Program Manual - Saint Louis University

Q. Varicella - Zoster (VZV):
1. Definition of exposure: Airborne by droplet spread. Direct contact with infected lesions.
2. Susceptible HCWs include those with no prior history of chickenpox, those not known to be immune by
varicella titer, and those not successfully immunized with two doses of live attenuated varicella vaccine 1 to 2
months apart.
3. Asymptomatic susceptible exposed HCWs are evaluated at Employee Health; varicella titer is drawn at the
time of post-exposure evaluation.
a. If the varicella titer is positive, HCWs need no intervention.
b. If the varicella titer is negative or pending, asymptomatic susceptible exposed HCWs are unable to work
from the eighth through the 21st day after exposure. Varicella vaccination is provided at Employee
Health. When given after exposure the vaccine may not provide protection. However, if exposure did not
result in infection, immunization should protect against subsequent infections. VZV immune globulin
(VZIG) may be considered for pregnant HCWs who are not immune and immunocompromised HCWs.
V. Tuberculosis Program
A. Pre-placement Tuberculosis Screening
1. Pre-placement PPD skin testing is required for each HCW who is PPD status negative or PPD status
unknown. Medical history/screening is performed. The pre-placement PPD test must have been completed
within the 12 months prior to placement into the new job.
2. PPD (Mantoux) tests can be administered and read 48 to 72 hours later at Employee Health.
3. HCW can provide PPD skin test documentation. This must include the date the test was given, the date it was
read, the result (in millimeters of induration), and a sign off of who read it. The HCW can not read their own
test. Tine tests are NOT acceptable.
4. For HCWs who have not had two negative PPD test results within a 12 month period, pre-placement PPD
testing will be the two-step method. This is OSHA required to detect boosting phenomena that might be
misinterpreted as a skin test conversion on subsequent annual Tb screening.
5. If the pre-placement PPD result is negative, HCW is cleared for patient care/work and second step PPD is
scheduled to be completed 2 to 3 weeks later.
6. If a pre-placement or 2-step PPD result is positive, a chest x-ray is provided by Employee Health.
(a) If the chest x-ray and medical screening are negative, the HCW is cleared for patient care/work.
The HCW is referred to the appropriate public health department for evaluation for possible
preventative therapy.
(b) If the chest x-ray and/or medical screening are positive, the HCW is referred to the appropriate
public health department for treatment. The HCW is cleared for patient care/work when the
infectious status is known to be non-communicable.
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