Progress Industries
Standard Procedures
Subject: Infections and Contagious Diseases and
Tuberculosis (TB) Testing Requirements
Section: G: Procedures – Health
Cross Ref: G: Policies – Health
Approved by: Dan Skokan, President & CEO
Effective date: 1-93
Review date: 1-94, 5-94, 8-94, 12-94, 4-95, 4-98, 5-00, 4-02, 6-03, 5-04, 3-05,
3-11, 3-12, 1-14
Modified date: 7-06, 7-07, 6-11, 3-13
1. Progress Industries (P.I.) will support, where feasible and practical, educational programs to enhance employee awareness and understanding of serious disease.
2. Employees with a serious disease are to be treated the same as any other employee. In addition, if the serious disease affects their ability to perform their assigned duties, such employees are to be treated like other employees who have disabilities that limit their job performance.
3. Employees who have a serious disease are to provide the Human Resource Department with any pertinent medical records needed to make decisions regarding job assignments, ability to continue working, or ability to return to work. P.I. may require a doctor’s certification of an employee’s ability to perform job duties.
4. The Human Resource Department will review with the employee, P.I.’s policy on such issues as assistance, leaves, disability, infection control, and available benefits.
5. P.I. will attempt to maintain the confidentiality of the diagnosis and medical records of employees with serious diseases, unless required otherwise by law. Information relating to an employee's serious disease will not be disclosed to other employees unless the information is, in the opinion of P.I., necessary to protect the health or safety of the employee, co-workers, or others.
6. P.I. will attempt to identify employees who are at risk of exposure to blood-borne diseases and, when required, will develop a system of “Standard and Transmission Based Precautions” to limit the spread of infections in the work place. Supervisors should instruct employees about any special precautions needed in individual work areas. A system of precautions is to include elements such as:
a. The use of protective barriers, such as gloves and goggles, by employees who are exposed to blood or bodily fluids or who are required to handle contaminated items and to clean contaminated areas.
b. Procedures for handling and disposing of potentially infectious materials, clothing, and other items;
c. Provisions for the cleaning and disinfecting of work areas or equipment contaminated with blood or bodily fluids with a suitable disinfectant;
d. Procedures for the treatment of open wounds, lesions, inflammations, and other skin problems; and
e. Basic provisions to monitor environmental conditions surrounding all work, housekeeping, and sanitation functions.
7. Employees concerned about being infected with a serious disease by a co-worker, customer, or other person should convey this concern to their supervisor.
8. Employees who refuse to work with or perform services for a person known or suspected to have a serious disease, without first discussing their concern with a supervisor, will be subject to discipline, up to and including termination.
TUBERCULOSIS (TB) TESTING REQUIREMENTS
This is an airborne communicable disease caused by the tubercle bacillus. It is spread by tiny airborne particles expelled by a person who has infectious TB. If another person inhales the droplet nuclei, transmission may occur. Symptoms may be weight loss, fatigue, loss of appetite, night sweats, a low-grade fever and chronic cough.
Employees
1. New employees will need to have a required 2 stick TB test upon employment with a purified protein derivative and have test read in 48 - 72 hours. 2 stick testing meaning the employee will receive a TB test upon hire and receive a 2nd TB test 1-4 weeks after initial test. (If person can show proof of a TB test done within that year, that result may be used as the 2nd test.)
2. Yearly TB tests will be done on all other employees. Results of TB tests will be read in 48-72 hours and be documented and kept in employees personnel file.
3. Negative TB tests will be repeated yearly.
4. Positive reaction to TB tests (a TB test shows signs of swelling, redness, in duration or raised area) will be referred to physician for further evaluation and treatment.
If an employee has a reaction to a TB test they will be referred to Occupational Medicine. They will determine if it is .10mm or above. At this time a Chest x-ray will be completed. If the CXR is questionable then a Quantum Gold Test for TB may be completed , this is a more accurate measurement of testing for determining if they have TB and need treatment. If the test is negative then the employee would be required to complete the TB questionnaire annually. If the employee completing the questionnaire indicates that they are symptomatic then a Quantum Gold test would be completed. No further CXR are indicated unless specifically requested by Occupational Medicine or the Physician
5. Documentation will need to be obtained from physical and placed in employee’s personnel file of present TB status.
6. TB Status:
a. Known Reactor:
This person has a history of a positive TB skis test, but has proven negative to actual disease. These people will do a yearly TB questionnaire screen with the Health Care Coordinator. If the person shows signs or symptoms of TB, employee will be referred to a physician for treatment and follow up. Upon returning to work, employee will need written documentation of present TB status.
b. Convertor:
A positive skin test with a past negative test. These people will do a yearly TB questionnaire screen with the Health Care Coordinator. If the person shows signs or symptoms of TB, upon returning to work, employee will need written documentation of present TB status.
c. Positive Diagnostic Findings:
Confirmation of TB, the employee will be restricted immediately from working in any capacity at Progress Industries during the infectious stage. Drug therapy will begin immediately upon receipt of the medications. Three weeks following the initiation of drug therapy, the employee may return to work with a doctor’s permission. Documentation of proof of treatment will be kept in personnel file. Any employee who refuses treatment or stops taking their medications will be subject to disciplinary actions. All persons having exposure to the infected person will need to have testing done immediately.
Person Served
1. All persons served, upon admission to Progress Industries will be required to have a physical and TB skin test done with a purified protein derivative.
2. ICF-ID persons served are required to have a physical examination completed annually. All other persons served should see a physician, as needed, and are encouraged to have a physical examination on an annual or regular basis. Person served case files should contain documentation of the person served physical or medical examination. Exceptions to an annual or regularly scheduled physical should be rare and the reasons for the exception should be documented in the person served case file.
3. Yearly TB tests will be done on all persons served by their physician. (Results of TB test will need to be read by the administering doctor’s office with in 48-72 hours after skin test administration. Documentation will be kept in the person served case file.)
4. Negative TB tests will be repeated yearly.
5. Positive reaction to TB test (a TB test that shows signs of swelling, redness, in duration (greater than .10mm) or raised area will be checked by doctor and further evaluation ordered, if needed. For positive reaction of TB skin test measuring greater than .15mm will be treated as positive. If a person served has a reaction to a TB test they will be referred to their primary care provider. They will determine if it is .10mm or above. At this time a Chest x-ray will be completed. If the CXR is questionable then a Quantum Gold Test for TB may be completed , this is a more accurate measurement of testing for determining if they have TB and need treatment. If the test is negative then the person served would be required to complete the TB questionnaire annually. If there are indicators that the person served is symptomatic then a Quantum Gold test would be completed. No further CXR are indicated unless specifically requested by the Physician.
6. Documentation will need to be obtained from physician and placed in persons served case file regarding present TB status.
7. TB Status:
Positive Reaction
This person has a history of a positive TB skin test, but has proven negative to the actual disease. These people will need to be evaluated for TB signs and symptoms at their annual physical by their physician. They will need to have written documentation of present TB status that will be kept in their case file.
Convertor
A positive skin test with a past negative test. The physician will need to provide documentation of current TB status. Drug therapy may be initiated if prescribed by the doctor. If drug therapy is prescribed, documentation that meds are being taken must be kept in the person served case file.
Positive Diagnostic Findings
The person served with TB infectious stage will be restricted from work and the residential site. Drug therapy will be initiated as ordered by the physician. Three weeks following the initiation of drug therapy, the persons served may return to work and the residential site with doctor’s permission. Documentation of proof of treatment will be kept in the persons served case file.
RESPIRATORY INFECTIONS
This includes all infections involving the respiratory tract including the lungs which may cause pneumonia.
1. Obvious runny nose, cough producing droplet sprays are considered contagious.
2. Flu shots will be offered to all employees of P.I. on a yearly basis.
3. Flu shots for person served will be done at their local doctor’s office or Flu Shot Clinics in the community.
4. Control Guidelines:
a. If febrile temperature is over 100.5, the persons should avoid contact with others.
b. See doctor if cold symptoms progress into a high fever or does not go away in 10-14 days.
c. Good health practices are important to good health (proper rest, diet, exercise, and decreasing stress) increase the resistance to respiratory infections.
d. Frequent hand washing to decrease spread of respiratory infections.
RUBELLA
This is a contagious viral disease resulting in a rash, fever, enlarged lymph glands, and respiratory symptoms. Complications may cause joint and arthritic pains. Rubella is spread via airborne droplets.
1. Rubella’s course is approximately 7-10 days.
2. Avoid pregnant women
3. Control Guidelines:
a. Bed rest - isolate to bedroom.
b. Encourage proper nutrition especially fluids
c. Monitor condition and follow directions from the doctor
STAPHYLOCOCCAL INFECTIONS:
This is the bacteria which may develop from any contaminated object, infecting an open area on the skin causing purulent drainage.
1. All purulent drainage from skin lesions is considered infectious.
2. Direct contact with the drainage is the mode of transmission.
3. Control guidelines:
a. All persons with open areas will keep those areas covered at all times until areas are scabbed over.
b. Use Standard and Transmission Based Precautions when dealing with any open area.
c. Frequent hand washing to prevent spread of infections.
HEPATITIS A (Infectious Hepatitis)
This is a disease that is spread by the fecal-oral route where improper personal hygiene methods are used or by eating contaminated foods. Symptoms are: flu like symptoms (abdominal pain, nausea, vomiting and fever). Occasionally a person may have
1. Control Guidelines
a. Frequent hand washing to prevent spread of disease
b. Wash hands after each toileting
c. Hepatitis A immunization is available
MRSA - Methicillin Resistant Staphylococcus Aureus
Due to the widespread use of antibiotics, strains of Staphylococcus Aureus have developed which are unaffected by Methicillin type drugs. These strains are referred to as MRSA. MRSA is resistant to a wide variety of antibiotics.
1. Transmission is frequently spread from one person to another via hands on contact. MRSA is also spread via airborne transmission especially when a person has a lower respiratory infection and coughs with out covering mouth.
2. MRSA is seen in people in very poor health or in a person with open pressure sores or any type of internal catheters.
3. Treatment of MRSA infection is Penicillinase - resistant Penicillin and first and second generation cephalosporin, erythromycin and Clindamycin. Vancomycin is considered to be the antibiotic for treating severe MRSA infections. If vancomycin - resistant MRSA develops, there is no antibiotic therapy available to treat such an infection.
4. Control Guidelines
1. Treatment with proper prescribed antibiotics
2. Avoid over use of antibiotics to prevent resistance from developing
3. Hand washing is the most important measure for controlling the spread of MRSA.
Vancomycin Resistant Enterococci
VRE, caused by strep infections and usually seen in the urinary tract, surgical sites or blood stream, is due to the widespread over use of antibiotics. There is a higher risk of patients to be diagnosed with VRE in those that are critically ill or those with severe underlying diseases, or those with long-term internal type catheters.
1. Education of staff regarding the problem of VRE (over use of antibiotics).
2. Proper infection control measures to prevent transmission from person to person.
3. Avoid over use of vancomycin
4. Those people diagnosed with VRE need to be kept isolated from others. Keep all contaminated items in the person’s room to prevent contamination to other areas.
HEPATITIS C VIRUS
The Hepatitis C virus (HVC) can also cause inflammation of the liver which leads to chronic liver disease and death. It is less common than (HBV) Hepatitis B virus and its signs and symptoms are similar to HBV. Currently, there is no vaccine to prevent HCB infection; but, with prompt and proper treatment, most cases can be treated successfully.
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