RI Committee on Occupational Safety &Health
Emerging Infectious Diseases
 SARS
 Marburg (hemorrhagic fevers)
 Anthrax
 Avian flu???
SELECTED INFECTIONS
HEALTH CARE PERSONNEL AND PATIENTS
[]
Hepatitis A
Hepatitis B
Hepatitis C …
Human immunodeficiency virus
Conjunctivitis
Cytomegalovirus
Diphtheria
Gastrointestinal infections
Herpes simplex
Staphylococcus aureus infection and
Tuberculosis
carriage
Mumps
Measles
Meningococcal disease
Parvovirus
Pertussis
Poliomyelitis
Rabies
Rubella
Scabies and pediculosis
Streptococcus, group A
Varicella
Viral respiratory infections
a. Influenza
b. Respiratory syncytial virus
c. SARs
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[]Biological Hazards in the Workplace
 Block transmission/infection
 Immunization/prophylactic


HCWer
Patients
 Environmental controls
Ventilation
PPErespirators
barriers/isolation
Some basic terms:
direct contact refers to body surface–to–body surface
contact and physical transfer of microorganisms
between a susceptible host and an infected
or colonized person
indirect contact refers to contact
of a susceptible host with a contaminated
object (e.g., instruments, hands);
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droplet contact refers to conjunctival, nasal, or oral mucosa contact
with droplets containing microorganisms from an infected person (by
coughing,
sneezing, and talking, or during certain procedures( suctioning and
bronchoscopy) that are propelled a short distance;
airborne transmission
refers to contact with droplet nuclei containing
microorganisms that can remain suspended in
the air for long periods or to contact with dust
particles containing an infectious agent that can
be widely disseminated by air currents;
common vehicle transmission refers to contact
with contaminated items such as food, water,
medications, devices, and equipment.
Standard precautions: list of hygiene practice to prevent bloodborne/or
fluid transmission
Isolation precaution: designed to block transmission of highly
transmissible/ contagious pathogens or extremely harmful pathogens
Droplet large respiratory unit >5micron
Airborne smaller respiratory units <5microns
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 Virulence
 How hard to get
 How Bad when you get it
 Host susceptible/immunity/gen phy health subpopulations

transmission/infection
Infectious agent virus/bacteria/mold
Source/People /Places/ Things

Persons with acute disease, persons in the incubation period of a
disease, persons who are colonized by an infectious agent but have no
apparent disease, or persons who are chronic carriers of an infectious
agent. (Deliberate releases of biological s (bioterrorism) are a subset of
sources.
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 Vectors: air/ blood bodyfluids/ surfaces
 Transmission/infection
Airborne/ droplet

Cough 3000 droplet nuclei ;5 mins of talking

40,000 sneeze



.02-.3microns viruses
0.3-10 microns bacteria cells/spores
2-5 micron fungal spores
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 Transmission/infection
Contaminated items: linen, clothing, utensils, surfaces
Percutaneous (into the blood stream)
Ingestion
 Surveillance detection and recordkeeping
[] Status of HCW:
Eg., “Tuberculosis (TB): Evidence that the health care worker is free of
active tuberculosis based upon the results of a negative two-step
tuberculin skin test shall be required.”
[] Lab work: what tests are effective and turn around time.
[] Incubation and evidence of infection
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
Immunization/prophylactic
 HCWer
 Patients
Vaccine for influenza, measles, rubella, varicella, polio, tetanus, hep A, hep B

prophylactic
 Environmental controls
Ventilation
PPE respirators
barriers/isolation
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RI Committee on Occupational Safety &Health
Generic features of infection control program for a facility:



criteria to define a case. cluster, outbreak
isolation practices relating to droplet precautions;
standard and contact precautions;
RI Committee on Occupational Safety &Health
(Cont}Generic features of infection control program for a facility:



respiratory protection policy (airborne and not just droplet exposures);
controls and practices for high risk procedures
patient cough etiquette;
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Generic features of infection control program for a facility:



drugs that
strict enforcement of hand and surface hygiene;
management of staff and visitor traffic
role of vaccines and anti-viral meds and related therapies (e.g.
interrupt mediators of sepsis).
Case Study: WHO Guidelines SARS: Protecting Health Care Workers (03)
1} Recognition of SARS case within one incubation period (about 10days)
and no secondary transmission:
A} close ward
B} isolate patients
C] Quarantine hcws and visitors
2} if not recognized within one incubation period
A} close hospital
B]Hcws work on quarantine
If cannot close hospital transfer all exposed patients to a SARS designated hospital
Surveillance of HCW
Fever check 3 x a day if temp >37.5C not allowed to work
If fever for >3days defined as a SARS case and quarantine.
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{} Occupational H&S Biologic standards
 OSHA BBP bloodborne pathogens 1910.1030(HIV/HVB/HCB)
[] Employers must determine where and when bloodborne pathogen exposure takes place
– usually situations and activities when handling blood and blood products and
instruments like needles and sharps.
[] Universal precautions must be established and observed. (Universal precautions mean
you assume that all body fluids are infected and that guidelines to control exposure
and transmission – given the situation and the work setting – are established
OSHA BBP bloodborne pathogens
[] Employees must be educated about risks and the control procedures and supplied
with appropriate protective gloves, gowns, and masks. The entire program (called an
Exposure Control Plan) must be in writing. And a responsible party to administer the
program.
[] The facility is responsible to vaccinate all workers at significant risk for hepatitis B.
[] Following a significant exposure to blood or tissue products (one that has been shown
to produce infection) employees must be tested for infection and treated
appropriately. Results must be kept confidential.
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 CDCTB Guidelines
 (OSHA enforces 1910.134/139 for TB}
 CDC Infection Control in Health Care Personnel/98[AJIC: American Journal of
Infection
Control (1998;26:289-354) and Infection Control and Hospital
Epidemiology(1998;19:407-63)
 CDC Isolation precautions in Hospitals

WHO Outbreak Communication Guidelines
 ISI Infection Control in Hospitals
RI Committee on Occupational Safety and Health
741 Westminster st. Prov RI 02903
401-751-2015/jobhealth @juno.com
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