Section: UTMB On-line Documentation Subject: Healthcare Epidemiology Policies and Procedures Topic: Employee Health Center: Communicable Disease Control

1.9 - Policy 06.29.09 - Revised 1980 - Author

1.9 Employee Health Center: Communicable Disease Control

Purpose	The Employee Health Center (EHC) will provide preventive and healthcare services to UTMB employees for occupationally-related diseases and injuries. The EHC will interact closely with the Department of Healthcare Epidemiology (HCE) to decrease the risk for acquisition of communicable diseases by UTMB employees.
Audience	All employees of UTMB hospitals and clinics
Responsibility of EHC	• Assures up-to-date health records for every employee. • Provides vaccination, prophylaxis and PPD skin testing for at-risk employees. • Reports any job-related infection to the Department of Healthcare Epidemiology. • Reports infection hazards to the appropriate department. • Assures that communicable diseases in employees are reported to the Department of Healthcare Epidemiology and to the local Health Department. • Assures the adequacy of policies through regular review and revision. • Maintains a database of employees required to have a PPD skin test. Reports PPD conversions by employee service and employee location to HCE on a routine basis. Reports on employee compliance with required PPD skin tests will also be provided to HCE.
Responsibility of HCE	• Will identify employees who are required to have PPD skin tests and the frequency of these tests. • Will review data regarding PPD skin test conversions for employees and take appropriate corrective action as necessary. • Will review data regarding employee compliance with PPD skin testing, and work with hospital management to increase compliance if necessary. • Will investigate job-related infections and exposures to communicable diseases. • Will advise appropriate action, including prophylaxis, after exposure of employees to communicable diseases. • Develop policies as needed.
Responsibility of UTMB Management	• Supports the Employee Health Program. • Encourages employee participation in programs by allowing employees to be seen in the EHC during working hours. • Communicates information regarding programs and advocates participation (i.e. influenza vaccination, Varicella vaccination, pertussis vaccination (Tdap) and TB skin testing).
Screening	Each new employee shall register with the EHC and complete a screening survey related to communicable diseases. An immunization history will be taken from the new employee. When the employee has no previous history of having received immunizations required by the institution, they will be offered and documented at that time.
Tuberculosis Screening	• Specified healthcare workers shall have a 2-step tuberculin skin test applied at the time of employment. [see HR/EHC database] • Employees who are initially skin test positive at the time of employment, or who subsequently convert their skin test, should be counseled regarding signs and symptoms of tuberculosis such as cough, fever, night sweats, and weight loss and instructed to report promptly to the EHC if such symptoms develop. • Tuberculosis screening shall be repeated annually for employees who have direct patient care. • Employees of the UTMB Community Based Clinics (CBC) will be allowed to have their PPD skin tests placed at their work site instead of the PPD skin test being placed at the Employee Health Clinic. One employee of each CBC clinic will be trained by the employee health clinic to place and read skin tests. All results of the tests will be sent to the Employee Health Clinic and documented in the employees chart. • PPD skin testing will be available for all employees even if they are not required to have skin tests. • Employees who have a documented positive skin test will not receive further skin testing. Employees will be counseled regarding signs and symptoms of tuberculosis. Routine chest x-rays are not necessary. • After exposure to tuberculosis, employees who have no previously documented positive skin test should be tested immediately after exposure. If the skin test done immediately postexposure is negative, it will be repeated in three months. A chest x-ray should be done on all new converters. All converters will be counseled and offered management through the EHC. • In cases of multiple exposures, employees should not be skin tested more than four times in one year. Individual cases shall be referred to the EHC physician.
Employees with Exudative Lesions or Weeping Dermatitis	These employees must refrain from all direct patient care and from handling patient care equipment until the condition resolves. Evaluation of such employees will be conducted by the EHC.
Pregnant Healthcare Workers	Pregnant healthcare workers are not at greater risk of contracting infectious diseases than are other healthcare workers who are not pregnant; however, if a healthcare worker develops an infection such as HIV, Varicella, Hepatitis B, CMV, or Rubella during pregnancy, the infant may be at risk of becoming infected. Because of this risk, pregnant healthcare workers should be especially familiar with and strictly adhere to precautions to minimize the risk of transmission of infectious diseases. Work reassignment is generally not necessary. Pregnant women should not work with patients who have Varicella infection without serologically documented immunity to Varicella Zoster virus. Pregnant healthcare workers who have questions regarding exposure in the hospital should contact HCE.
Hepatitis A Exposures	Direct contacts (parenteral or enteral) of patients with Hepatitis A should be given gamma globulin IM 0.02 ml/kg as soon as possible after exposure.
Hepatitis B Exposures	See Policy: 1.2 Bloodborne Pathogens (BBP) – Occupational Post-Exposure Prophylaxis.
Meningococcal Disease	• Any individual who has been within < three feet of a patient with meningococcal disease while not wearing a surgical mask is a candidate for prophylaxis. “Intimate” contact with a patient defined as extremely close exposure to the patient’s respiratory secretions (i.e. mouth-to-mouth resuscitation) is an even stronger indication for prophylaxis. • The EHC, as well as HCE, should be notified immediately of possible exposure to meningococcal infection so that prophylaxis may be initiated as soon as possible if it is determined by HCE that exposure has occurred. • The following regimens are recommended for chemoprophylaxis and should be given as soon as possible after exposure (within 24-48 hours): Children: Rifampin … <1 month….5 mg/kg PO q 12h x 2 days ≥1 month…10 mg/kg PO q 12h x 2 days (600 mg maximum) Adult: Ciprofloxacin ……………….…..500 mg PO x 1 Pregnant women: Ceftriaxone …......<15 years…… 125mg IM x 1 ≥15 years…… 250mg IM x 1 • Persons receiving chemoprophylaxis for exposure should be cautioned to seek immediate medical attention if fever, headache or stiff neck or any other signs or symptoms consistent with meningococcal disease develop.
Syphilis Exposure	• Any employee, who has had direct contact (due to cuts or other breaks in his/her skin) with skin or mucous membrane lesions or the blood of a patient who has primary or secondary syphilis, should have a VDRL drawn and be given the following prophylaxis: 2.4 million units of benzathine penicillin G (Bicillin) IM. • Employees who are penicillin sensitive should be treated with either tetracycline, 500 mg, po qid for 15 days or Azithromycin 2.0g po x1. (Pregnant women should not receive tetracycline.)
Varicella Exposure	See policy: Varicella-Zoster Virus Infection Control Program.
Pertussis Exposure	• Any individual who has been within < three feet of a patient with pertussis while not wearing a surgical mask is a candidate for prophylaxis. “Intimate” contact with a patient defined as extremely close exposure to the patient’s respiratory secretions (i.e. mouth-to-mouth resuscitation) is a stronger indication for prophylaxis. • The EHC, as well as HCE, should be notified immediately of possible exposure so that prophylaxis may be initiated as soon as possible if it is determined by HCE that exposure has occurred. • The following treatment regimen is recommended for chemoprophylaxis of adults and should be given as soon as possible after exposure (within 24-48 hours): Adult: Azithromycin (Zithromax – Z-pac): 500mg day 1; 250 mg per day for days 2-5 Allergy: Bactrim (TMP/SMX DS) 1 tab po BID x 14 days (Pregnant women should not receive Bactrim) Children: Azithromycin: < 1mo. – 5 mos. 10mg/kg per day as a single dose for 5 days > 6 mos. and children 10mg/kg as a single dose on day 1 (maximum 500mg); then 5mg/kg per day as a single dose on days 2-5 (maximum 250mg/day) Allergy: Bactrim (TMP/SMX): (Contraindicated at < 2 mos. of age) > 2 mos. of age – children: TMP, 8 mg/kg per day; SMX, 40 mg/kg per day in 2 doses for 14 days.