SCREENING AND IMMUNISATION OF HEALTHCARE AND LABORATORY STAFF POLICY
Version / 1Name of responsible (ratifying) committee / Health and Safety Committee
Date ratified / 23 March 2018
Document Manager (job title) / Consultant Occupational Physician
Date issued / 30 April 2018
Review date / 22 March 2021
Electronic location / Health and Safety Policies
Related Procedural Documents / Hepatitis B Virus (HBV): Protecting employees and patients.
Control of TB in NHS employees.
Key Words (to aid with searching) / Work Health Assessment; Blood borne virus; tuberculosis; BCG; hepatitis B; Measles; Mumps; Rubella; Varicella; Vaccination; MMR vaccine; Occupational health and safety.Influenza
Version Tracking
Version / Date Ratified / Brief Summary of Changes / Author1 / 28.03.2018 / Merger of two related policies:
Immunisation of Healthcare and Laboratory Staff
and
Measles, Mumps & Rubella (MMR) and Varicella (chickenpox) Policy: Occupational Health Screening and Vaccination / Dr M Glover
CONTENTS
QUICK REFERENCE GUIDE
1.INTRODUCTION
2.PURPOSE
3.SCOPE
4.DEFINITIONS
5.DUTIES AND RESPONSIBILITIES
6.PROCESS
7.TRAINING REQUIREMENTS
8.REFERENCES AND ASSOCIATED DOCUMENTATION
9.EQUALITY IMPACT STATEMENT
10.MONITORING COMPLIANCE WITH PROCEDURAL DOCUMENTS
EQUALITY IMPACT SCREENING TOOL
QUICK REFERENCE GUIDE
For quick reference the guide below is a summary of actions required. This does not negate the need for the document author and others involved in the process to be aware of and follow the detail of this policy.
1.The Health and Safety at Work Act 1974 requires employers and employees to protect, as far as reasonably practicable, those at work and others who may be affected by their work, e.g. patients. The Control of Substances Hazardous to Heath (COSHH) Regulations 2002 require employers to assess the risks from exposure to hazardous substances, including pathogens (called biological agents in COSHH) and to implement measures necessary to protect workers and others from risk as far as reasonably practicable.This includes appropriate immunization.
2.Any vaccine-preventable disease that is transmissible from person to person poses a risk to healthcare workers and their patients. Health Care Workers (HCWs) have a duty of care towards their patients to protect them from communicable diseases which includes taking precautions, such as vaccination.
3.The four main staff groups for vaccination are: ‘staff involved in direct patient care’; ‘non-clinical staff in healthcare settings’; ‘laboratory and pathology staff’ and ‘staff handling specific organisms’. Occupational Health identifies the vaccinations required by different groups of staff and arranges for these to be provided. Line managers are to ensure their staff attend for vaccinations where required and are informed whether their staff attend for vaccination and if workplace restrictions are required.
4.Staff involved in direct patient care should beimmunised againsttetanus, diphtheria, polio (provided by their general practitioner), hepatitis B, Measles, Mumps and Rubella (MMR), varicella and seasonal influenza. Satisfactory evidence of protection includes documentation of having received 2 doses of MMR or having positive antibody tests for measles and rubella.
5.HCWssusceptible to Varicella (chickenpox) pose a significant risk to immunocompromised and seriously ill patientswith whom they have direct contact. They are also at risk of infectionfrom their patients. A definite history of chickenpox or herpes zoster in UK is a reasonable predictor of naturally-acquired immunity,but a survey reported in 2004 shows that a history of chickenpox is a less reliable predictor of immunity in individuals born orraised in tropical climatesin whom routine testing should be considered.
6.Occupational Health will assess new employees during the Work Health Assessment process for measles, rubella and varicella immunity by history and / or testing as appropriate. Non-immune staff will be offered vaccination. New staff born after the introduction of MMR vaccine in 1988 who do not have evidence of 2 doses MMR vaccine can proceed to vaccination without serological screening. Written consent will be obtained before vaccination and a post vaccination information sheet will be provided.
7.Influenza immunisation helps prevent influenza in staff and can reduce the transmission of influenza to vulnerable patients. At Portsmouth Hospitals NHS Trust, for future influenza seasons, the quadrivalent seasonal influenza vaccine will be offered on an annual basis to healthcare workers directly involved in patient care, as well as non- clinical staff in healthcare settings, laboratory and pathology staff and staff handling specific organisms
8.Further specific details about other vaccinations can be obtained from the individual Trust policies: ‘Hepatitis B Virus (HBV): Protecting employees and patients’; ‘Control of TB in NHS employees’.
1.INTRODUCTION
The Control of Substances Hazardous to health (COSHH) Regulations 2002 require employers to assess the risks from exposure to hazardous substances, including pathogens (biological agents in COSHH), and to introduce measures necessary to protect workers and others who may be exposed from those risks, as far as is reasonably practicable. Any vaccine preventable disease that is transmissible from person to person is a hazard to both health care professionals and their patients. Health care workers have a duty of care towards their patients to take reasonable precautions, including immunisation, to protect themselves from communicable diseases. Immunisation of healthcare and laboratory workers may therefore be indicated to:
- Protect the individual and their family from an occupationally-acquired infection
- Protect patients and service users, including vulnerable patients who may not respond well to their own immunisation
- Protect other healthcare and laboratory staff
- Allow for the efficient running of services without disruption.
The most effective method for preventing laboratory-acquired infections is the adoption of safe working practices. Immunisation should not be regarded as a substitute for good laboratory practice, although it does provide additional protection. Staff who work mainly with clinical specimens or have patient contact may be exposed to a variety of infections, while staff who mainly work with specific pathogens are only likely to be exposed to those pathogens handled in their laboratory. The health assessment for laboratory staff should take into account the local epidemiology of disease, the nature of material handled, the frequency of contact with infected or potentially infected material, the laboratory facilities and the nature and frequency of any patient contact. Staff considered to be at risk of exposure to pathogens should be offered pre-exposure immunisation as appropriate.
Measles, Mumps and Rubella (MMR) vaccine can be given to individuals of any age and those who have not received MMR should be offered immunisation. Individuals born between 1980 and 1990 may not be protected against mumps but are likely to be vaccinated against measles and rubella, although may have only had one dose of MMR. A second dose should be given in this case.Those born between 1970 and 1979 may have been vaccinated against measles and many will have been exposed to mumps and rubella during childhood. Those born before 1970 are likely to have had all three natural infections and are less likely to be susceptible. Serology should be checked in relevant staff groups and immunisation offered where indicated.
2.PURPOSE
To inform Portsmouth Hospitals NHS Trust employees of the hazards from common vaccine-preventable communicable diseases in the health care setting and the requirements and duties for workplace vaccinations. Staff are divided into four main groups: ‘staff involved in direct patient care’; ‘non-clinical staff in healthcare settings’; laboratory and pathology staff’ and ‘staff handling specific organisms’.
3.SCOPE
The policy applies to all employees of Portsmouth Hospitals NHS Trust, including staff employed on temporary or honorary contracts.
‘In the event of an infection outbreak, flu pandemic or major incident, the Trust recognises that it may not be possible to adhere to all aspects of this document. In such circumstances, staff should take advice from their manager and all possible action must be taken to maintain ongoing patient and staff safety’
4.DEFINITIONS
Healthcare and Laboratory Staff
Employees who fall into the following four broad groups:
- Staff involved in direct patient care
- Non-clinical staff in healthcare settings
- Laboratory and pathology staff
- Staff handling specific organisms
Measles
Measles is a highly infectious acute viral illness transmitted via droplet infection. Complications include otitis media, pneumonia, convulsions and encephalitis. Measles infection in pregnancy can result in miscarriage or premature delivery. Since 1988, exposure to natural measles has declined dramatically soyounger members of the UK population who have not been fully vaccinated are likely to remain susceptible into adult life and outbreaks in adults and children still occur, typically in those who have not received a full course of MMR.
Mumps
Mumps is an acute viral illnessspread by airborne or droplet transmission. Asymptomatic infection is common in children. Complications include meningitis, encephalitis, pancreatitis and orchitis. Initially high coverage of MMR vaccine resulted in a substantial reduction in mumps transmission in the UK and those most likely to lack immunity are adults born since 1980 who have not been vaccinated.
Rubella
Rubella is a mild infectious disease. Clinical diagnosis is unreliable and so serological evidence is requiredto prove a history of infection. Maternal rubella infection in the first 8-10 weeks of pregnancy results in fetal damage in up to 90% of infants and multiple defects are common. The risk of damage declines to about 10-20% by 16 weeks and after this stage of pregnancy fetal damage is rare. Rubella is a notifiable disease. All Health Care Workers (HCWs)who have direct patient contact should be screened for rubella antibodies by blood testing. Non-immune HCWs should be immunised with MMR.
Varicella (chickenpox)
Varicella (chickenpox) is an acute, highly infectious disease caused by the Varicella zoster (VZ) virusand transmitted directly by personal contact or droplet spread. Herpes zoster (shingles) is caused by the reactivation of the Varicella virus. Virus from lesions can be transmitted to susceptible individuals to cause chickenpox.Varicella is most common in children less than 10 years age, in whom it usually causes mild infection. The disease can be more serious in adults, particularly in pregnant women and in smokers, as they are at greater risk of fulminating Varicella pneumonia. Pregnant women appear to be at greatest risk late in second or early in the third trimester. For neonates and immunosuppressed individuals the risk of disseminated or haemorrhagic Varicella is greatly increased. Susceptible HCW can pose a significant health risk to high-risk patients. Susceptible HCW are at risk of being infected by their patients. Since chickenpox is so common in childhood, 90% of adults raised in the UK are immune.Since 2003 it has been recommended that non-immune healthcare workers are vaccinated against Varicella. This gives protection to the HCW from infected patients but also protects non-immune patients.
Immunosuppression
- Current treatment with chemotherapy or generalised radiotherapy, or within 6 months of terminating such treatment
- Organ transplant recipient and currently on immunosuppressive treatment
- Bone marrow transplant recipients who are still considered to be immunosuppressed, including those with graft versus host disease
- Adults who have received a dose of around 40mg prednisolone per day for more than 1 week in the previous 3 months
- Patients on lower doses of steroids, given in combination with cytotoxic drugs
- Some individuals on lower doses of steroids or other immunosuppressant for prolonged periods, or who because of their underlying disease, may be immunosuppressed and at increased risk of infection.
- Patients with evidence of impaired cell mediated immunity e.g. immunodeficiency syndromes
5.DUTIES AND RESPONSIBILITIES
Directors
Employers need to be able to demonstrate that an effective employee immunisation programme is in place.
Occupational HealthDepartment
The Occupational Health and Safety Service is responsible for the management of the immunisation programme and will undertake screening and vaccination of employees as set out in this policy. Occupational Health will inform employees of the risks to their health and others if they refuse, or are a poor or non-responder to an immunisation programme.Occupational Health will inform managers when employees do not attend for appointments, refuse vaccinations or if they are contraindicated.
Managers
Managers must complete Risk Identification Forms for new employees and ensure that these are available to Occupational Health. Managers must ensure that any employees for whom they have line management responsibility have had all relevant workplace vaccinations. All managers responsible for staff ina health care setting should ensure that new and existing staff (including agency and locum staff and visiting HCWs) are aware of the contents of this policy and that they have been cleared as fit for work following Occupational Health assessment.
Employees
Employees must comply with screening and vaccinations as set out in this policy and with other relevant Trust policies such as the Infection Control Policy. Health Care Workers have an additional duty of care towards their patients which includes taking reasonable precautions to protect themselves from communicable diseases, including by appropriate immunisations. Immunisation must not be used as a substitute for good practice in relation to the prevention of infection and general measures to prevent occupational transmission of blood-borne viruses must be followed.
6.PROCESS
Work Health Assessment
All new employees must undergo a Work Health Assessment which will include a review of immunisation needs. The job risk assessment form will indicate which pathogens staff are likely to be exposed to in their workplace. Staff considered to be at risk of exposure to pathogens will be offered routine pre –exposure immunisation as appropriate. Staff not considered to be at risk will not routinely be offered immunisation, although post-exposure prophylaxis may occasionally be indicated.
Staff involved in direct patient care
This includes staff, including those in primary care, who have regular clinical contact with patients and who are directly involved in patient care. This includes doctors, dentists, midwives, nurses, paramedics and ambulance workers, occupational therapists, physiotherapists, radiographers and porters. Students and trainees in these disciplines and volunteers who are working with patients must also be included.
All staff involved in direct patient care must be up to date with their routine immunisations, e.g. tetanus, diphtheria, polio and MMR (Measles, Mumps and Rubella). Any missed immunisations or required updates for tetanus, diphtheria and polio must be obtained from the employee’s General Practitioner.
The MMR vaccine is especially important in the context of the ability of staff to transmit measles or rubella infections to vulnerable groups. While healthcare workers may need MMR vaccination for their own benefit, they should also be immune to measles and rubella in order to protect patients.
BCG vaccine is recommended for healthcare workers who may have close contact with infectious patients. It is particularly important to test and immunize staff working in maternity and paediatric departments, and departments in which the patients are likely to be immunocompromised, e.g. transplant, oncology and HIV units. For more details on BCG vaccine and tuberculosis (TB) screening in employees please refer to the separate Trust policy “Control of tuberculosis (TB) in NHS employees” There is currently a shortage of BCG vaccine and, while this situation continues, it will impact on vaccination activity.
Hepatitis B vaccination is recommended for health care workers who may have direct contact with patients’ blood or blood-stained body fluids. This includes any staff who are at risk of injury from blood-contaminated sharp instruments, sustain a splash of blood stained body fluid to broken skin or mucous membranesor of being deliberately injured or bitten by patients. For more details please refer to separate Trust policy “Hepatitis B Virus (HBV): Protecting Employees and Patients”. There is currently a shortage of Hepatitis B vaccine and, while this situation continues, it will impact on vaccination activity.
Varicella vaccine is recommended for susceptible healthcare workers who have direct patient contact. Those with a definite history of chickenpox or herpes zoster (shingles) can be considered protected. Health care workers with a negative or uncertain history of chickenpox or herpes zoster should be serologically tested and vaccine offered to those without immunity.
Influenza immunisation helps prevent influenza in staff and may also reduce the transmission of influenza to vulnerable patients. Influenza vaccination is therefore recommended for healthcare workers directly involved in patient care, who should be offered influenza immunisation on an annual basis.
Non-clinical staff in healthcare settings
These individuals are not directly involved in patient carebut may have social contact with patients which is not usually of a prolonged or close nature. This group includes receptionists, ward clerks, cleaners and other administrative staff working in hospitals and primary care settings and maintenance staff such as engineers and cleaners.
These staff should be up to date with their routine immunisations, e.g. tetanus, diphtheria, polio and MMR (Measles, Mumps and Rubella). With regards to tetanus, diphtheria and polio, any missed immunisations or required updates must be obtained from the employee’s General Practitioner.
The MMR vaccine is especially important in the context of the ability of staff to transmit measles or rubella infections to vulnerable groups.
At Portsmouth Hospitals NHS Trust, BCG vaccine is recommended for non-clinical staff in healthcare settings. For more details on BCG vaccine and tuberculosis (TB) screening in employees please refer to the separate Trust policy “Control of tuberculosis (TB) in NHS employees” There is currently a shortage of BCG vaccineand,while this situation continues, it will impact on vaccination activity.
Hepatitis B vaccination is recommended for workers who are at risk of injury from blood-contaminated sharp instruments, splashes ofblood stained body fluid to broken skin or mucous membranes or of being deliberately injured or bitten by patients. For more details please refer to separate Trust policy “Hepatitis B Virus (HBV): Protecting Employees and Patients”.