Healthcare Workers’ Risks and Handling Exposures

Catherine T. Yu, MD
• Graduate of University of Santo Tomas
• IM residency and ID fellowship, SLMC-QC
• Fellow of the PCP and PSMID
• Training officer, Infectious Disease Fellowship
Program, SLMC-QC
• Member of the Residency Training Committee,
Department of Internal Medicine, SLMC-QC
• Active consultant, SLMC-QC

American College of Occupational and
Environmental Medicine
Centers for Disease Control and Prevention
Morbidity and Mortality Weekly Reports
Advisory Committee on Immunization Practices
Philippine HIV/AIDS Registry of DOH

Healthcare Workers’ Risks and
Handling Exposures

Objectives
• To give an overview of the common infectious hazards
for workers in the healthcare setting
• To discuss how occupational exposures are handled
and managed
• To discuss the important preventive strategies to
avoid transmission of these occupational infections
• To gain knowledge on the importance of vaccination
of healthcare personnel

Occupational Exposure
• A reasonably anticipated skin, eye, mucous
membrane, or parenteral contact with blood or other
potentially infectious materials that may result from
the performance of an employee’s duties

HCW
Other
Air Blood
Lab-
acquired

Potentially High risk group of Healthcare Workers for
Acquiring Blood-borne Transmissible Pathogens
• Laboratory personnel:
- Phlebotomist
- Virology laboratory personnel
• Surgery personnel
- Surgeons (cardiothoracic, gynecologic, abdomen,
orthopedic)
- Surgical ward personnel
• Others:
dentist
public health attendants
U.S. Public Health Service Guideline 2001
Occupational Risk for HIV,HCV,HBV

Infectious Agents Potentially Transmissible by Blood
• Viruses •Parasites •Spirochetes •Bacteria
Hepatitis A Malaria Syphilis Yersinia enterocolitica
Hepatitis B Babesiosis Relapsing fever P fluorescens
Hepatitis C E. coli
Cytomegalovirus Serratia marcescens
HIV-1 Brucella spp
HIV-2 Coagulase (-) staph
HTLV type1/2
Parvovirus
Mandell et al, Principles and Practice of Infectious Disease
8th ed. 2616-2632

Modes Of Bloodborne Pathogen Transmission
• Percutaneous or mucosal exposure to blood and body fluids
• Direct inoculation of virus into cutaneous scratches, skin lesions,
abrasions or burns
• Inoculation of virus onto mucosal surfaces of the eyes, nose or
mouth through accidental splashes
• Airborne transmission DO NOT occur
Beltrami EM, Williams IT, et al. Risk and Management of Blood-borne Infections
in Health Care Workers. Clin Microbiol Rev July 2000;13(3): 385-407

• Post exposure Management
of HBV, HIV and HCV

Elements of Postexposure Management
• Wound management
• Exposure reporting
• Assessment of infection risk
– Type and severity of exposure
– Bloodborne infection status of the source person
• Appropriate treatment
– When to give
– What to give
• Follow-up and counseling

Benefits
• If administered immediately and properly, it can
reduce the risk of HIV by 79% and HBV by 75%
• For HCV, it is largely ineffective but a postexposure
management guide will help in early detection of
infection
2009 Post Exposure Management (PEM) for HIV, Hepatitis B and C in
Healthcare settingsNational AIDS and STI Prevention and Control
Programme, Department of Health in Partnership with WHO

If an exposure occurs:
• Wash with soap and water
– No evidence of benefit with “milking” or application of
antiseptics or disinfectants
– Avoid using bleach or other agents
• Report incident
• Document incident
• Seek “immediate” medical evaluation
– Prompt medical evaluation
– Time limits on effectiveness of prophylactic measures
vary depending on the infection of concern

Concentration of HBV
in Body Fluids

The Risk of HBV Transmission
Pruss Ustun A. Am J Ind Med 2005; 48: 482-90.
Six to 30% risk of transmitting to susceptible
HCWs
Hepatitis B is 50 to 100x more infectious than HIV
and 10x more infectious than HCV
Less than 20% of HCWs in some regions have
received all three doses needed for immunity
Hepatitis B is 95% preventable with immunization

• HBV risk varies depending on the e-antigen status
of source person
• if e-Ag positive, risk is up to 30%
• if e-Ag negative, risk is 1-6%

HBV Postexposure Prophylaxis
• Determine if the exposure source is HB positive
• If possible, determine anti-HBs of a completely
vaccinated HCW
GENERAL GUIDELINES:

HBV Postexposure Prophylaxis
VACCINATION/ANTIBODY
RESPONSE OF HCP
Treatment
SOURCE IS HBsAg
POSITIVE
SOURCE IS
HBsAg
NEGATIVE
SOURCE
UNKNOWN OR
NOT AVAILABLE
FOR TESTING
Vaccinated: Responder
( adequate antiHBs >10
mIU/ml)
NO PEP NO PEP NO PEP
Vaccinated:
Non-responder
HBIG (0.06 ml/kg IM
route) x 1 plus
revaccinate OR HBIG x 2
(at time of exposure and
1 month after exposure
NO PEP If known high
risk, treat as
HBsAg positive
Unvaccinated HBIG (0.06 ml/kg IM
route) x 1 plus vaccine
Vaccinate Vaccinate

1
Figure 3. Number of HIV Cases Reported in the Philippines by Year, January 1984 to December 2015 (N=30,356)
Reported modes of transmission (MOT) were sexual contact (632),
mother-to-child transmission (1), and needle sharing among injecting
drug users (IDU) [17] Eighty-eight percent of the sexually
transmitted cases were among males who have sex with males
(MSMa
).
a
male-male sex and sex with both males & females
2013 380 339 370 388 415 431 449 382 427 491 384 358
2014 448 486 498 393 495 494 585 509 565 537 492 509
2015 536 646 667 560 748 772 682 598 692 651 627 650
'84 '85 '86 '87 '88 '89 '90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09 '10 '11 '12 '13 '14 '15
TOTAL 2 10 29 38 32 39 66 85 72 102 118 116 154 117 189 158 123 174 184 193 199 210 309 342 528 835 1,591 2,349 3,338 4,814 6,011 7,829
Aymptomatic 0 6 18 25 21 29 48 68 51 64 61 65 104 94 144 80 83 117 140 139 160 171 273 311 505 804 1,562 2,239 3,152 4,476 5,468 7,326
AIDS 2 4 11 13 11 10 18 17 21 38 57 51 50 23 45 78 40 57 44 54 39 39 36 31 23 31 29 110 186 338 543 503
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
5500
6000
6500
7000
7500
8000
NumberofCases
2009
Philippine HIV /AIDS Registry, Dec. 2015
1984
Number of HIV cases reported in the Phil (Jan 1984 to
Dec 2015: N=30,356)
MSM

Number of Newly Diagnosed
with HIV Per Day:
1 4 9 17 22
2008 2010 2012 2014 2015
Philippine HIV /AIDS Registry, Dec 2015

Percentage of newly
diagnosed and
cumulative cases
per region
sero-positive individuals
(Table 1). This was 28%
higher compared to the
same period last year
(509) [Figure 1]. Most
(96%) of the cases were
still asymptomatic at
the time of reporting
(Figure 3).
Ninety-seven percent
were male. The median
age was 27 years old
(age range: 2 years-78
years). More than half
belong to the 25-34 year
age group while 28%
were youth aged 15-24
Jan1984 -
Dec 2015
30,356
27,804
2,552
27,925
2,420a
1-82(28)
90b
8,094b
15,465b
5,728b
905b
12,533
1,530
5)
NCR 38%
4A 15%
3 10%
11 8%
7 7%
6 6%
12 3%
1 2%
10 2%
4B 2%
9 2%
5 1%
8 1%
2 1%
CAR 1%
CARAGA 1%
ARMM <1%

Percentage of HIV Cases Per Region
REGION
DEC 2015
(N=650)
JAN-DEC
2015
(N=7,829)
JAN 2010 TO
DEC 2015
(N=25,932)
CUMULATIVE JAN
1984 TO DEC 2015
(N=30,356)
NCR 250 (38%) 3,061 (39%) 11,477 (44%) 13,153 (43%)
4A(CALABARZON) 98 (15%) 1,267 (16%) 3,673 (14%) 4,128 (14%)
7 (CENTRAL VISAYAS) 48 (7%) 676 (9%) 2,524 (10%) 2,704 (9%)
3 (CENTRAL LUZON) 62 (10%) 681 (9%) 2,038 (8%) 2,500 (8%)
11 (DAVAO) 54 (8%) 448 (6%) 1,660 (6%) 1,777 (6%)
REST OF THE COUNTRY 138 (21%) 1,694 (22%) 4,393 (17%) 4,947 (16%)

Occupationally Acquired HIV
During 1985-2013, there are 58
confirmed and 150 possible cases of
occupationally acquired HIV
infection among HCWs reported to
the CDC
Joyce, MP, Kuhar, D. Morbidity and Mortality
Weekly Report Jan 2015; 63(53): 1245-46.

HIV Situation In The Philippines
• Dec 2015 data is 25% higher compared to the same period last year (n=509)
Philippine HIV/AIDS Registry, Dec 2015
MODE OF
TRANSMISSION
DECEMBER 2015
n= 650
JAN-DEC 2015
n= 7,829
CUMULATIVE (JAN
1984-DEC 2015)
N=30,356
M F M F M F
SEXUAL CONTACT 612 20 7,239 301 26,330 2,204
MALE-FEMALE SEX 57 20 774 301 3,805 2,204
MALE-MALE SEX 349 0 3,893 0 13,699 0
SEX WITH MALE & FEMALE 206 0 2,572 0 8,826 0
BLOOD/BLOOD PRODUCTS 0 0 0 0 5 15
SHARING OF NEEDLES 16 1 259 13 1,255 85
NEEDLE PRICK INJURY 0 0 0 0 2 1
MOTHER-TO-CHILD 1 0 9 8 46 38
NO DATA 0 0 0 0 287 77

Risk of Transmission of HIV
ROUTE OF
EXPOSURE
RISK WITH HIV-
POSITIVE SOURCE
FACTORS INCREASING THE RISK
PERCUTANEOUS ˜ 1 IN 300 (0.3%)
HOLLOW BORE NEEDLES, VISIBLE BLOODY
DEVICES, DEEP INJURY, SOURCE WITH
TERMINAL ILLNESS
CUTANEOUS <1 IN 1000 (0.09%) INVOLVE NONINTACT SKIN INTEGRITY
MUCOUS
MEMBRANE
˜ 1 IN 1000 (0.09%) HIGH VIRAL LOAD IN SOURCE

Risk Factors for HIV Transmission After
Percutaneous Exposure to HIV-Infected Blood
RISK FACTOR ADJUSTED ODDS RATIO (95% C.I)
Deep Injury 15 (6.0-41)
Visible blood on device 6.2 (2.2-21)
Procedure involving needle 4.3 (1.7-12)
placed in artery or vein
Terminal illness in source patient5.6 (2.0-16)
Post-exposure use of Zidovudine 0.19 (0.06-0.52)

Management of HIV Exposures
• Should be started ASAP, preferably within 2 hours
• PEP should complete a full 4-week regimen
• Selection of regimen must balance the risk of
infection against the potential toxicities
Updated US Public Health Service Guidelines for the
Management of Occupational Exposures to HIV and Recommendations
For Postexposure Prophylaxis. MMWR; September 2013; 34(9): 875-892.

Recommendations for PEP
• 3-drug regimen is now recommended for ALL
occupational exposures to HIV
• Guidelines no longer require assessing the severity of
exposure

PEP Regimen
• Zidovudine 300mg, twice daily
• Lamivudine 300mg, once daily
• Lopinavir / Ritonavir 400/100mg, 2 tablets, twice
daily

• PEP is given for 28 days
• If source person is negative for HIV, PEP can be
stopped before 28 days
• During the follow-up period (first 6-12weeks),
precautions should be undertaken to prevent
further transmission

Postexposure Testing
• Baseline testing at time of exposure,
• Follow-up testing could be performed at 6 weeks and at
3 mos
– A negative result at 12 weeks reasonably excludes HIV infection
related to occupational exposure
– Routine testing at 6 mos is NO longer recommended
• Extended HIV follow-up (for 12 mos) is recommended
for HCW who became infected with HCV after exposure
to a source co-infected with HIV and HCV.
• If PEP is offered and taken and the source if later determined
to be negative, STOP PEP with no HIV follow-up testing

Monitoring Recommendations after Initiation of PEP Regimen
following Occupational Exposure
BASELINE WEEK 1 WEEK 2 WEEK 3 WEEK 4
WEEK
12
CLINIC VISIT ✓ ✓ ✓ ✓ ✓
PREGNANCY TEST ✓
LIVER ENZYMES,
BUN, CREA, CBC
✓ ✓ ✓
HIV TEST ✓ ✓ ✓

• Adverse events are self-limited
• Gastrointestinal symptoms
• Headache, fatigue, insomnia
• Toxicities are rare and not life-threatening
• NO need to modify patient care responsibilities of
exposed healthcare worker
• Special considerations during pregnancy
• Avoid breastfeeding for 3 mos after exposure

Occupational Transmission of HCV
• Inefficiently transmitted by occupational exposure
• Average incidence of 1.8% following percutaneous exposure from
HCV-positive source
• Prevalence of 1-2% among healthcare personnel
• Lower than general population
• 10x lower than for HBV infection

Hepatitis C Postexposure Management
• For the source person, do baseline anti-HCV
• For the exposed HCW, do baseline and follow-up
testing:
• Baseline anti-HCV and ALT
• Follow-up anti-HCV and ALT (4-6mos)
• HCV-RNA if anti-HCV-positive
Testing

Hepatitis C
• PEP not recommended after exposure
• Immune globulin is NOT effective in preventing
Hepatitis C
• NO data on use of antivirals
• If anti-HCV (+) and ALT elevated, refer to a
specialist
– Pegylated interferon and ribavirin has a
response rate of 40 to 80%
Treatment

Sharps container must be:
• Closable and puncture-resistant
• Leak-proof
• Labeled or color-coded
• Functional
• Sufficient in number
• Easily accessible and maintained
in upright position
• Replaced per agency policy
• NOT BE overfilled

Coughing and sneezing are excellent
ways to spread germs.
A sneeze can travel over 100miles per hour project out 5000
droplets, containing around 10,000 bacteria and propelled
up to a distance of 12 feet

Philippines
• one of the four countries that
account for 93% of TB cases in
the Western Pacific Region
• among the 22 “high-burden”
countries for TB epidemic,
accounting for >80% of global
cases
• Filipinos with TB have
decreased by 52%
• more MDR-TB cases are
reported yearly
Global Tuberculosis Report, 2012

Workplace Burden of Tuberculosis
• Risk of development of TB is higher among HCWs in
the medical and TB wards (13%) compared to other
areas in the hospital1
• 40x higher than the general population
• Lost productivity, absenteeism, high hospitalization
costs, disease transmission to other employees2
1 Fennely KP. Int J Tuberc Lung Dis 1998; 2(9): S103-S109
Silva VMC, Cunha AJLA, et al. Int J Tuberc Lung Diss 2000; 4(5): 420-426
2 Marks S. Tuberculosis evidence-statement: screening.2006

TB Outbreaks In The Healthcare Setting
• Delayed diagnosis
• Delayed initiation of airborne precautions
• Lapses in practices and precautions for cough-
inducing and aerosol-generating procedures
• Lack of adequate respiratory protection
Guidelines for Preventing Transmission of M. tuberculosis
In Health-care Settings, MMWR 2005; vol 54: RR-17

Environmental factors that increase the risk the
probability of transmission of Tuberculosis
• Small, enclosed areas
• Inadequate local and general ventilation that results in
ineffective removal of infectious droplet nuclei
• Recirculation of air containing infectious droplet nuclei
• Inadequate cleaning and disinfection of medical equipment
• Improper handling of specimens

An employee with TB might lose an average of
3-4 months of work and income

Respiratory Protection Controls
• Surgical masks DO NOT protect the user
from exposure to TB
• Disposable respirators (N-95) are
commonly used in TB isolation rooms, in
transport of TB cases in other areas of
health facility
• High-risk procedures (bronchoscopy or
autopsy) needs full facepiece negative
pressure respirators, PAPRs, positive-
pressure airline respirators
TB Respiratory Protection Program in Health Care Facilities
NIOSH Publication No. 99-143
TB Infection Control

• Periodic training of HCW to enhance awareness and
maintain appropriate index of suspicion for new TB
cases
• Appropriate management of patients likely to have
undiagnosed TB
• Use of negative pressure rooms, adequate air
exchanges in rooms of patients with suspected TB,
adjunctive use of UV germicidal irradiation
• Masking of patients with suspected TB
• Mandatory respiratory protection of HCW in contact
with TB patients esp engaged in high-risk procedures
• TB surveillance testing

Workplace Restrictions
! Confirmed pulmonary, laryngeal, endobronchial
or tracheal TB, draining TB skin lesion
! Allow return to work only if:
o 3 negative sputum samples
o Responded to anti-TB treatment
o Person has been determined to be non-
infectious by a physician knowledgeable and
experienced with TB management

Workplace Restrictions
• Those with extra-pulmonary disease do not need to
be excluded from the workplace
• Those on LTBI can return to work immediately

Influenza Modes of Transmission
• Droplet transmission
• Indirect: hand transfer

Elements to Prevent Influenza Transmission
• Administration of influenza vaccine
• Respiratory hygiene and cough etiquette
• Appropriate management of ill HCP
• Adherence to infection control precautions for all
patient activities and aerosol-generating procedures
• Engineering controls: physical barriers, curtains

Respiratory Hygiene/Cough Etiquette
• Prevents transmission of ALL
respiratory infections
• Implemented at first point of contact
with a potentially infected person
• Should be incorporated into infection
control practices as one component of
standard precautions
• Covering mouth and nose when
coughing or sneezing
• Hand hygiene after contact with
respiratory secretions and
contaminated objects/materials
http://www.cdc.gov/flu/professionals/infectioncontrol/resphygiene

Flu Prevention
• Keep frequently touched work surfaces clean
• Encourage frequent hand hygiene
• Respiratory Etiquette
• Stay home when sick to avoid infecting other
personnel

• Annual immunization of healthcare workers is the
most efficient method of preventing influenza
infection and minimizing exposure to vulnerable
patients

Laboratory-acquired Infections
• Handling tissue and body substances from infected
patients
• Exposures for blood-borne pathogens including HBV, HCV,
and HIV
• “sniffing” plates, creating aerosols and making subcultures,
making slides, inoculating tubed and multiwell kit
biochemicals
Wilson and Reller 1998. Clinical Laboratory-Acquired Infections.
Hospital Infections 4th ed. pp 343-355.

Safety Recommendations
• TRAIN annually
– Risks, use of safety equipment
• Vaccination
• Use of gloves in handling specimens
• Use of plastic shields (if aerosol production is
possible)
• Hand hygiene (before and after)
• Respiratory protection – N95
Baron EJ, Miller JM. Bacterial and Fungal Infections Among
Diagnostic Laboratory Workers: Evaluating the Risks. Diagnostic
Microbiology and Infect Dis 2008; 60: 241-246.

Other Issues
Pregnant Personnel
• Some infections may be more severe during
pregnancy
• Transplacental infections have been associated
with abortion, congenital anomaly and mental
retardation
• Drugs used to treat or prevent certain infections
may be contraindicated in pregnancy
CDC Guideline for Infection Control
in Healthcare Personnel, 1998

Other Issues
Pregnant Personnel
– Female personnel in child-bearing age should be
strongly encouraged to receive immunizations
for vaccine-preventable diseases before
pregnancy
– Adherence to standard precautions when caring
for patients
CDC Guideline for Infection Control
in Healthcare Personnel, 1998

Antibiotic-resistant Infections in the
Critically Ill
• ESBL, MRSA, Carbapenemase-producing organisms,
MDROs
• Patient-to-patient transmission is common through
hands of HCWs and their equipment especially when
hand hygiene is suboptimal or not observed
Silveira F. Fujitani S, Paterson DL. Antibiotic-Resistant Infections in
the Critically Ill Adult. Clin Lab Med 2004; 24: 329-41.

General Control Measure: Hand Hygiene
• Core element of patient safety
• Prevention of HAI and spread of antimicrobial
resistance
• Effectively interrupts microbial transmission during
care sequence
Sax H. Allegranzi B. Uckay I. et al. J Hosp Infect 2007; 67: 9-21

My 5 moments for hand hygiene
Sax, H, et al. J Hosp Infec 2007; 67(1): 9-21

Important Points about Measles in the
Workplace
• HCWs are at higher risk than the general population owing
to greater opportunity for exposure
• MMR vaccine is highly effective in preventing measles
– 1-dose vaccine effectiveness of 95%
– 2-dose vaccine effectiveness of 99%
– 2-dose vaccine provided long-lasting immunity
• Spread by respiratory droplet and can stay in an area for
up to two hours after a person with measles has left
• Airborne-precautions should be observed to prevent
spread
• People are contagious from 4 days before they develop
the measles rash to 4 days after it goes away

Measles Postexposure Prophylaxis
• Vaccination within 72 hours of exposure
• If vaccination contraindicated - IG
– Infants 6 mos to 1 year, pregnants,
immunocompromised
– Within 6 days of exposure
– Dose: 0.25ml/KBW (max 15ml) per IM
– For immunocompromised pts: 0.5ml/KBW
– Should not be used to control measles outbreak
• HCWs without evidence of immunity should be offered first
dose of MMR vaccine and excluded from work 5-21 days
following exposure
Centers for Disease Control and Prevention

Important Points about Mumps
• Healthcare-associated transmission is infrequent
• Vaccination is effective in preventing mumps
– 1-dose vaccine effectiveness of 80-85%
– 2-dose vaccine effectiveness of 79-95%
• Observe droplet precautions to prevent spread of
mumps
• Isolation for 5 days after onset of parotitis
• Exposed HCW with no evidence of immunity should
be offered first dose of MMR and excluded from duty
from day12 after unprotected exposure through day
25 after most recent exposure

Important Points about Rubella
• German measles
• Less contagious than measles
• Effects during first trimester of pregnancy
– Miscarriages, stillbirths, therapeutic abortions,
congenital rubella syndrome
– Birth defects: blindness,deafness, mental retardation,
congenital heart defects
• Maximal communicability extends from few days
before to 7 days after rash onset
• No documented transmission of rubella to HCW

Important Points about Rubella
• Vaccine effectiveness is 95%
• Counsel women to avoid becoming pregnant for
28days after receiving MMR
• Observe droplet precautions to prevent
transmission, until 7 days after onset of symptoms
• Special ventilation in room not required
• Exposed HCW should be excluded from work for 23
days after exposure
• No evidence shows that postexposure vaccination is
effective

Important Points about Pertussis
• Highly contagious
• Transmission by direct contact with respiratory
secretions or large aerosolized droplets from
respiratory tract
• Communicability starts at onset of catarrhal stage
to paroxysmal stage
• Single dose Tdap
• Priority given to those who have direct contact
with babies younger than 12 months of age

• Droplet precautions
• HCW who develop symptoms after pertussis
exposure should be excluded from work until 5
days after the start of appropriate therapy
• Postexposure antibiotics: azithromycin,
clarithromycin, erythromycin
• Observe for 21days after exposure and treated at
onset of signs and symptoms of pertussis
Important Points about Pertussis

Important Points about Varicella
• Highly contagious: direct contact, inhalation of
aerosols; 1-2days before rash until all lesions are
crusted
• Vaccine effectiveness is lower in adults than children
• 2 doses, 4-8 weeks apart
• Observe airborne and contact precautions to avoid
spread, until all lesions are dried and crusted
• Unvaccinated HCW exposed to VZV are potentially
infective from days8-21 after exposure
– Vaccination within 3-5 days of exposure may be
offered

Important Points about Meningococcemia
• Nosocomial transmission is rare
• Infection occurs only after direct contact with
respiratory secretions of infected persons and in a
laboratory setting
Risk of acquisition through casual contact is negligible
Adherence to droplet precautions
• Vaccination is recommended for:
– Asplenia, complement deficiency
– Clinical microbiologists, research microbiologists
– HCW >55 years old with risk factor for meningococcal
disease
– Booster every 5 years
• PEP: Rifampicin, ciprofloxacin, ceftriaxone (w/n 24hrs)

Important Points about Typhoid
• Two typhoid vaccines: oral and parenteral
– Estimates 2-3 year efficacy
• parenteral Vi polysaccharide is 55%
• Oral Ty21a vaccine is 48%
– Boosters: oral – every 5 yrs; parenteral – every 2 yrs
• Microbiologists and other laboratory workers
• Hand hygiene will minimize transmission of
enteric pathogens
• HCWs with diarrhea (fever,cramps,bloody stools)
should be excluded from care of patients until
illness evaluated and treated

Summary
• Multiple infectious risks that surrounds our healthcare workers
and should not be taken for granted
• Simple infection control practices are of great importance in
controlling the transmission of occupation-associated infections
• Immediate medical attention is key in the success of any post-
exposure prophylaxis
• Vaccination of all healthcare workers is of utmost importance

Healthcare Workers’ Risks and Handling Exposures

Healthcare Workers’ Risks and Handling Exposures

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