Management Of Healthcare Personnel Research Articles

CDC issues guidance on exposure to HCV for health professionals

In late July, CDC released guidance on the testing and clinical management of health care personnel potentially exposed to hepatitis C virus (HCV). The agency noted that the incidence of acute HCV infections among patients is increasing in the United States as a result of risky behaviors such as injection drug use, placing providers at risk for HCV infections if exposed to the blood and other bodily fluids of infected patients. “Testing for occupational exposure for blood- or fluid-borne pathogens is standard practice for many years,” said Rima A. Mohammad, PharmD, FCCP, BCPS, clinical pharmacist specialist in general surgery/gastroenterology/nutrition at the University of Michigan. “This guideline outlines the steps to take specific to HCV occupational exposure, which is similar to any exposure to other blood- or fluid-borne pathogens. Baseline testing of the source patient and the health care provider should occur immediately, preferably within 48 hours of exposure. CDC notes that the source patient should be tested for HCV RNA using a nucleic acid test. However, for low-risk patients, screening for anti-HCV serology (i.e., antibodies) can be done as an alternative, followed by a nucleic acid test if the serology is positive. For providers, testing should include anti-HCV testing, and if positive, HCV RNA testing. If the HCV RNA is positive at baseline, then the provider is considered to have a preexisting HCV infection and should be referred for HCV treatment. If a patient is anti-HCV positive but HCV RNA negative, then follow-up testing for the provider is not required. However, if the patient is HCV RNA positive or if the RNA status of the patient is unknown, then the provider should have follow-up HCV RNA testing 3 to 6 weeks postexposure and a final anti-HCV test 4 to 6 months postexposure as there may be periods of aviremia during acute HCV infection. Postexposure prophylaxis for HCV is not recommended for health care providers who have occupational exposure to blood or other bodily fluids. It is estimated that only 0.2% of percutaneous exposures and 0% of mucocutaneous exposures result in HCV transmission. CDC recommends that curative antiviral regimens be reserved for treatment if confirmed HCV transmission occurs. “Compared to previous HCV treatments, HCV is much easier to treat with the newer therapies that are a shorter duration, [are] well tolerated, and have efficacy rates of more than 95% for a cure or sustained virologic response,” said Mohammad. “Therefore, we can delay HCV treatment until we confirm that the health care provider is positive for HCV. The key difference between hepatitis B virus (HBV) and HCV occupational exposure is that postexposure prophylaxis is recommended after HBV exposure in select situations. “Unfortunately, with other viruses, such as HBV, there is no ‘cure’ for the infection and health care providers may need to be on long-term treatment,” said Mohammad. “Therefore, it is important to treat providers with postexposure prophylaxis (if appropriate) as soon as we confirm that the patient has an HBV infection. Routine use of the HBV vaccination for health care providers, combined with standard precautions, has resulted in a 98% decline in HBV infections over the past 2 decades, according to CDC. For those who are exposed to HBV, CDC has specific recommendations based on the vaccination status of the provider, the anti-HBs levels of the provider (i.e., < or ≥10 mIU/mL), and the status of the source patient. Postexposure recommendations vary based on these factors, but administration of HBIG and the hepatitis B vaccines are listed as options. The HCV and HBV postexposure guidance documents are available on CDC's website. The new HCV information can be used to update procedures for postexposure testing and clinical management of providers potentially exposed to the virus.

Lessons from healthcare personnel screening and management during H1N1 pandemic in preparation for the impending COVID-19 pandemic in a tertiary care hospital in India

BackgroundIn the wake of the COVID-19 pandemic caused by a novel corona virus, health care personnel are at increased risk of acquiring the infection. In preparation for the management of health care personnel that are likely to be infected, we looked in to the data collected during the Influenza pandemic in 2009, caused by a novel strain of H1N1 influenza called swine flu. The care of healthcare personnel in our institution, who had an acute febrile respiratory illness (AFRI) during that period was routed through a single channel using a uniform protocol. We retrospectively analysed the available data, during the initial four months of the pandemic, to draw lessons from it. ObjectiveTo study the prevalence, clinical profile and risk factors of swine flu among health care personnel during the pandemic of 2009 in a tertiary care hospital in South India. MethodologyThis retrospective study enrolled all the health care personnel including students of a tertiary care institution in South India, who presented with an AFRI between June to August, the initial four months of the swine flu pandemic of 2009. The clinical profile and risk factors were extracted. The results of the RT PCR for swine flu was obtained. Prevalence in each demographic group was calculated and compared. Characteristics of those with swine flu were compared with those who turned negative for the swine flu. ResultsThe prevalence of all AFRI and only swine flu among health care personnel during the study period was 18 per thousand and 8.7 per thousand respectively. Highest prevalence of swine flu was found among students and office staff. After adjusting for confounding factors, hyperthermia at presentation was significantly higher {OR = 1.97; 95% CI (1.01–3.76)} among those who tested positive for swine flu as compared with those with other AFRI's. Only 2.5% of the entire AFRI group required admission and there was no mortality. ConclusionHealth care personnel are at increased risk of acquiring infection. Our study demonstrated that students and office staff were the most susceptible. Unprotected exposure to unknown infectious patients and relatives is likely to have been an important factor. Though the mode of transmission is similar, compared to H1N1, COVID-19 is associated with different comorbidities and has significantly higher mortality. Therefore, in preparation for the COVID-19 pandemic, the personal protective equipment of the healthcare personnel need to be escalated.

Recomendaciones clínicas para la evaluación y manejo de riesgo de COVID-19 en personal de salud del Seguro Social del Perú (EsSalud)

Actualmente estamos viviendo una pandemia de enfermedad causada por coronavirus (COVID-19). Un grupo vulnerable de ser infectado por este agente patógeno es el personal de salud. Por ello, el Instituto de Evaluación de Tecnologías en Salud e Investigación (IETSI) del Seguro Social del Perú (EsSalud) ha emitido recomendaciones clínicas sobre la Evaluación de riesgo y manejo de personal de salud en el contexto de la pandemia de COVID-19, que resumiremos en el presente artículo. Se incluye un flujograma de evaluación y manejo, así como una tabla para determinar el riesgo de presentar infección por COVID-19.

Updated Recommendations for the Management of Health Care Personnel Occupationally Exposed to Human Immunodeficiency Virus

The U.S. Public Health Service has released new recommendations for the management of health care personnel who experience occupational exposures to blood or other body fluids that might contain human immunodeficiency virus.

Updated Recommendations for the Management of Health Care Personnel Occupationally Exposed to Human Immunodeficiency Virus

The U.S. Public Health Service has released new recommendations for the management of health care personnel who experience occupational exposures to blood or other body fluids that might contain human immunodeficiency virus.

Task Overlap Among Primary Care Team Members: An Opportunity for System Redesign?

This article presents the results of research on a systematic approach to the assignment of primary care work in the Veterans Health Administration. Based on a functional job analysis protocol, the study identified overlap in the performance of primary care tasks among multiple occupational groups as prima facie evidence of opportunities to reallocate work responsibilities. Results show that registered nurses, physicians, advanced practitioners, and licensed vocational nurses reported performing 60 percent to 97 percent of the same tasks, while clerks and health technicians appeared to be underutilized. The frequency and duration with which occupational groups performed each task were also examined, providing additional evidence to be used in improving clinic efficiency. The management of healthcare personnel can be improved through systematic analysis of the work, the worker, and the work organization and through more informed decisions about the appropriateness of task assignment (or reassignment). This article presents an evidence-based approach to personnel management with important implications for clinic efficiency. The approach can be used to guide strategic planning and staffing decisions by identifying not only who currently does the work but, more importantly, who should be doing the work given the full array of data.