Infection Control Manual
Section III - Employee Health

Employee Health Scope of Services
Employee Health Services Summary
Reporting Work Related Injuries/Illnesses
Work Restrictions for Communicable Diseases
Management of Blood/Body Substance Exposure

SCOPE OF CARE

The Employee Health Service (EHS) provides services and participates in administrative activities that promote and enhance a safe environment for workers and clientele within the physical campus and/or for the programs of Harborview Medical Center.

A. Types and ages of patients served:

The following persons are eligible for Employee Health Services:

• Employees and Faculty of HMC (Full time, part time, per diem and temporary)
• Students of affiliated teaching programs**
• Employees of the University of Washington, Seattle-King County, and other agencies who have employees located within HMC buildings*
• Volunteers of HMC and its affiliated programs**

*General services such as TB screening, routine immunizations, minor first aid, and certain post-infectious disease exposure protocols are available. Restrictions, however, may govern extent workers' compensation-related care, depending on the employing agency.

**Students and volunteers may be required to have prerequisite immunizations and screening exams administered by and documented with outside agencies, and completed prior to any affiliation with HMC, as stated in the agency's affiliation agreement.

B. Methods used to assess and meet service needs

The EHS in conjunction with the Infection Control Committee, the Health and Safety Committee, HMC and University administration, and the Employee Health Medical Director, establishes a structure for:

• defining health screening standards for employees,
• implementing immunization and medical surveillance programs
• providing assessment, direct care and/or medical triage of work related injuries and illness
• maintaining a confidential employee health record keeping system
• evaluating occupational hazard risk and determining strategies for risk reduction
• coordinating and providing health promotion activities for HMC personnel
• representing the organization on internal and external committees, educational activities, and task forces.

C. Scope of Service

The EHS performs or provides the following services:

• evaluation of immunity to specified communicable diseases and tuberculosis screening for new and existing volunteers, employees and faculty.
• immunizations, periodic screening and medical surveillance and exposure management for specified communicable diseases.
• minor first aid and/or triage to appropriate healthcare professional for work related illness/injury, and related psycho-social sequelae.
• assessment of work environment for health related hazards.
• development, coordination, and implementation of health promotion and wellness activities for employees.
• instruction and consultation for occupational health related topics.

D. The appropriateness, clinical necessity, and timeliness of support services provided directly by the hospital or through referral sources

Affiliated support structure:

Clinical support is provided through, but not limited to the Employee Health Medical Director, Emergency Department, Urgent Care Clinic, and specialty clinics such as Occupational Medicine, Dermatology, Orthopedics, Pulmonary Medicine, and the Seattle-King County Public Health Department. Social services and employee assistance programs are available through HMC and the Employee Assistance Program for the University of Washington.

Consultation for administrative/policy issues is provided by the appropriate department or committee structure, such as Infection Control Committee and the Department of Epidemiology, Safety Professional under the guidance of the Associate Administrator for Clinical Support Services.

E. The availability of necessary staff:

EH professional nursing staff have specific training, experience, and demonstrated competency for performing assessments and effecting appropriate triage of clinical and administrative areas listed above. The Medical Director has oversight of clinical protocols and is responsible for pharmaceutical prescription signature.

F. The extent to which the level of care or service provided meets patients' needs:

Comprehensive services, ranging from health promotion strategies, emotional, mental health, and social services, through Level I trauma care are available via the referral and clinical support system.

G. Recognized Standards of Practice:

The following organizations have published standards from which the EHS derives its scope of services:

• American Association for Occupational Health Nursing;
• Centers for Disease Control and Prevention, including National Institute for Occupational Safety; and Health, and Advisory Committee on Immunization Practices.
• Joint Commission for Accreditation of Health Care Organizations;
• Occupational Safety and Health Administration; and
• Washington Administrative Code, and the Washington State Department of Health.

EMPLOYEE HEALTH SERVICES SUMMARY

OFFICE LOCATION: 7EC-02 PHONE: 731-3081 PAGE: Digital 0484

The following is a summary of services offered to employees through the Employee Health Service at Harborview Medical Center. These services are available to all employees and volunteers. Students are eligible for first aid and exposure management; other services may be referred to appropriate providers. Prescriptions for prophylactic drug therapies for work related communicable disease exposures are available as needed.

WORK RELATED INJURIES

• First aid for minor injuries.
• Referral available for more serious injuries.

SELF CARE

• Blood pressure measurements, medication administration.
• Information, counseling, referral for minor non work-related illness or injury.

REPORTING WORK RELATED INJURIES/ILLNESSES

WORK RESTRICTIONS FOR COMMUNICABLE DISEASES

PURPOSE: To prevent nosocomial spread of communicable diseases to patients and staff within Harborview Medical Center from staff with contagious illnesses.

POLICY: Persons with communicable diseases or who are susceptible and exposed to communicable disease shall be restricted from direct contact with patients when:

1. Transmission of the disease to the recipients of care or others in the workplace can occur in that particular job environment.
2. The disease can cause serious illness.

INCLUSIONS: Harborview Medical Center staff, students, volunteers, and all persons who work within the Medical Center Buildings.

REGULATORY REFERENCE:

Washington Administrative Code (WAC) 248-100-186

Employee Health staff (x3081), Epidemiology staff (744-9560), or the Infectious Disease fellow (x147) on call should be consulted if there are questions concerning the safety of allowing a person to return to work. Guidelines for managing employees are listed below. Please note that there are two sections--one for employees with communicable illnesses and the other for employees exposed to a communicable disease to which they are susceptible.

REFERENCE:
Control of Communicable Diseases in Man. American Public Health Association.

MANAGEMENT OF BLOOD/BODY SUBSTANCE EXPOSURE

Exposure to blood or body fluids/substances is a serious occupational hazard. Immediate reporting of these events allows for appropriate risk assessment, counseling and initiation of post exposure prophylaxis (PEP). HMC follows guidelines set forth by the Centers for Disease Control.

PROCEDURE:

1. Wash area immediately. Use water and appropriate cleansing solution. Mild non irritating soap or antibacterial scrub is used on skin. If splashed in eyes or mucous membranes, flush area with saline or non irritating solution. Do not use harsh agents which may cause additional injury to tissues.
2. Seek care immediately through the EMPLOYEE HEALTH SERVICE or the EMERGENCY DEPARTMENT. Prophylactic medications are most likely to be effective when treatment is started within the first few hours after exposure.
   
   Employee Health Service 7 East Clinic
   Monday-Friday, 7 am to 4:30 pm
   731-3081 (24-hour report hotline)
   D-pager 0484
   Emergency Department (when EHS not available) 1^st Floor Hospital
   731-3074
   
   
3. Verbally report the exposure immediately to the Employee Health Service 24-hour hotline at 731-3081. Leave a confidential message, giving your name, date of injury, name and location of the source patient, and phone number where you can be reached.
4. Confidential counseling, treatment and testing are provided at no cost to the exposed person and the source patient. Source patient counseling and testing will not be done until the exposed person has notified EHS. This assures that appropriate and legal counseling, consent and test notification are completed*, and that the source patient is not billed.
5. Complete the Unusual Incident/Accident Report (UIAR) form. All follow-up care is provided through the Employee Health Service.