Employee/Occupational Health
Domain 4 - Employee/Occupational Health
This domain tests the interface between infection prevention and employee health: pre-placement screening, immunizations, exposure management, and work restrictions.
Core rules
- Pre-placement: immunity documentation (MMR, varicella, hepatitis B, Tdap, influenza, COVID-19 per policy) and baseline TB test (two-step TST or IGRA).
- Bloodborne pathogen exposure: wash/flush the site, report immediately, test source and worker. HBV - if the worker is unvaccinated or a non-responder, give HBIG plus vaccine within 24 h (up to 7 days); HIV - start PEP as soon as possible, ideally within 2 h and no later than 72 h, for 28 days; HCV - no PEP, monitor RNA at 4–6 weeks and later.
- Work restrictions (examples): herpetic whitlow or zoster on the hands - exclude from patient contact until resolved; active conjunctivitis - no patient contact until discharge resolves; influenza-like illness - exclude until 24 h afebrile; susceptible worker exposed to measles or varicella - exclude days 5–21; chronic HBV, HCV, or HIV - no restriction on patient contact under standard precautions.
- Annual respirator fit testing and training; sharps injury prevention programs with rate tracking.
Worked example
A nurse sustains a hollow-bore needlestick from an HIV/HBV/HCV-positive source. She completed hepatitis B vaccination with documented anti-HBs >10 mIU/mL. Reasoning: HBV PEP is not indicated because she is a documented responder; HIV PEP begins now, ideally within hours, with baseline testing and a 28-day regimen; HCV requires baseline and follow-up RNA testing, not prophylaxis.
Traps
Delaying HIV PEP while awaiting source results; giving HBV vaccine alone to an unvaccinated exposed worker (HBIG is also required); restricting HBV- or HCV-positive staff from patient care; forgetting source-patient testing and consent procedures.