Human health care workers

National Institute for Occupational Safety and Health. Protect Yourself against Tuberculosis A Respiratory Protection Guide for Health Care Workers. Washington, DC U.S. Department of Health and Human Services, 19.95. 

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. 

Injected forms of antibodies which have been generated in another body or animal can be isolated, purified, and administered as standard human immune serum globulin (ISG), and ISG plus preparation, or as an animal antiserum or antitoxin. Some serums which are available are those for rabies, snake and insect bites, botulism, and tetanus. Temporary immunity of up to six months to hepatitis can be imparted by one "gamma globulin" shot. More permanent active immunity is available to health care workers. 

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). 

Ippolito, G. Puro, V. De Carli, G. The Italian study group on occupational risk of HIV infection. The risk of occupational human immunodeficiency vims infection in health care workers. Arch. Intern. Med. 1993, 153, 1451-1458. 

Centers for Disease Control Cooperative Needlestick Surveillance Group. Surveillance of health care workers exposed to blood from patients infected with human immunodeficiency vims. N. Engl. J. Med. 1988, 319, 1118-1123. 

Nerad JL, Kessler HA. Hypercholesterolemia in a health care worker receiving th3(roxme after postexposure prophylaxis for human immunodeficiency virus infection. Clin InfectDis (2001)... 

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... 

Each day health care workers are exposed to many types of hazards. The main ones are shown in Figure 7.2 [8]. These are infectious hazards, physical hazards, environmental hazards, chemical hazards, and psychosocial/psy-chological hazards (i.e., emotional stress). Infectious hazards are basically concerned with various types of infections. Health care workers are exposed routinely to many types of infectious hazards, particularly blood-borne pathogens. Over the past few decades, blood-borne pathogens have received increasing attention because of the focus on the human immunodeficiency virus (HIV), which can resulf in acquired immune deficiency S5mdrome (AIDS) [8]. 

While we acknowledge the imperfections of human beings, we can proactively support the monitoring of competence as well as early intervention for professionals at risk, thus saving professionals and patients from injirry. Gawande (2002) believes that physicians mirror the general population in terms of their own impairment due to substance abuse, psychological or physical illness, age-related declines in competence, and personality problems as expressed in reckless, disruptive, or abusive behavior toward other health care workers or toward patients. 

CDC (1987) Update human immunodeficiency virus infections in health-care workers exposed to blood of infected patients. MMWR 36 285-289... 

Bernard L, Steinbrook R (1992) Health care workers infected with the human immunodeficiency virus. JAMA 267 1100-1105... 

Gerberding, J.L., C.E. Bryant-LeBlanc, K. Nelson, A.R. Moss, D. Osmond, H.F. Chambers, J.R. Carlson, W.L. Drew, J.A. Levy, and M.A. Sande. 1987. Risk of transmitting the human immunodeficiency virus, cytomegalovirus, and hepatitis B virus to health care workers exposed to patients with AIDS and AIDS-related conditions./. Infect. Dis. 156 1-8. 

Intravenous drug users using unsterilized needles Workers involved with non-human primates Food service handlers Patients with clotting factor disorders Individuals residing in health care institutions Hepatitis B and Hepatitis D Men having sex with other men Individuals with multiple heterosexual partners Intravenous drug users using unsterilized needles Recipients of blood products... 

There is little doubt that the identification and control of hazardous chemicals is necessary to protect human health and the environment. An assessment of the occupational health benefits of REACH estimates that improved chemical risk assessment and risk management can reduce compensation for worker-related illness by between 18 and 54 billion over a 30-year period [190]. The long-term benefits of improved environmental protection resulting from the identification of hazardous chemicals under REACH (e.g., avoided costs for carrying out environmental remediation) can readily result in savings of hundreds of million Euro per substance [190]. Based on World Bank estimates that chemicals and chemical pollution causes between 0.6% and 2.5% of diseases in developed countries, the European Commission calculated a saving of 50 billion on health and medical care within the EU over 30 years could result if REACH can reduce the occurrence of disease by 0.1% [282]. 

Human health biomonitoring using biomarkers and chemical analyses are used in the following applications (1) Health surveillance of persons who are known to have high occupational or environmental exposures to potentially toxic chemicals. This may include those who work with chemicals, radioactive materials, or biohazards as part of their occupation. Examples include factory workers, chemical industry employees, farmers, health care professionals, nuclear plant employees, and veterans of the Gulf War I. This may also consist of those who are involuntarily exposed to such hazards in their everyday surroundings. Some examples are people living near land fills, factories, hazardous waste sites, or environmental catastrophes such as the Chernobyl... 

National Institute for Occupational Safety and Health. Guidelines for Prevention of Transmission of Human Immunodeficiency Virus and Hepatitis B Virus of Health-Care and Pubhc Safety Workers. DHSS (NIOSH) Pubhcation No. 89-107. Washington DC ... 

As interest of herbal products continues to grow, so do reports of fraudulent health-care claims. Consumers want so much to find a cure for what ails them or improve their well being that they may be taken in by magazine ads and TV infomercials. The FDA describes health fraud as articles of unproven effectiveness that are promoted to improve health, well being, or appearance, and these articles can be drugs, devices, foods, or cosmetics for human or animal use (Kurtzweil, 1999, p. 22). Social workers need to help clients be objective consumers. According to Kurtz-... 

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