Occupational Health, Preventive Care, and Health Maintenance
Occupational and preventive care essentials
Occupational health questions focus on regulation, exposure management, and fitness for duty. Know OSHA’s Bloodborne Pathogens Standard: exposure control plan, hepatitis B vaccination offer, personal protective equipment, and post-exposure evaluation. Needlestick management: wash the site with soap and water, do not squeeze or apply caustic agents, report immediately, test source and exposed worker, and initiate HIV post-exposure prophylaxis as soon as possible, ideally within hours and no later than 72 hours, for 28 days when indicated. Hepatitis B and C and tetanus status guide additional prophylaxis.
Understand workers’ compensation basics, return-to-work restrictions, DOT medical examiner responsibilities, respirator fit testing, TB screening, and hearing conservation. Preventive care: USPSTF-based screening intervals for hypertension, lipids, colorectal cancer, cervical cancer, breast cancer, lung cancer, hepatitis C, HIV, and diabetes; adult immunization schedules; and travel medicine. Document occupational exposures and maintain confidentiality.
Traps: delaying PEP to wait for source results; assuming a needlestick from an unknown source is low risk; recording a needlestick incorrectly on OSHA logs; missing vaccine contraindications; and applying general screening intervals to high-risk patients.
Worked example: a nurse sustains a hollow-bore needlestick from a patient with unknown HIV status. Wash, report, draw baseline labs, and start HIV PEP within hours while source testing proceeds; do not wait for the result. Rule of thumb: in occupational exposure, the clock starts at the moment of injury, not at the moment of diagnosis.