Contact health care workers

People who can transmit flu to others at high risk for complications. Any person in close contact with someone in a high-risk group should get vaccinated. This includes all health care workers, household contacts, and out-of-home caregivers of children 0 to 23 months of age and adults 65 years of age and older. 

Infection is spread person to person, usually via the fecal-oral route by animals, particularly cattle and sheep and through the environment, especially water. People at increased risk of contracting cryptosporidiosis include household and family contacts and sexual partners of someone with the disease, health care workers, day-are workers, users of public swimming areas, and people traveling to regions of high endemicity.3... 

Most health care workers are at risk for exposure to many diseases in the normal course of their work. Additionally, health care workers may transmit vaccine-preventable diseases to their patients. At the time of employment and on a regular basis, health care workers should be screened for immunity to measles, rubella, and varicella if found to be non-immune, the measles, mumps, and rubella, and varicella vaccines should be administered. The hepatitis B series should be given if not already completed. Tetanus should be updated and given every 10 years. Health care personnel in hospitals and ambulatory settings with direct patient contact should receive Tdap if not already received an interval as short as 2 years from the last tetanus-containing vaccine should be used. Priority for receiving Tdap should be given to personnel with direct contact with infants less than 12 months of age. 

Influenza vaccine is recommended annually for children aged >59 months with certain risk factors, health-care workers, and other persons (including household members) in dose contact with persons in groups at high risk. SeeMW/ 2006 55(No. RR-10) 1-41. 

Yes. Vaccinia vaccine is recommended for laboratory workers who directly handle cultures, animals contaminated or infected with, nonhighly attenuated vaccinia virus, recombinant vaccinia viruses derived from nonhighly attenuated vaccinia strains, or other orthopoxviruses that infect humans. These would include monkeypox, cowpox, vaccinia, and variola. Other health-care workers, such as physicians and nurses whose contact with nonhighly attenuated vaccinia viruses is limited to contaminated materials such as medical dressings but who adhere to appropriate infection control measures, are at lower risk for accidental infection than laboratory workers. However, because a theoretical risk for infection exists, vaccination can be offered to this group. Vaccination is not recommended for people who do not directly handle nonhighly attenuated virus cultures or materials or who do not work with animals contaminated or infected with these viruses. 

The upsurge of latex allergy is traced back to a GDC report published on August 21, 1987 that came to be known as universal precautions. It emphasized the need for all health care workers to routinely use appropriate barrier precautions, such as gloves, when contacting body fluids. New and inexperienced glove manufacturers entered the glove market and produced poorly compounded. 

Health care workers who are pregnant should consider avoiding direct care of patients receiving aerosolized ribavirin. If close patient contact cannot be avoided, take precautions to limit exposure. 

In addition to oral administration for hepatitis C infection in combination with interferon alfa, aerosolized ribavirin is administered by nebulizer (20 mg/mL for 12-18 hours per day) to children and infants with severe respiratory syncytial virus (RSV) bronchiolitis or pneumonia to reduce the severity and duration of illness. Aerosolized ribavirin has also been used to treat influenza A and infections but has not gained widespread use. Systemic absorption is low (< 1%). Aerosolized ribavirin is generally well tolerated but may cause conjunctival or bronchial irritation. Health care workers should be protected against extended inhalation exposure. The aerosolized drug may precipitate on contact lenses. 

Health care workers and others in contact with high-risk groups... 

Latex surgical gloves cause severe allergies for some people, especially health-care workers who must wear gloves for most of theirworking day. Latex gloves also deteriorate overtime or in contact with oil-based creams and ointments. 

Health care workers who come in contact with patients in whom anthrax is suspected should use universal precautions at all times, including the use of rubber gloves, disposal of sharps, and frequent hand washing. No human-to-human transmission of anthrax has been reported and respiratory isolation precautions are not needed. Patients with inhalational or cutaneous anthrax should be placed on contact isolation, due to the potential for contact with open wounds or wound drainage. 

Postexposure prophylaxis is not recommended for contacts of patients infected with B. anthracis, or for health care workers who may treat anthrax patients. It is also not recommended for the prophylaxis of cutaneous anthrax. It is currently only indicated for persons who may have been exposed to airspace contaminated with aerosolized B. anthracis (Bell, Kozarsky, Stephens, 2002). The duration of therapy is generally determined to be 60 days of either ciprofloxacin or doxy-cycline, with amoxicillin as an option for children and pregnant or lactating women. The U.S. Department of Health and Human Services has recently announced additional options for prophylaxis of inhalational anthrax, especially for those in whom inhalational exposure may have been significant. These options include 60 or 100 days of prophylaxis, as well as 100 days of prophylaxis plus anthrax vaccine as an investigational agent (GDG, 2001a Nass, 2002). 

Disaster events may create a sudden influx of patients who have been exposed to a chemical, radiation, or other hazard that requires decontamination. Protecting nurses and other health care workers who respond to chemical or hazardous materials (HAZMAT) mass casualty incidents is critical. Patient decontamination is an organized method of removing residual contaminants from the victim s skin and clothing and should be performed whenever known or suspected contamination has occurred with a hazardous substance through contact with either aerosols, solids, or liquids. The degree of decontamination performed will... 

Aldehydes such as formaldehyde, glyoxal, and glutaral (glutaraldehyde) are used as solutions and vapours for disinfection and sterilization. They are irritating and sensitizing and cause contact dermatitis in health-care workers (SEDA-21, 254). 

Smallpox spread slower than other viral rash illnesses like chickenpox and measles. When smallpox still occurred naturally, most people who became infected were close contacts of an index case, snch as household members, close friends and health care workers. Honsehold secondary attack rates were typically 50-60% (25). Larger ontbreaks in schools were nncommon. Two reasons for this are that that transmission did not occnr before rash onset and that the disease caused severe incapacitation. By the time of rash onset, victims were so ill that they did not attend school or go to other commnnity events where they might have exposed others. Secondary cases typically occnrred in hospital and household contacts. 

Although Section 304 satisfied some of the liability concerns, it failed to address health care worker worries about compensation for lost wages due to side effects of the vaccine (27). In addition. Section 304 did not address hospital and health care worker concerns about whether compensation would be adequate for victims of vaccine complications, including victims, such as household contacts, who were not vaccine recipients. Consequently, on April 30, 2003, the President signed a law to compensate health care workers or first responders injured by the preevent smallpox vaccination program. The law established a no-fault fund that had the following provisions (35) ... 

To protect patients and health care workers, it is essential to determine the responsible hazardous chemical as early in the decontamination process as possible. Based on previous experience with hazardous exposures, the National Institute of Occupational Safety and Health (NIOSH) and the Environmental Protection Agency (EPA) recommend level B protection as a minimal precaution (see Table 3.1) before the offending substance is identified (11). However, if available evidence suggests that the substance involves the skin as a route of exposure or is dangerous by dermal absorption or corrosion, health care workers and others coming in contact with victims require the additional skin protection of Level A PPE (9). 

General The foundation of all the measures of compliance will be that universal precautions will be followed. In August 1987, the CDC published a document entitled Recommendations for Prevention of HIV Transmission in Health Care Settings. This document introduced the concept of universal precautions which basically recommended that steps be taken to prevent exposure of health care workers to possibly contaminated blood, other body fluids, tissue from a human living or dead, HlV-containing cultures and other possibly contaminated items which might be found in the laboratory (see the first part of this section). The universal part of this concept comes from the assumption that all of these possible sources of infections are treated as if they were infected. This assumption extends to all personnel who may become infected by coming into contact with contaminated materials, from the physician or research scientist to the laundry employee. The plan must make a commitment to adopt this policy and enforce it... 

Since most systemic sensitizers are drugs, it would be unlikely that photosensitivity to systemic agents would occur in the workplace as a function of chemical exposure on the job. Of course, many patients with outdoor occupations would be liable for occupationally related reactions due to drugs they take for personal medical problems. Many of the systemic photosensitizers listed in Table 4 can cause photo-contact reactions in health-care workers who have topical exposure to these medications while delivering them to their patients and in farmers who administer drugs to animals. Therefore, the vast majority of occupationally related photosensitivity reactions are due to PACD and PICD. 

A number of systemic drugs that produce photosensitivity have been reported to cause PACD when contacted topically. Theoretically, this might occur with many such agents. The two most frequently reported are the phenothiozines, chlorpromazine hydrochloride (Thorazine) and promethazine (Phener-gan). The PACD reported for the former has been found in health-care workers who have frequent skin contact with the agents. 

Nethercott JR, Holness DL, Page E (1988) Occupational contact dermatitis due to glutaraldehyde in health care workers. Contact Dermatitis 18 93-197... 

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