average risk for HIV infection after a needle stick or cut exposure to HlV-infected blood is 0.3% (about 1 in 300). The risk after exposure of the eye, nose, or mouth to HIV-infected blood is estimated to be, on average, 0.1% (1 in 1,000). The risk after exposure of the skin to HlV-infected blood is estimated to be less than 0.1%. A small amount of blood on intact skin probably poses no risk at all. Human Immunodeficiency Virus (HIV) The incubation period from HIV infection to AIDS can be up 8 to 10 years Varies greatly among individuals Signs and symptoms include: Weight loss, Night sweats or fever, Gland swelling or pain, Muscle and/or joint pain Cannot rely on signs and symptoms to confirm if one is infected. HIV Prevention There is no vaccine to prevent HIV infection Follow Standard Precautions Post Exposure Prophylaxis (PEP) Medical response given to prevent the transmission of blood borne pathogens following a potential exposure Hepatitis B Virus Post Exposure Prophylaxis Hepatitis B Virus Post Exposure Prophylaxis ⚫Post-exposure prophylaxis should begin within 24 hours; no later than 7 days after exposure ⚫ The decision to begin treatment is based on several factors, such as: 1. Whether the source individual is positive for hepatitis B surface antigen 2. Whether the HCW have been vaccinated 3. Whether the vaccine provided immunity Hepatitis C Virus Post Exposure Prophylaxis & Follow-up ⚫There is no vaccine against hepatitis C ⚫Neither immune globulin or antiviral therapy is recommended after exposure. ⚫For these reasons, following recommended infection control practices to prevent percutaneous injuries is imperative. HIV Post-Exposure Prophylaxis & Follow-up Workers sustaining accidental parenteral exposures to HIV should be counseled to undergo baseline and follow-up testing for 6 months after exposure (e.g., 6 weeks, 3 months, and 6 months) to diagnose infection. Extended follow-up (e.g., for 12 months) is recommended for HCWs who become infected with HCV after exposure to a source coinfected with HIV and HCV. HIV antibodies usually become detectable within 3 months of infection. Treatment should be started as soon as possible, preferably within hours as opposed to days, after the exposure. Post Exposure to HIV ❑ Post-exposure prophylaxis and consultation with an infectious diseases consultant should initiated as early as possible to all individuals with exposure that has the potential for HIV transmission, and ideally within 72 hours. ❑ Determine the HIV status of the exposure source patient to guide the need for HIV PEP, if possible. ❑ Start PEP medication regimens as soon as possible after occupational exposure to HIV and continue them for a 4-week duration. ❑ PEP medication regimens should contain 3 (or more) antiretroviral drugs for all occupational exposures to HIV. ❑ Provide close follow-up for exposed personnel that includes counseling, baseline and follow-up HIV testing, and monitoring for drug toxicity. Thank You