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Healthcare Workers’ Risks and Handling Exposures

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Healthcare Workers’ Risks and Handling Exposures

  1. 1. Catherine T. Yu, MD • Graduate of University of Santo Tomas • IM residency and ID fellowship, SLMC-QC • Fellow of the PCP and PSMID • Training officer, Infectious Disease Fellowship Program, SLMC-QC • Member of the Residency Training Committee, Department of Internal Medicine, SLMC-QC • Active consultant, SLMC-QC
  2. 2. American College of Occupational and Environmental Medicine Centers for Disease Control and Prevention Morbidity and Mortality Weekly Reports Advisory Committee on Immunization Practices Philippine HIV/AIDS Registry of DOH
  3. 3. Healthcare Workers’ Risks and Handling Exposures
  4. 4. Objectives • To give an overview of the common infectious hazards for workers in the healthcare setting • To discuss how occupational exposures are handled and managed • To discuss the important preventive strategies to avoid transmission of these occupational infections • To gain knowledge on the importance of vaccination of healthcare personnel
  5. 5. Occupational Exposure • A reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee’s duties
  6. 6. HCW Other Air Blood Lab- acquired
  7. 7. HCW Other Air Blood Lab- acquired
  8. 8. Potentially High risk group of Healthcare Workers for Acquiring Blood-borne Transmissible Pathogens • Laboratory personnel: - Phlebotomist - Virology laboratory personnel • Surgery personnel - Surgeons (cardiothoracic, gynecologic, abdomen, orthopedic) - Surgical ward personnel • Others: dentist public health attendants U.S. Public Health Service Guideline 2001 Occupational Risk for HIV,HCV,HBV
  9. 9. Infectious Agents Potentially Transmissible by Blood • Viruses •Parasites •Spirochetes •Bacteria Hepatitis A Malaria Syphilis Yersinia enterocolitica Hepatitis B Babesiosis Relapsing fever P fluorescens Hepatitis C E. coli Cytomegalovirus Serratia marcescens HIV-1 Brucella spp HIV-2 Coagulase (-) staph HTLV type1/2 Parvovirus Mandell et al, Principles and Practice of Infectious Disease 8th ed. 2616-2632
  10. 10. Modes Of Bloodborne Pathogen Transmission • Percutaneous or mucosal exposure to blood and body fluids • Direct inoculation of virus into cutaneous scratches, skin lesions, abrasions or burns • Inoculation of virus onto mucosal surfaces of the eyes, nose or mouth through accidental splashes • Airborne transmission DO NOT occur Beltrami EM, Williams IT, et al. Risk and Management of Blood-borne Infections in Health Care Workers. Clin Microbiol Rev July 2000;13(3): 385-407
  11. 11. • Post exposure Management of HBV, HIV and HCV
  12. 12. Elements of Postexposure Management • Wound management • Exposure reporting • Assessment of infection risk – Type and severity of exposure – Bloodborne infection status of the source person • Appropriate treatment – When to give – What to give • Follow-up and counseling
  13. 13. Benefits • If administered immediately and properly, it can reduce the risk of HIV by 79% and HBV by 75% • For HCV, it is largely ineffective but a postexposure management guide will help in early detection of infection 2009 Post Exposure Management (PEM) for HIV, Hepatitis B and C in Healthcare settingsNational AIDS and STI Prevention and Control Programme, Department of Health in Partnership with WHO
  14. 14. If an exposure occurs: • Wash with soap and water – No evidence of benefit with “milking” or application of antiseptics or disinfectants – Avoid using bleach or other agents • Report incident • Document incident • Seek “immediate” medical evaluation – Prompt medical evaluation – Time limits on effectiveness of prophylactic measures vary depending on the infection of concern
  15. 15. Concentration of HBV in Body Fluids
  16. 16. The Risk of HBV Transmission Pruss Ustun A. Am J Ind Med 2005; 48: 482-90. Six to 30% risk of transmitting to susceptible HCWs Hepatitis B is 50 to 100x more infectious than HIV and 10x more infectious than HCV Less than 20% of HCWs in some regions have received all three doses needed for immunity Hepatitis B is 95% preventable with immunization
  17. 17. • HBV risk varies depending on the e-antigen status of source person • if e-Ag positive, risk is up to 30% • if e-Ag negative, risk is 1-6%
  18. 18. HBV Postexposure Prophylaxis • Determine if the exposure source is HB positive • If possible, determine anti-HBs of a completely vaccinated HCW GENERAL GUIDELINES: 2009 Post Exposure Management (PEM) for HIV, Hepatitis B and C in Healthcare settingsNational AIDS and STI Prevention and Control Programme, Department of Health in Partnership with WHO
  19. 19. HBV Postexposure Prophylaxis VACCINATION/ANTIBODY RESPONSE OF HCP Treatment SOURCE IS HBsAg POSITIVE SOURCE IS HBsAg NEGATIVE SOURCE UNKNOWN OR NOT AVAILABLE FOR TESTING Vaccinated: Responder ( adequate antiHBs >10 mIU/ml) NO PEP NO PEP NO PEP Vaccinated: Non-responder HBIG (0.06 ml/kg IM route) x 1 plus revaccinate OR HBIG x 2 (at time of exposure and 1 month after exposure NO PEP If known high risk, treat as HBsAg positive Unvaccinated HBIG (0.06 ml/kg IM route) x 1 plus vaccine Vaccinate Vaccinate
  20. 20. 1 Figure 3. Number of HIV Cases Reported in the Philippines by Year, January 1984 to December 2015 (N=30,356) Reported modes of transmission (MOT) were sexual contact (632), mother-to-child transmission (1), and needle sharing among injecting drug users (IDU) [17] Eighty-eight percent of the sexually transmitted cases were among males who have sex with males (MSMa ). a male-male sex and sex with both males & females 2013 380 339 370 388 415 431 449 382 427 491 384 358 2014 448 486 498 393 495 494 585 509 565 537 492 509 2015 536 646 667 560 748 772 682 598 692 651 627 650 '84 '85 '86 '87 '88 '89 '90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09 '10 '11 '12 '13 '14 '15 TOTAL 2 10 29 38 32 39 66 85 72 102 118 116 154 117 189 158 123 174 184 193 199 210 309 342 528 835 1,591 2,349 3,338 4,814 6,011 7,829 Aymptomatic 0 6 18 25 21 29 48 68 51 64 61 65 104 94 144 80 83 117 140 139 160 171 273 311 505 804 1,562 2,239 3,152 4,476 5,468 7,326 AIDS 2 4 11 13 11 10 18 17 21 38 57 51 50 23 45 78 40 57 44 54 39 39 36 31 23 31 29 110 186 338 543 503 0 500 1000 1500 2000 2500 3000 3500 4000 4500 5000 5500 6000 6500 7000 7500 8000 NumberofCases 2009 Philippine HIV /AIDS Registry, Dec. 2015 1984 Number of HIV cases reported in the Phil (Jan 1984 to Dec 2015: N=30,356) MSM
  21. 21. Number of Newly Diagnosed with HIV Per Day: 1 4 9 17 22 2008 2010 2012 2014 2015 Philippine HIV /AIDS Registry, Dec 2015
  22. 22. Percentage of newly diagnosed and cumulative cases per region Philippine HIV /AIDS Registry, Dec. 2015 sero-positive individuals (Table 1). This was 28% higher compared to the same period last year (509) [Figure 1]. Most (96%) of the cases were still asymptomatic at the time of reporting (Figure 3). Ninety-seven percent were male. The median age was 27 years old (age range: 2 years-78 years). More than half belong to the 25-34 year age group while 28% were youth aged 15-24 Jan1984 - Dec 2015 30,356 27,804 2,552 27,925 2,420a 1-82(28) 90b 8,094b 15,465b 5,728b 905b 12,533 1,530 5) NCR 38% 4A 15% 3 10% 11 8% 7 7% 6 6% 12 3% 1 2% 10 2% 4B 2% 9 2% 5 1% 8 1% 2 1% CAR 1% CARAGA 1% ARMM <1%
  23. 23. Percentage of HIV Cases Per Region REGION DEC 2015 (N=650) JAN-DEC 2015 (N=7,829) JAN 2010 TO DEC 2015 (N=25,932) CUMULATIVE JAN 1984 TO DEC 2015 (N=30,356) NCR 250 (38%) 3,061 (39%) 11,477 (44%) 13,153 (43%) 4A(CALABARZON) 98 (15%) 1,267 (16%) 3,673 (14%) 4,128 (14%) 7 (CENTRAL VISAYAS) 48 (7%) 676 (9%) 2,524 (10%) 2,704 (9%) 3 (CENTRAL LUZON) 62 (10%) 681 (9%) 2,038 (8%) 2,500 (8%) 11 (DAVAO) 54 (8%) 448 (6%) 1,660 (6%) 1,777 (6%) REST OF THE COUNTRY 138 (21%) 1,694 (22%) 4,393 (17%) 4,947 (16%) Philippine HIV /AIDS Registry, Dec. 2015
  24. 24. Occupationally Acquired HIV During 1985-2013, there are 58 confirmed and 150 possible cases of occupationally acquired HIV infection among HCWs reported to the CDC Joyce, MP, Kuhar, D. Morbidity and Mortality Weekly Report Jan 2015; 63(53): 1245-46.
  25. 25. HIV Situation In The Philippines • Dec 2015 data is 25% higher compared to the same period last year (n=509) Philippine HIV/AIDS Registry, Dec 2015 MODE OF TRANSMISSION DECEMBER 2015 n= 650 JAN-DEC 2015 n= 7,829 CUMULATIVE (JAN 1984-DEC 2015) N=30,356 M F M F M F SEXUAL CONTACT 612 20 7,239 301 26,330 2,204 MALE-FEMALE SEX 57 20 774 301 3,805 2,204 MALE-MALE SEX 349 0 3,893 0 13,699 0 SEX WITH MALE & FEMALE 206 0 2,572 0 8,826 0 BLOOD/BLOOD PRODUCTS 0 0 0 0 5 15 SHARING OF NEEDLES 16 1 259 13 1,255 85 NEEDLE PRICK INJURY 0 0 0 0 2 1 MOTHER-TO-CHILD 1 0 9 8 46 38 NO DATA 0 0 0 0 287 77
  26. 26. Risk of Transmission of HIV ROUTE OF EXPOSURE RISK WITH HIV- POSITIVE SOURCE FACTORS INCREASING THE RISK PERCUTANEOUS ˜ 1 IN 300 (0.3%) HOLLOW BORE NEEDLES, VISIBLE BLOODY DEVICES, DEEP INJURY, SOURCE WITH TERMINAL ILLNESS CUTANEOUS <1 IN 1000 (0.09%) INVOLVE NONINTACT SKIN INTEGRITY MUCOUS MEMBRANE ˜ 1 IN 1000 (0.09%) HIGH VIRAL LOAD IN SOURCE
  27. 27. Risk Factors for HIV Transmission After Percutaneous Exposure to HIV-Infected Blood RISK FACTOR ADJUSTED ODDS RATIO (95% C.I) Deep Injury 15 (6.0-41) Visible blood on device 6.2 (2.2-21) Procedure involving needle 4.3 (1.7-12) placed in artery or vein Terminal illness in source patient5.6 (2.0-16) Post-exposure use of Zidovudine 0.19 (0.06-0.52)
  28. 28. Management of HIV Exposures • Should be started ASAP, preferably within 2 hours • PEP should complete a full 4-week regimen • Selection of regimen must balance the risk of infection against the potential toxicities Updated US Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations For Postexposure Prophylaxis. MMWR; September 2013; 34(9): 875-892.
  29. 29. Recommendations for PEP • 3-drug regimen is now recommended for ALL occupational exposures to HIV • Guidelines no longer require assessing the severity of exposure Updated US Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations For Postexposure Prophylaxis. MMWR; September 2013; 34(9): 875-892.
  30. 30. PEP Regimen • Zidovudine 300mg, twice daily • Lamivudine 300mg, once daily • Lopinavir / Ritonavir 400/100mg, 2 tablets, twice daily
  31. 31. • PEP is given for 28 days • If source person is negative for HIV, PEP can be stopped before 28 days • During the follow-up period (first 6-12weeks), precautions should be undertaken to prevent further transmission
  32. 32. Postexposure Testing • Baseline testing at time of exposure, • Follow-up testing could be performed at 6 weeks and at 3 mos – A negative result at 12 weeks reasonably excludes HIV infection related to occupational exposure – Routine testing at 6 mos is NO longer recommended • Extended HIV follow-up (for 12 mos) is recommended for HCW who became infected with HCV after exposure to a source co-infected with HIV and HCV. • If PEP is offered and taken and the source if later determined to be negative, STOP PEP with no HIV follow-up testing Updated US Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations For Postexposure Prophylaxis. MMWR; September 2013; 34(9): 875-892.
  33. 33. Monitoring Recommendations after Initiation of PEP Regimen following Occupational Exposure BASELINE WEEK 1 WEEK 2 WEEK 3 WEEK 4 WEEK 12 CLINIC VISIT ✓ ✓ ✓ ✓ ✓ PREGNANCY TEST ✓ LIVER ENZYMES, BUN, CREA, CBC ✓ ✓ ✓ HIV TEST ✓ ✓ ✓
  34. 34. • Adverse events are self-limited • Gastrointestinal symptoms • Headache, fatigue, insomnia • Toxicities are rare and not life-threatening • NO need to modify patient care responsibilities of exposed healthcare worker • Special considerations during pregnancy • Avoid breastfeeding for 3 mos after exposure
  35. 35. Occupational Transmission of HCV • Inefficiently transmitted by occupational exposure • Average incidence of 1.8% following percutaneous exposure from HCV-positive source • Prevalence of 1-2% among healthcare personnel • Lower than general population • 10x lower than for HBV infection
  36. 36. Hepatitis C Postexposure Management • For the source person, do baseline anti-HCV • For the exposed HCW, do baseline and follow-up testing: • Baseline anti-HCV and ALT • Follow-up anti-HCV and ALT (4-6mos) • HCV-RNA if anti-HCV-positive Testing 2009 Post Exposure Management (PEM) for HIV, Hepatitis B and C in Healthcare settingsNational AIDS and STI Prevention and Control Programme, Department of Health in Partnership with WHO
  37. 37. Hepatitis C • PEP not recommended after exposure • Immune globulin is NOT effective in preventing Hepatitis C • NO data on use of antivirals • If anti-HCV (+) and ALT elevated, refer to a specialist – Pegylated interferon and ribavirin has a response rate of 40 to 80% Treatment
  38. 38. Sharps container must be: • Closable and puncture-resistant • Leak-proof • Labeled or color-coded • Functional • Sufficient in number • Easily accessible and maintained in upright position • Replaced per agency policy • NOT BE overfilled
  39. 39. HCW Other Air Blood Lab- acquired
  40. 40. Coughing and sneezing are excellent ways to spread germs. A sneeze can travel over 100miles per hour project out 5000 droplets, containing around 10,000 bacteria and propelled up to a distance of 12 feet
  41. 41. Philippines • one of the four countries that account for 93% of TB cases in the Western Pacific Region • among the 22 “high-burden” countries for TB epidemic, accounting for >80% of global cases • Filipinos with TB have decreased by 52% • more MDR-TB cases are reported yearly Global Tuberculosis Report, 2012
  42. 42. Workplace Burden of Tuberculosis • Risk of development of TB is higher among HCWs in the medical and TB wards (13%) compared to other areas in the hospital1 • 40x higher than the general population • Lost productivity, absenteeism, high hospitalization costs, disease transmission to other employees2 1 Fennely KP. Int J Tuberc Lung Dis 1998; 2(9): S103-S109 Silva VMC, Cunha AJLA, et al. Int J Tuberc Lung Diss 2000; 4(5): 420-426 2 Marks S. Tuberculosis evidence-statement: screening.2006
  43. 43. TB Outbreaks In The Healthcare Setting • Delayed diagnosis • Delayed initiation of airborne precautions • Lapses in practices and precautions for cough- inducing and aerosol-generating procedures • Lack of adequate respiratory protection Guidelines for Preventing Transmission of M. tuberculosis In Health-care Settings, MMWR 2005; vol 54: RR-17
  44. 44. Environmental factors that increase the risk the probability of transmission of Tuberculosis • Small, enclosed areas • Inadequate local and general ventilation that results in ineffective removal of infectious droplet nuclei • Recirculation of air containing infectious droplet nuclei • Inadequate cleaning and disinfection of medical equipment • Improper handling of specimens Guidelines for Preventing Transmission of M. tuberculosis In Health-care Settings, MMWR 2005; vol 54: RR-17
  45. 45. An employee with TB might lose an average of 3-4 months of work and income
  46. 46. Respiratory Protection Controls • Surgical masks DO NOT protect the user from exposure to TB • Disposable respirators (N-95) are commonly used in TB isolation rooms, in transport of TB cases in other areas of health facility • High-risk procedures (bronchoscopy or autopsy) needs full facepiece negative pressure respirators, PAPRs, positive- pressure airline respirators TB Respiratory Protection Program in Health Care Facilities NIOSH Publication No. 99-143 TB Infection Control
  47. 47. • Periodic training of HCW to enhance awareness and maintain appropriate index of suspicion for new TB cases • Appropriate management of patients likely to have undiagnosed TB • Use of negative pressure rooms, adequate air exchanges in rooms of patients with suspected TB, adjunctive use of UV germicidal irradiation • Masking of patients with suspected TB • Mandatory respiratory protection of HCW in contact with TB patients esp engaged in high-risk procedures • TB surveillance testing
  48. 48. Workplace Restrictions ! Confirmed pulmonary, laryngeal, endobronchial or tracheal TB, draining TB skin lesion ! Allow return to work only if: o 3 negative sputum samples o Responded to anti-TB treatment o Person has been determined to be non- infectious by a physician knowledgeable and experienced with TB management Guidelines for Preventing Transmission of M. tuberculosis In Health-care Settings, MMWR 2005; vol 54: RR-17
  49. 49. Workplace Restrictions • Those with extra-pulmonary disease do not need to be excluded from the workplace • Those on LTBI can return to work immediately Guidelines for Preventing Transmission of M. tuberculosis In Health-care Settings, MMWR 2005; vol 54: RR-17
  50. 50. Influenza
  51. 51. Influenza Modes of Transmission • Droplet transmission • Indirect: hand transfer
  52. 52. Elements to Prevent Influenza Transmission • Administration of influenza vaccine • Respiratory hygiene and cough etiquette • Appropriate management of ill HCP • Adherence to infection control precautions for all patient activities and aerosol-generating procedures • Engineering controls: physical barriers, curtains
  53. 53. Respiratory Hygiene/Cough Etiquette • Prevents transmission of ALL respiratory infections • Implemented at first point of contact with a potentially infected person • Should be incorporated into infection control practices as one component of standard precautions • Covering mouth and nose when coughing or sneezing • Hand hygiene after contact with respiratory secretions and contaminated objects/materials http://www.cdc.gov/flu/professionals/infectioncontrol/resphygiene
  54. 54. Flu Prevention • Keep frequently touched work surfaces clean • Encourage frequent hand hygiene • Respiratory Etiquette • Stay home when sick to avoid infecting other personnel
  55. 55. • Annual immunization of healthcare workers is the most efficient method of preventing influenza infection and minimizing exposure to vulnerable patients
  56. 56. HCW Other Air Blood Lab- acquired
  57. 57. Laboratory-acquired Infections • Handling tissue and body substances from infected patients • Exposures for blood-borne pathogens including HBV, HCV, and HIV • “sniffing” plates, creating aerosols and making subcultures, making slides, inoculating tubed and multiwell kit biochemicals Wilson and Reller 1998. Clinical Laboratory-Acquired Infections. Hospital Infections 4th ed. pp 343-355.
  58. 58. Safety Recommendations • TRAIN annually – Risks, use of safety equipment • Vaccination • Use of gloves in handling specimens • Use of plastic shields (if aerosol production is possible) • Hand hygiene (before and after) • Respiratory protection – N95 Baron EJ, Miller JM. Bacterial and Fungal Infections Among Diagnostic Laboratory Workers: Evaluating the Risks. Diagnostic Microbiology and Infect Dis 2008; 60: 241-246.
  59. 59. HCW Other Air Blood Lab- acquired
  60. 60. Other Issues Pregnant Personnel • Some infections may be more severe during pregnancy • Transplacental infections have been associated with abortion, congenital anomaly and mental retardation • Drugs used to treat or prevent certain infections may be contraindicated in pregnancy CDC Guideline for Infection Control in Healthcare Personnel, 1998
  61. 61. Other Issues Pregnant Personnel – Female personnel in child-bearing age should be strongly encouraged to receive immunizations for vaccine-preventable diseases before pregnancy – Adherence to standard precautions when caring for patients CDC Guideline for Infection Control in Healthcare Personnel, 1998
  62. 62. Antibiotic-resistant Infections in the Critically Ill • ESBL, MRSA, Carbapenemase-producing organisms, MDROs • Patient-to-patient transmission is common through hands of HCWs and their equipment especially when hand hygiene is suboptimal or not observed Silveira F. Fujitani S, Paterson DL. Antibiotic-Resistant Infections in the Critically Ill Adult. Clin Lab Med 2004; 24: 329-41.
  63. 63. General Control Measure: Hand Hygiene • Core element of patient safety • Prevention of HAI and spread of antimicrobial resistance • Effectively interrupts microbial transmission during care sequence Sax H. Allegranzi B. Uckay I. et al. J Hosp Infect 2007; 67: 9-21
  64. 64. My 5 moments for hand hygiene Sax, H, et al. J Hosp Infec 2007; 67(1): 9-21
  65. 65. Important Points about Measles in the Workplace • HCWs are at higher risk than the general population owing to greater opportunity for exposure • MMR vaccine is highly effective in preventing measles – 1-dose vaccine effectiveness of 95% – 2-dose vaccine effectiveness of 99% – 2-dose vaccine provided long-lasting immunity • Spread by respiratory droplet and can stay in an area for up to two hours after a person with measles has left • Airborne-precautions should be observed to prevent spread • People are contagious from 4 days before they develop the measles rash to 4 days after it goes away
  66. 66. Measles Postexposure Prophylaxis • Vaccination within 72 hours of exposure • If vaccination contraindicated - IG – Infants 6 mos to 1 year, pregnants, immunocompromised – Within 6 days of exposure – Dose: 0.25ml/KBW (max 15ml) per IM – For immunocompromised pts: 0.5ml/KBW – Should not be used to control measles outbreak • HCWs without evidence of immunity should be offered first dose of MMR vaccine and excluded from work 5-21 days following exposure Centers for Disease Control and Prevention
  67. 67. Important Points about Mumps • Healthcare-associated transmission is infrequent • Vaccination is effective in preventing mumps – 1-dose vaccine effectiveness of 80-85% – 2-dose vaccine effectiveness of 79-95% • Observe droplet precautions to prevent spread of mumps • Isolation for 5 days after onset of parotitis • Exposed HCW with no evidence of immunity should be offered first dose of MMR and excluded from duty from day12 after unprotected exposure through day 25 after most recent exposure
  68. 68. Important Points about Rubella • German measles • Less contagious than measles • Effects during first trimester of pregnancy – Miscarriages, stillbirths, therapeutic abortions, congenital rubella syndrome – Birth defects: blindness,deafness, mental retardation, congenital heart defects • Maximal communicability extends from few days before to 7 days after rash onset • No documented transmission of rubella to HCW
  69. 69. Important Points about Rubella • Vaccine effectiveness is 95% • Counsel women to avoid becoming pregnant for 28days after receiving MMR • Observe droplet precautions to prevent transmission, until 7 days after onset of symptoms • Special ventilation in room not required • Exposed HCW should be excluded from work for 23 days after exposure • No evidence shows that postexposure vaccination is effective
  70. 70. Important Points about Pertussis • Highly contagious • Transmission by direct contact with respiratory secretions or large aerosolized droplets from respiratory tract • Communicability starts at onset of catarrhal stage to paroxysmal stage • Single dose Tdap • Priority given to those who have direct contact with babies younger than 12 months of age
  71. 71. • Droplet precautions • HCW who develop symptoms after pertussis exposure should be excluded from work until 5 days after the start of appropriate therapy • Postexposure antibiotics: azithromycin, clarithromycin, erythromycin • Observe for 21days after exposure and treated at onset of signs and symptoms of pertussis Important Points about Pertussis
  72. 72. Important Points about Varicella • Highly contagious: direct contact, inhalation of aerosols; 1-2days before rash until all lesions are crusted • Vaccine effectiveness is lower in adults than children • 2 doses, 4-8 weeks apart • Observe airborne and contact precautions to avoid spread, until all lesions are dried and crusted • Unvaccinated HCW exposed to VZV are potentially infective from days8-21 after exposure – Vaccination within 3-5 days of exposure may be offered
  73. 73. Important Points about Meningococcemia • Nosocomial transmission is rare • Infection occurs only after direct contact with respiratory secretions of infected persons and in a laboratory setting Risk of acquisition through casual contact is negligible Adherence to droplet precautions • Vaccination is recommended for: – Asplenia, complement deficiency – Clinical microbiologists, research microbiologists – HCW >55 years old with risk factor for meningococcal disease – Booster every 5 years • PEP: Rifampicin, ciprofloxacin, ceftriaxone (w/n 24hrs)
  74. 74. Important Points about Typhoid • Two typhoid vaccines: oral and parenteral – Estimates 2-3 year efficacy • parenteral Vi polysaccharide is 55% • Oral Ty21a vaccine is 48% – Boosters: oral – every 5 yrs; parenteral – every 2 yrs • Microbiologists and other laboratory workers • Hand hygiene will minimize transmission of enteric pathogens • HCWs with diarrhea (fever,cramps,bloody stools) should be excluded from care of patients until illness evaluated and treated
  75. 75. Summary • Multiple infectious risks that surrounds our healthcare workers and should not be taken for granted • Simple infection control practices are of great importance in controlling the transmission of occupation-associated infections • Immediate medical attention is key in the success of any post- exposure prophylaxis • Vaccination of all healthcare workers is of utmost importance

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