Management of Employee Illness or Exposure to Infectious/Communicable Disease EH8660-585
IC8750-301
Revised: 10/07
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Management of Illness or Exposure to EH8660-585
Communicable/Infectious Disease Revised: 12/13
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TABLE OF CONTENTS
Procedure for Reporting Exposure or Illness 2-3
Notification of Local Health Authority 3
Employees/Patients with a BBP Disease 3-4
Treatment of Exposure 4
TB Exposure 4-5
Chicken Pox/Varicella Zoster, Measles, or other Vaccine Preventable
Diseases Exposure 5
Meningitis Exposure 5-6
Pertussis Exposure 6
Influenza Exposure 6
Lice or Scabies Exposure 6-7
Bloodborne Pathogen (BBP) Exposure 7
Hazardous Substance Exposure 7-8
Summary of Recommendations for Personnel Exposed to Infectious Diseases Attachment A
Tuberculosis Exposure Protocol Attachment B
Varicella/Herpes Zoster Protocol Attachment C
Measles, Mumps, Rubella and other Vaccine Preventable Diseases Protocol Attachment D
Neisseria Meningitis Exposure Protocol Attachment E
Pertussis Exposure Protocol Attachment F
Influenza Exposure Protocol Attachment G
Lice Exposure Protocol Attachment H
Scabies Exposure Protocol Attachment I
Bloodborne Pathogen (BB) Exposure Protocol Attachment J
I. POLICY
Employees, Licensed Independent Practitioners (LIPs), students/trainees and volunteers will report to their supervisor immediately if they have contracted and/or been exposed to infectious/communicable diseases or are identified as potentially having an infectious disease. Employees will not report to work with symptoms of illness, especially cough or sore throat with fever, rash, drainage from the eye, diarrhea with fever or other undiagnosed potentially contagious illness.
Employees with, or exposed to, infectious/communicable diseases will be restricted as outlined in the table in ATTACHMENT A.
Employees, LIPs, students, volunteers, other employers, patients, visitors, and contractors will be notified by verbal or written notice if they have been exposed to a suspected or confirmed infectious disease case in the course of their duties.
Employees of other agencies or organizations reporting to Lodi Health through the ED, Occupational Health Medicine Clinic, the Urgent Care Clinic or other clinics within the Lodi Health organization with an exposure will be treated according to established standards.
II. PROCEDURE
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Communicable/Infectious Disease Revised: 12/13
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A. Employees, LIPs, students/trainees and volunteers, identified as potentially having an infectious disease or illness, will be reported to and followed, as indicated, by the Employee Health Department. The employee will be sent home immediately and instructed to contact the Employee Health Department by telephone for instructions for return to work.
1. Employees, LIPs, students/trainees and volunteers may be referred to the Employee Health Nurse if assessment, testing, immunization and/or prophylaxis/treatment and counseling as indicated.
2. The Employee Health Nurse in consultation with the Infection Preventionist and department Medical Directors and Administration will monitor for trends, establish screens, and determine testing and treatment as indicated by protocol, CDC, OSHA, Cal-OSHA, and/or the Department of Public Health (California and Federal).
3. Return to work is based on ATTACHMENT A criteria.
B. Employees, LIPs, students/trainees, volunteers and visitors, identified as potentially exposed to suspect or confirmed infectious disease cases will be contacted and treated as indicated in the protocols (see ATTACHMENTS B-J).
C. The Employee Health Nurse, Infection Preventionist, or Department Director may determine if a release to return to work is required.
1. A copy of the release will be sent to Employee Health and Human Resources.
D. Employees ill on the job may be seen by the Employee Health Nurse or Urgent Care/ED physician if indicated.
E. Employees will report any potentially communicable illnesses or any exposures to communicable diseases to the Employee Health Department and Infection Prevention immediately.
1. Employee Health Services will conduct an investigation when notification is received.
2. When indicated, the department director/supervisor will be contacted to generate a list of employees, visitors, patients who may have been exposed.
3. The Employee Health Nurse and Infection Preventionist, if needed, will conduct follow-up investigations on exposed contacts to ensure treatment/resolution.
4. An investigation will be conducted by Employee Health and Infection Prevention, if needed, to determine the cause of the exposure and any practices that may require revision to prevent future exposures.
5. Investigation and follow-up documentation will be completed by Employee Health Services to include requirements outlined in CCR Title 8 § 5199. Documentation is completed utilizing:
a. Exposure Analysis & Post Exposure Evaluation Form, and
b. Exposure Incident Evaluation Form
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F. Lodi Health will provide testing for Bloodborne Pathogen (BBP) exposure for non Lodi Health Employees including: LIP, students, and pre-hospital personnel employees according to regulation and established guidelines.
1. Initial screening and base line testing is provided at Lodi Health Laboratory free of charge to LIP; all others are billed for the services.
2. Follow-up testing can be done through Lodi Health lab services but may be charged to non-employee or sent to the clinicians worker’s compensation carrier.
3. Should the non-employee choose to use a lab service other than Lodi Health lab services, the clinician will be financially responsible for that service.
4. The treating provider will give appropriate post-exposure counseling. The non-employee may choose to continue with Lodi Health for follow-up counseling and testing or may go to their own physician/occupational health service.
III. NOTIFICATION OF LOCAL HEALTH AUTHORITY
A. Employee Health Services and/or the Infection Preventionist and/or the physician confirming a diagnosis of a communicable disease is responsible for submitting the Confidential Morbidity Report (C.M.R.) to the Preventive/Public Health Services, Morbidity Unit.
1. If Employee Health Service is the diagnosing unit, they will file a C.M.R.
2. If the disease is diagnosed by a private physician, he/she will be responsible for filing the C.M.R.
IV. EMPLOYEES/PATIENTS WITH A BBP DISEASE
A. Employees with AIDS, known to be HIV positive, a Hepatitis B carrier, Hepatitis C positive or other potentially communicable disease will be evaluated according to the type of work performed including direct patient contact.
1. The Employee Health Nurse will review placement and precautions with the employee and complete the Work Clearance and Counseling for Healthcare Workers with HCV, HBV and/or HIV Form.
2. These employees will not be permitted to perform procedures or work in positions that require working with sharps without the ability to see the sharp while it is in contact with the patient. (Blind Procedures)
V. TREATMENT OF EXPOSURE
A. Follow protocols for specific exposure. (ATTACHMENTS B-J)
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1. If there is no protocol, contact Employee Health or after hours the ER physician on duty for immediate treatment needs.
B. Provide and/or ensure immediate first aid is given.
1. Eye wash, wash exposed area; remove from immediate danger, etc.
C. Compile a list of those potentially exposed.
VI. TB
A. Exposure is defined as contact within three feet of a patient diagnosed with pulmonary tubercle Bacillus (tuberculosis) without using respiratory protection equal to or greater than an N95 respirator.
B. Department Managers will have potentially exposed employees complete TB Exposure protocol (ATTACHMENT B) and/or send list of names to Employee Health.
C. Employee Health, in cooperation with affected Department Managers, will contact potentially exposed employees.
D. Upon receipt of employee contact list, Employee Health Services will:
1. Sends notices, protocol and testing forms to those potentially exposed informing them of the exposure and the need for baseline and follow-up testing.
2. Instruct employees to report any symptoms as outlined on the TB surveillance form.
3. Do Baseline TSTs on employees who have not had a PPD in the last three months.
4. Do Follow-up TST at least 12 weeks post-exposure if confirmed positive TB.
5. Have employees with a history of a positive PPD test complete the TB History and Respiratory Symptom Review portion of the Tuberculosis Surveillance Form.
6. Provide employee with conversion from a negative to a positive skin test, a PA and lateral chest x-ray.
a. Until the results are obtained, the employee may continue to work if they have no signs or symptoms consistent with TB disease.
7. Offer counseling and treatment for latent TB according to CDC and PHD guidelines.
8. Report conversion to Public Health Department.
9. Record all procedures and results in Employee Health Record.
E. If an employee develops signs and symptoms consistent with TB disease, a posterior anterior and lateral check x-ray will be done and the employee will be removed from work until a negative chest x-ray is received.
1. If the chest x-ray is positive, the employee will be referred to a pulmonologist or other appropriate medical doctor for diagnosis and treatment.
2. The employee will be able to return to work when they have completed two weeks of successful drug therapy and are no longer symptomatic.
a. A release from the treating physician must be provided prior to return.
F. Post-exposure testing is done regardless of annual testing and does not change that mandated annual date. Employees failing to comply with testing requirements within two weeks of notification will not be allowed to work until testing and clearance is obtained.
G. Employers of pre-hospital personnel are notified of potential exposure and positive culture results by the Public Health Department, Employee Health, or the Infection Preventionist as needed.
VII. CHICKEN POX/VARICELLA ZOSTER, MEASLES OR OTHER DISEASES FOR WHICH IMMUNITY IS PRESENT IN MOST PEOPLE
A. Have employee complete and follow the instructions on the protocol ATTACHMENT D.
1. The Employee Health Nurse will review Employee Health Records to determine if the employee has immunity to the specific disease.
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B. Employees with immunity are not considered exposed.
C. Those employees without immunity, or those with no documentation of immunity, will be contacted and immunization, testing or prophylaxis will be provided according to Lodi Health Policy, CDC, and/or Public Health.
D. Employee may be restricted from work based on CDC and Public Health guidelines and Lodi Health policy. (ATTACHMENT A)
1. Employee Health will adjust restrictions as indicated by the specific disease based on CDC and Public Health guidelines.
VIII. MENINGITIS
A. Exposure is defined as intensive contact with a patient with meningococcal disease (N. meningitides). There is a negligible risk of disease following casual contact. Intensive contact would occur in unprotected:
1. Mouth to mouth resuscitation.
2. Suctioning without using proper precautions.
3. Participation in intubation.
4. Oral or fundoscopic examination.
5. Assisting with vomiting patient.
6. Other mucus membrane contact with respiratory secretions.
B. Have the employee complete and follow the instructions on the Meningitis Exposure Protocol Form.
(ATTACHMENT E)
C. Inform the Pharmacy Department that there has been a confirmed exposure.
IX. PERTUSSIS
A. Exposure is defined as intensive contact with a patient with Pertussis. There is a negligible risk of disease following casual contact. Intensive contact includes unprotected:
1. Mouth to mouth resuscitation.
2. Suctioning without using proper precautions.
3. Participation in intubation.
4. Oral or fundoscopic examination.
5. Assisting with vomiting patient.
6. Other mucus membrane contact with respiratory secretions.
B. Data on the need for post exposure antimicrobial prophylaxis in Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine (Tdap)-vaccinated HCP are inconclusive. Some vaccinated HCP are still at risk for B pertussis. Tdap vaccination may not preclude the need for post exposure antimicrobial prophylaxis.
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1. Post exposure antimicrobial prophylaxis is recommended for all HCP who have unprotected exposure to pertussis and are likely to expose a patient at risk for severe pertussis (e.g., hospitalized neonates and pregnant women).
2. Other HCP can receive post exposure antimicrobial prophylaxis or be monitored daily for 21 days after pertussis exposure and treated at the onset of signs and symptoms of pertussis.
C. Have the employee complete and follow the instructions on the Pertussis Protocol Form. (ATTACHMENT F)
D. Inform the Pharmacy Department that there has been a confirmed exposure.
X. INFLUENZA EXPOSURE
A. Large droplet spread through coughing and sneezing is believed to be the primary mode of transmission. Contact with surfaces may also be a source of transmissible particles. Exposure is defined as contact within three feet of a patient diagnosed with influenza without use of respiratory or contact protection.
B. Have the employee complete and follow the instructions on the Influenza Protocol Form. (ATTACHMENT G)
C. Inform the Pharmacy Department that there has been a confirmed exposure.
XI. LICE OR SCABIES EXPOSURE AND TREATMENT
A. Definition of exposure to LICE: Occurs when an employee comes into direct contact with another person with lice. Contact must be close head to head, or sharing of same fabric covered chair, lab coats, or other personal items. Time is not a factor to determine exposure.
B. Definition of exposure to SCABIES: Occurs when an employee comes into direct skin to skin contact with another person with scabies. Occasionally, transmission may occur when there is contact with heavily contaminated clothing or bed sheets.
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C. Any employee, who suspects exposure by any source, will immediately notify their director or supervisor.
D. Provide the potentially exposed employee(s) with the Scabies or Lice protocol to complete and follow the instructions. (ATTACHMENT H or I)
E. If the source of exposure is a patient, the director or supervisor will:
1. Initiate isolation of the patient.
2. Notify Infection Prevention immediately with patient name and room number.
3. Have potentially exposed employees complete the protocol and follow the instructions.
a. Contact the Pharmacy Department to let them know employees may be reporting for medication.
F. Employees with lice or scabies are relieved from direct patient contact and patient care areas until 24 hours after effective treatment.
XII. BLOODBORNE PATHOGEN (BBP) EXPOSURE
A. Obtain and complete the BBP Exposure Protocol (ATTACHMENT J) for exposures that include:
1. Needle stick, cut or puncture with a device contaminated with another’s blood or bloody fluid.
2. Mucous-membrane contact to eye, nose or mouth with another’s blood or bloody fluid.
3. Contact with large amounts of blood or prolonged contact with blood, or bloody fluids on broken or non-intact skin.
4. Human bite if visibly bloody oral secretions and employee skin is broken.
B. Provide employee with signed copies of handouts. Forward originals to Employee Health.
C. Instruct the employee to call Employee Health the next work day.
XIII. HAZARDOUS SUBSTANCE EXPOSURE – CHEMICALS
OCCUPATIONALLY RELATED ALLERGIES AND/OR SKIN SENSITIVITIES
A. Definition: Intermittent or chronic skin conditions, respiratory, or other condition, which may be related to glove use, latex exposure, chemical use/exposure or other irritants in the work place.