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Occupational Health Risks for Healthcare Workers

Occupational Health Risks for Healthcare Workers. Learning Objectives. Recognize infection health hazards for healthcare workers. Explain the use of an occupational infection risk evaluation. Outline methods of reducing occupational risk of infection for healthcare workers.

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Occupational Health Risks for Healthcare Workers

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  1. OccupationalHealth Risks forHealthcare Workers

  2. Learning Objectives • Recognize infection health hazards for healthcare workers. • Explain the use of an occupational infection risk evaluation. • Outline methods of reducing occupational risk of infection for healthcare workers.

  3. Time involved • 40 minutes

  4. Health Hazards in Healthcare Facilities • Biological hazard • Chemical hazard • Physical hazard • Ergonomic hazard • Psychosocial hazard

  5. Occupational Health • If a separate department, size based on • Institution size • Number of staff • Services offered • Elements • Medical evaluations • Education • Immunisation program • Management of illness/exposures • Maintenance of records

  6. Prevention of Occupational Riskin Healthcare Facilities • Conduct written risk assessment for staff hazards • Physical • Chemical • Biological • Ergonomic • psychosocial • Assess risk and estimate degree of risk annually

  7. Bloodborne Infection among Healthcare Workers • 3 million healthcare workers exposed to bloodborne pathogens each year • > 90% of infections occur in developing countries • 95% of HIV seroconversions in HCWs caused by needlestick injuries

  8. Biological Agents: Risk of Infection

  9. Risk evaluation for infectious agents - 1

  10. Risk evaluation for infectious agents - 2

  11. Risk evaluation for infectious agents - 3

  12. Risk evaluation for infectious agents - 4

  13. Risk evaluation for infectious agents - 5

  14. Risk evaluation for infectious agents - 6

  15. Risk Reduction - 1 • Eliminate the hazard • Reduce the number of injections by providing oral medication • Assign a central hospital for treating highly infectious patients

  16. Risk Reduction - 2 • Remove or isolate the hazard • Use safety needles • Single-use needles designed to retract or cover the sharp end immediately after use • Transport blood specimens in leak- and puncture-resistant boxes • Use puncture-resistant waste boxes for discarding sharp items and needles

  17. Risk Reduction - 3 • Organisational measures • Limit number of staff members caring for a patient with certain illnesses • Tuberculosis or MRSA • Train staff regularly in safe work practices • Establish an occupational safety committee • Consider every patient to be potentially infected with hepatitis B or C or HIV • Strict adherence to Standard Precautions/Routine Practices • Audit compliance with prevention measures periodically

  18. Risk Reduction - 4 • Evaluate use of personal protective equipment • Gloves • Discard and change between patients • Use only once or disinfect 2-3 times maximum • Gowns • Use if spills/splashes are possible • Change between patients • Single-use gowns preferred • If used several times put on and remove it without touching the outer potentially contaminated side • e.g., during a shift time

  19. Risk Reduction - 5 • Evaluate use of personal protective equipment • Eye goggles or face shields • Use if spills/splashes to the face possible • Disinfect regularly and if visibly soiled • Masks and respirators • N95/FFP respirators with a tight face seal used if a risk of exposure to airborne pathogens • When not available, use surgical masks • Develop written standard operating procedures • For medium and high-risk activities • Include staff protection and vaccination recommendations

  20. Risk Reduction - 6 • Provide a medical examination for all HCWs • Examination records and other health information should be kept confidential • Store in a secure place • Repeat the examination periodically • All injuries documented in the respective staff member’s medical record

  21. Risk Reduction - 7 • Provide vaccinations for all non-immune HCWs • Hepatitis B • Influenza • Mumps/Measles/Rubella/Varicella/Pertussis • Poliovirus • Tetanus, Diphtheria (as a routine adult vaccination)

  22. Causes of Needle-stick Injury in Low Resource Countries • Recapping of needles • Unsafe handling of sharps waste • Overuse of injections • Lack of supplies • disposable syringes, safer needle devices, sharps-disposal containers • Failure to place needles in sharps containers immediately after injection • Passing instruments from hand to hand(e.g., in the OR) • Lack of awareness of the problem • Lack of training for staff

  23. Risk of Blood-borne Pathogen Transmission • The risk of transmission of bloodborne pathogen from an infected patient to a HCW by a needlestickinjury: • 30% for hepatitis B • 3% for hepatitis C • 0.3% for HIV

  24. Hepatitis B Prevention: PEP Post-exposure prophylaxis varies with immune status of HCW

  25. Prevention of Hepatitis C • Currently no recommended PEP for hepatitis C virus • Perform baseline and follow-up testing for anti-HCV and alanine aminotransferase • Up to six months after exposure • Perform HCV RNA testing at 4-6 weeks • If an earlier diagnosis of HCV infection is desired • Staff members who develop hepatitis C should be treated after seroconversion

  26. Prevention of HIV Infection: PEP • Start as soon as possible, within 2-24 hours, not after 72 hours • Consider contraindications (e.g., pregnancy) • Medication taken for at least 4 weeks • Seek expert consultation if viral resistance is suspected • In case no PEP is available • Perform HIV antibody testing for at least six months post exposure (e.g., at baseline, 6 weeks, 3 months, and 6 months) • Perform HIV antibody testing if an illness compatible with an acute retroviral syndrome occurs • Advise exposed persons to use precautions to prevent secondary transmission during the follow-up period

  27. Prevention of TB - 1 • Establish a tuberculosis control committee • Increase awareness about TB among HIV-positive patients • Place patients with suspected TB or with an abnormal chest radiograph in an isolation room • With door closed and a special ventilation system (natural or artificial) • Place automatic closing devices on all TB isolation room doors • Continue isolation of TB patients until at least three negative acid-fast bacilli sputum smears obtained • Ensure that all HCWs entering a TB isolation room wear a N95/FFP mask • Restrict sputum induction procedures and aerosolised pentamidine treatments to TB isolation rooms

  28. Prevention of TB - 2 • Assign adequate number of trained staff to perform routine and urgent acid-fast bacilli smears on a daily basis • Initial anti-TB treatment regimens should include four drugs • TB patients should only be allowed to leave their rooms when medically necessary and must always wear a surgical mask when outside the room • Forbid immunocompromised staff from contact with, or caring for, TB patients • Perform routine tuberculin testing for tuberculin negative staff • Treat HCWs as soon as active TB is confirmed

  29. Summary • Healthcare workers are exposed to biological, chemical, physical, ergonomic, and psychosocial hazards • HBV, HCV, HIV and TB pose the greatest risk of infection • Infection with hepatitis B virus is preventable with immunisation • All healthcare workers should be vaccinated against hepatitis B • Written standard procedures on how to manage needlestick injuries should be available and known to all staff

  30. References • Health worker occupational health. World Health Organization. 2010. http://www.who.int/occupational_health/topics/hcworkers/en/ • AIDE-MEMOIRE for a strategy to protect health workers from infection with bloodborne viruses. World Health Organization. 2011. http://www.who.int/injection_safety/toolbox/en/AM_HCW_Safety_EN.pdf • Simonsen L, Kane A, Lloyd J, Zaffran M, Kane M. Unsafe injections in the developing world and transmission of bloodborne pathogens: a review. Bull WHO 1999; 77: 789-800. http://www.who.int/bulletin/archives/77(10)789.pdf

  31. Quiz • Mucosal exposures cause 95% of HIV seroconversions in staff. T/F. • Prevention of tuberculosis includes • Placing patient in an isolation room • Patient wears mask when leaving the room • Perform AFB lab tests daily • All of the above • A risk assessment for staff hazards is useful to determine appropriate prevention strategies. T/F.

  32. International Federation of Infection Control • IFIC’s mission is to facilitate international networking in order to improve the prevention and control of healthcare associated infections worldwide. It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe . • The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication, consensus building, education and sharing expertise. • For more information go to http://theific.org/

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