Domain 4: Employee/Occupational Health
Employee/Occupational Health tests pre-placement assessment, immunization, exposure management, work restrictions, and regulatory requirements for healthcare personnel. The exam favors practical decisions that protect workers and patients.
Core rules and concepts
- OSHA Bloodborne Pathogens Standard (29 CFR 1910.1030) requires an exposure control plan, hepatitis B vaccination within 10 working days of assignment, PPE, and post-exposure evaluation; the Respiratory Protection Standard requires medical evaluation, fit testing, and training.
- Document immunity to measles, mumps, rubella, varicella, and hepatitis B; use TST or IGRA for TB screening based on risk.
- HIV post-exposure prophylaxis should start as soon as possible, ideally within hours and no later than 72 hours; hepatitis C has no PEP, so baseline and follow-up RNA testing are used.
- Work restrictions depend on transmission route, immune status, and duties; confidentiality of worker health information is required.
Worked example
A nurse sustains a needlestick from a patient with known hepatitis C. The reasoning is: wash the site, report immediately, test the source for HCV RNA and the nurse for baseline HCV antibody/RNA, and provide counseling. No HCV prophylaxis exists; follow-up RNA at the recommended intervals detects seroconversion. Starting HIV PEP would be irrelevant unless the source also had HIV risk.
Traps
Waiting for source results before starting HIV PEP, assuming hepatitis B vaccination guarantees immunity, recording only exposures that seroconvert, and sharing worker health details with managers without need-to-know are costly errors.