Transcript Training Presentation Materials - Oregon Patient Safety Commission

EMPLOYEE HEALTH PROGRAM
REQUIREMENTS FOR ASCs
Mary T. Post, RN, MS, CNS, CIC
Infection Prevention Specialist
Oregon Patient Safety Commission
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http://www.youtube.com/watch?v=3ZEZa_8m98
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http://www.youtube.com/watch?v=4P1EToToHE
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Objectives
• List three elements of an employee health (EH)
program that should be included in your Infection
Prevention Program (IPP) Plan
• Describe two recently published guideline
changes for immunization and screening of
healthcare workers
• Identify three post-exposure interventions to
follow after an occupational exposure to potential
bloodborne pathogen viruses and TB
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CMS Requirement: ASC Identifies Risks for
Acquiring & Transmitting Infections
Include employee related data in your analysis:
• Percentage of individuals compliant with TB screening
policy
• If applicable, number of TB employee conversions
• Number of unprotected communicable disease
exposures
• Blood and body fluid exposure/sharps injury rates
• Employee compliance rates with immunizations and
screenings
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Set Goals Based on Identified Risks
• Limit unprotected exposure to pathogens
(PPE, hand hygiene)
• Limit the transmission of infections associated
with the use of medical equipment, devices
(sharp safety), and supplies
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CMS Requirement: ASC Has an
Infection Prevention Plan
• Include employee infection prevention data
and goals
• Include employee exposures/potential
source for possible disease outbreaks
• Occupational health programs may assist
with communication of responsibilities to
licensed independent practitioners (LIPs)
and staff; if service is contracted, be certain
contractor’s role is well defined
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CMS Requirement: ASC Prepares to Respond
to Influx of Potentially Infectious Patients
Emergency Management
• Role of employee health programs in
pandemics:
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Exposure management
Employee illness tracking/evaluations
Vaccinations
Respiratory protection (N95 masks)
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Implementing IPP Plan
• Communicate responsibilities to LIPs and staff;
include hand and respiratory hygiene
• Report, share employee infection prevention
data with LIPs and staff
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ASC Infection Prevention Policies
The ASC has policies and procedures to prevent the
transmission of infectious disease among patients,
licensed independent practitioners, and staff.
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Immunizations and Screening
Screening for exposure and/or immunity to
infectious diseases should be available to LIPs
and staff
• Tuberculosis screening
• Screening for vaccine preventable diseases
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Ill Provider Policies
If suspected of having an infectious disease
that places others at risk, must have a system
to provide or refer LIPs/staff for assessment,
potential testing, prophylaxis/treatment, or
counseling
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Exposure Follow-up and Treatment
Refer or provide assessment and potential
testing, prophylaxis/treatment, or counseling
to staff or LIPs with occupational exposures
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Influenza Vaccination
The ASC offers vaccination against
influenza to licensed independent
practitioners and staff
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Influenza Vaccination Program
• Educates LIPs and staff
• Influenza vaccine
• Non-vaccine control and
prevention measures
• Diagnosis, transmission, impact
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Accessible sites
Evaluates rates and reports to state
Declination reasons
Improves vaccination rates
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Post-occupational Exposure
INTERVENTIONS FOR SELECT
COMMUNICABLE DISEASES
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Exposure Determination
• Verify the diagnosis and patient infectivity
• Determine if PPE worn by healthcare workers
(HCWs)
• Identify the exposed HCWs
• Determine if the individual is susceptible
• Determine appropriate disease specific postexposure follow-up
• Always use as a “teachable moment”
• Promote your program and resource needs
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What to do if You Have a Blood or
Body Fluid Exposure
1. Wash the area well with soap and water
2. Flush eyes well with water if splashed
3. Immediately report accident according
to your facility’s policy
4. Encourage employee to bring patient
name, medical record number, and
any known HIV risk factors for
post-exposure prophylaxis (PEP)
consideration
Employers are required to provide confidential and free
baseline and follow up lab testing and counseling
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Blood & Body Fluid Exposures
Lab Work
Exposed employee
• Hepatitis B surface antibody
• HIV Elisa/EIA
• Hepatitis C antibody
• Repeat at 6 and 12 weeks and 6 months based on source
patient lab results
Source patient
• Hepatitis B surface antigen
• HIV ELISA/EIA standard
• Rapid HIV (consider)
• Hepatitis C antibody
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HIV Post-exposure Prophylaxis
• If indicated, start PEP (drugs) as soon as possible
• Reevaluate 72 hours after exposure
• Be familiar with agents, their side effects,
contraindications, and the management of
toxicity
• Anticipate toxicity labs for renal/hepatic failure,
complete blood count
• Counsel employee on risks and symptoms of
bloodborne pathogens
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Tuberculosis (TB) Exposures
• Unprotected exposures: initial testing at time of
exposure; repeat 10-12 weeks post-exposure
• Employees should monitor for symptom onset
• Usually have “teachable moments” with possible
TB exposures
• Two-step testing for baseline on employment has
shed light on conversions
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MMWR January 14, 2011
Recommended Adult Immunization Schedule, United States
IMMUNIZATIONS FOR
HEALTHCARE WORKERS
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Contraindications
As always, check the vaccinations for age
exclusions, allergy exclusions, underlying
medical condition exclusions, and other
possible vaccination contraindications
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Tetanus, Diptheria, and Acellular
Pertussis (Td/Tdap)
• Tdap should replace a single dose of Td for
adults who have not received Tdap (can now
be given if > 64)
• Tdap for unvaccinated pregnant women
(preferably during the third or late second
trimester), close contacts of infants aged < 12
months, HCWs
• Direct patient care HCWs: interval = 2 years
since Td suggested, but can be shorter
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Varicella Vaccination
• Adults without
immunity should
have 2 doses total
• HCWs have contact
with persons at
high risk of disease
and should be
immune
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Varicella Documentation of
Immunity (HCWs)
• Documentation of two doses of varicella at least
four weeks apart
• Laboratory evidence of immunity or confirmation
of disease
• History of varicella or zoster based on diagnosis or
verification of varicella by a healthcare provider
• Atypical or mild case of varicella,
seek epidemiologic link
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Measles, Mumps, Rubella (MMR)
Adults born after 1957 and HCWs
born before 1957 without immunity:
• Should consider vaccinating
personnel with 2 doses of MMR at
the appropriate interval (Measles,
Mumps) and 1 dose Rubella
• During outbreaks, healthcare
facilities should recommend
workers receive 2 doses of MMR
(Measles, Mumps) and 1 dose
Rubella
Measles
Mumps
Rubella
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MMR Documentation
• Second dose of MMR recommended for HCWs
• Documentation of vaccination(2 dose mumps and
measles, 1 dose rubella)
• Laboratory evidence of immunity
• Documentation of physician-diagnosed measles or
mumps
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Seasonal Influenza Vaccination
• Occupational: all healthcare personnel
(including those employed by long term care
and assisted living facilities) and caregivers of
children aged < 5 years should receive annual
influenza vaccinations
• New high-dose vaccine approved for > 65
years
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Influenza Vaccine
• HCWs may receive either inactivated
influenza vaccine (IIV) or live attenuated
influenza vaccine (LAIV)
• Restrict HCWs from care of patients in
protective environments for 7 days postLAIV
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Hepatitis B Vaccination
• HCWs who are exposed to blood or other
potentially infectious body fluids per OSHA
• Recommended for all adults in many
ambulatory practice areas
• Safe vaccine
• No booster doses are currently recommended
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Hepatitis B Vaccine
• Series of three immunizations (two doses
four weeks apart; third dose five months
after second)
• Titers post-completion of series
1-2 months later
• Non-responders repeat
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Oregon ASC Employee Health
Program Findings
Evidence in personnel records of new
employee TB screening and Hepatitis B
immunization within 30 days of
employment was not present
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Toolkit Contents
• Screening and Immunizations for Vaccinepreventable Diseases and Tuberculosis Policy (6.01)
• Declination of Influenza and Hepatitis B Forms (6.02a-b)
• Tuberculosis Screening Documentation Form (6.03)
• HCW Communicable Disease Illness Policy (6.04)
• Occupational Exposure to Communicable Diseases
Policy and Procedure (6.05)
• Blood & Body Fluid Exposure Policy (6.06)
• Blood & Body Fluid Exposure Documentation Form
(6.07)
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Conclusion
The ASC’s employee health program:
• Plays an important role in assuring patient
safety and a safe work environment
• Is an essential component of the Infection
Prevention Program (IPP) and should be
reflected in the organization’s IPP Plan
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