Employee and Occupational Health
Scope
Occupational health programs protect both staff and patients through pre-placement history and screening, immunization requirements, exposure management, work restrictions, and surveillance for TB and vaccine-preventable illness. Required vaccination typically includes MMR, varicella, hepatitis B (offered, with documented declination acceptable), Tdap, and annual influenza, with COVID-19 per current policy.
Exposure management
Needlestick: wash immediately, report, and evaluate the source and the worker. HIV post-exposure prophylaxis should begin within hours (ideally under two) and continue 28 days with a three-drug regimen; window periods mean a negative source test does not fully exclude infection. Hepatitis B: unvaccinated exposed staff receive HBIG plus the vaccine series; vaccinated staff with documented protective anti-HBs need nothing further. Hepatitis C has no prophylaxis but requires follow-up testing and treatment if seroconversion occurs. TB screening uses IGRA or two-step TST at baseline and after exposure; IGRA is unaffected by prior BCG vaccination.
Work restrictions
Exclude staff with active pulmonary TB, measles, and varicella (until all lesions are crusted) from patient contact; restrict herpes whitlow until lesions heal; restrict diarrheal illness until symptoms resolve and follow pathogen-specific clearance rules; exclude febrile respiratory illness until fever has resolved for 24 hours.
Traps
Items test the timing of prophylaxis, the definition of a TB conversion (an increase in induration of at least 10 mm), and the difference between an annual quantitative fit test and a user seal check performed at each donning.
Rule of thumb: Handle time-critical steps first - wash the site, report, draw source and worker serology, start post-exposure prophylaxis if indicated - then complete the investigation and documentation.