Occupational Hazards of Health Care Personnel-II

Respiratory infections

Droplet infection

• droplets from patients with these infections could reach persons located 6 feet or more from their source.

• 1 Inch = 2.54 cm, 1 Feet = 30.48 cm • Droplets traditionally have been defined as

being >5 μm in size.

Droplet infection

• Bordetella pertussis , influenza virus , adenovirus , rhinovirus , Mycoplasma pneumoniae , SARS-associated coronavirus (SARS-CoV), group A streptococcus , and Neisseria meningitidis . Although respiratory syncytial virus may be transmitted by the droplet route, direct contact with infected respiratory secretions is the most important determinant .

Airborne transmission

• Mycobacterium tuberculosis , rubeola virus (measles), and varicella-zoster virus (chickenpox).

• spores of Aspergillus spp• Preventing the spread of pathogens that are

transmitted by the airborne route requires the use of special air handling and ventilation systems (e.g., AIRs)

http://www.cdc.gov/h1n1flu/masks.htm

• N 95= respirator• Surgical mask are different

• The hospital epidemiology program must work closely with the employee health service. Issues such as the management of exposure to blood-borne pathogens and other communicable diseases (e.g., varicella, influenza, meningococcal disease, tuberculosis) require a concerted effort by the two groups.

• In addition, the employee health service is responsible for ensuring that health care workers are fit for duty and free of communicable diseases. At the time of employment, workers should be reviewed to ensure that they have adequate immunity against illnesses such as rubella, measles, mumps, pertussis, tetanus, hepatitis B, and varicella.

• In addition, baseline and periodic skin testing for tuberculosis should be performed, as well as postexposure testing. The employee health service should proactively and creatively devise delivery systems that encourage compliance with and remove barriers to annual influenza vaccination by all health care workers.

Vaccination for heath care personel

(keep upto date)• ─Td • ─MMR(KKK)• ─Seasonale influenza• ─Hep-B• ─Hep-A • ─ Varicella

http://saglik.gov.tr

2010

1-Tdvaccine• Primer immunization should be complete for

health care personel.• Every ten year shold be repeated

2-MMR(KKK)

• The ones who had the history of disease Measles-Mumps-Rubella or positive spesific IgG, should not be vaccinated

MMR(KKK)• The ones born after 1980, with a history of

vaccination of two doses 1 month apart have no need for vaccination

• 2 doses 1 month apart

3-Seosonal flue vaccine

• Every year at the beginning of the season

4-Hepatitis A vaccine

• Health care personal who are commonly contact with feces in paediatric wards

• 2 doses 6 months apart • Prevaccination serology(If Anti-HAV IgG

positive: no need)

Hepatitis B vaccine

• In every age group no prevaccination serology is needed

• Hep-B vaccine:0-1-6 monthes

Hepatitis B vaccine

• After the 3. dose Anti-HBs response is detected.

• If Anti-HBs is greater than 10 mIU/mL, that person is immune. No test and vaccine is necessary in the future.

Hepatitis B vaccine

• Anti-HBs negative (less than 10 mIU/mL) • 3 doses are repeated and evaluated for Anti-

HBs 1-2 months later

5-Hepatitis B vaccine

• If Anti-HBs:negative after 6 doses, those people are acepted nonresponders

6-Varicella vaccine• For those in wards for newborn and

immunocompromised patients

If no previous chickenpox history, antibody (spesific varicella IgG level should be known)

Laboratory acquired infections

• Laboratory safety • Personal attributes• Risk-based classification of microorganisms• Biosafety and clinical laboratory design

Laboratory acquired infections

• Risk-based classification of microorganisms:• 2: many pathogenic bacteria• 3:Bacillus anthtracis,Brucella, Coxiella,

Francisella, Mycobacterium• 4:Ebola, Lassa virus

Laboratory acquired infections

• Biosafety and clinical laboratory design:• Splasguards• Biosafety cabinets• Centrifuges• Sharp protection

Laboratory acquired infections

• Requirements of the international organization for standardization

• ISO standarts

Laboratory acquired infections

• Hand hygiene• Gloves !!• Immunization

Nitrile gloves/latex gloves !!!!

Electronic information

• http://saglik.gov.tr• http://www.rshm.saglik.gov.tr/• Cdc• ecdc

Rare exotic viruses ‘!!!’

• Crimean-congo hemorrhagic fever• Ebola, Marburg virus…

Ebola virus disease outbreak

• The ongoing is taking an appalling toll on health workers in West Africa. More than 240 have been infected and more than 120 have died. At Kenema Government Hospital (KGH) in Sierra Leone, where the country’s first case was diagnosed, more than 2 dozen nurses, doctors, and support staff have died of Ebola. KGH is where many of the samples were collected for a paper published online today in Science that analyzes the genetics of the virus responsible for the disease. Highlighting the danger to those caring for infected people, five of the paper’s co-authors—all experienced members of the hospital’s Lassa fever team—died of Ebola before its publication. (A sixth co-author, uninfected, also recently died as well.)