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|Title:||Health Care Worker Immunisation Protocol|
|Document ID:||Operational Directive OD 0049/07|
|Date of issue:||Tuesday, 8 May 2007|
|Status:||NO LONGER APPLICABLE|
|Description:||The purpose of this document is to describe the Department of Healthís policy in relation to immunisation of health care workers, including students.|
|Period of effect:||from 9 May 2007|
|Authorised by:||Dr Peter Flett, ACTING DIRECTOR GENERAL, DEPARTMENT OF HEALTH, 08-May-2007|
|Subject terms:||Communicable Disease Immunisation Infection Control|
Health Care Worker Immunisation Protocol
The purpose of this document is to describe the Department of Health’s (DOH) policy in relation to immunisation of Health Care Workers (HCWs), including student HCWs.
Health Care Workers refers to all people delivering health care services, including students, trainees, laboratory staff and mortuary attendants, who have direct contact with patients or with a patient’s blood or body substances.
Health Care Workers (HCWs) may be exposed to vaccine preventable diseases (VPD) in the course of their work (e.g. influenza, measles, rubella, pertussis, hepatitis B) and, if infected, can transmit diseases to other non-immune HCWs and patients. The use of vaccines has continued to reduce the burden of bacterial and viral diseases (NHMRC Immunisation Handbook 2003). Immunisation is a safe and cost effective strategy for Health Service Providers (HSP), and the risks associated with illness from VPD has been reduced in both HCW and patients who are immunised against VPD.
Responsibility of Health Care Workers
HCWs have a responsibility to be informed of:
Responsibility of Health Service Providers
Health Service Providers must formulate a comprehensive immunisation strategy that aims to ensure all HCWs are offered and immunised against VPD to prevent disease. Each worker should be individually assessed using a risk category approach as to the likelihood of patient contact and exposure to blood or body fluids to determine vaccination requirements.
Some HCWs, such as microbiology laboratory workers, have a higher risk of exposure to certain VPD micro-organisms than other HCWs, and they should be vaccinated accordingly (Refer NHMRC Immunisation Guidelines 8th Edition 2004, Pages 99-104).
HSPs are responsible for and should provide HCWs with screening, testing, and maintaining a vaccination service at pre-employment and to existing staff. This includes establishing and maintaining a database for recording the following:
Maintaining Database Confidentiality
HSPs must ensure database information is secure and accessible by authorised personnel when needed, 24 hours a day, 7 days a week.
Administration of vaccines
A nominated doctor within the Health Service must be responsible for overseeing staff immunisation programs as per the Poison’s Act 1964 and Regulations 1965.
HCWs should be given appropriate information, and pre and post test counselling, to enable them to make informed decisions about screening and vaccination. Information should include advising the HCW about the recommended proposed action taken in response to screening results, reporting adverse events, and the need to be tested for seroconversion after receiving hepatitis B vaccination.
HSPs should ensure that medical locum, external staffing agencies and universities are requested to check the immunisation status of the staff/students they engage to work in the various health settings, in line with NHMRC HCW immunisation recommendations.
HSPs should also be aware of their Duty of Care to those HCWs, who remain non-immune through failure to seroconvert, have medical contraindications to vaccines or conscientiously object.
HSPs should provide HCWs with copies of their immunisation screening and vaccination record on termination of their employment.
Administration of BCG vaccine or Mantoux testing should only be undertaken by a doctor or nurse with appropriate training and experience.
Funding and Ordering HCWs Vaccines
It is the responsibility of the HSP to fund HCWs vaccines in accordance with the NHMRC Immunisation Guidelines (8th Edition 2004, Pages 99-104) regarding recommended risk category, with the exception of:
Ordering of Vaccines
Vaccines should be ordered direct from the pharmaceutical company, with the exception of PPD and Mantoux testing, which is ordered through CSL (telephone (08) 9328 7322).
All HCWs should be provided with a personal record of their screening test result and vaccination given. Adult Immunisation Record Cards can be obtained from the hospital or by phoning the Department of Health Information Line on 1300 135 030.
Proof of Vaccination
A sighted vaccination record is proof of vaccination. Alternatively, staff should have sighted HCWs test results to ascertain their immune status.
Consent must be obtained and recorded for each HCWs screening test or vaccination. Verbal consent is sufficient. If a recommended screening test or vaccination is refused by a HCW, then this refusal must be recorded on the HCWs record and employer’s vaccination database.
The following categorisation of risk is offered as a guide to determining the risk status of HCWs.
Category A — Direct contact with blood or body substances
This category includes all persons who have physical contact with or potential exposure to blood or body substances. Examples include dentists, medical practitioners, nurses, allied health practitioners, health care students, health care assistants, emergency personal (fire, ambulance and volunteer first aid workers), maintenance engineers who service health equipment, mortuary technicians, central sterile supply staff, and cleaning staff responsible for decontamination and disposal of contaminated materials.
Category B — Indirect contact with blood or body substances
This category includes workers in patient areas who rarely have direct contact with blood or body substances. These employees may be exposed to infections spread by droplets, such as measles, rubella and influenza, but are unlikely to be at risk from blood-borne diseases. Examples include catering staff and ward clerks.
Laboratories pose special risks because of the equipment used (centrifuges), and the possibility of exposure to high concentrations of micro-organisms generated by culture procedures. An additional risk to laboratory staff occurs in the handling of human blood and tissues.
Category D — Minimal patient contact
Other occupational groups employed, such as gardening and clerical staff, and volunteers, that have no patient contact have no greater exposure to infectious diseases than do the general public. These employees do not need to be included in vaccination programs or other programs aimed at protecting category A, B and C staff.
Pertussis (Whooping Cough)
Who is eligible?
Record 1 dose of acellular pertussis vaccine using DTPA, vaccine registered for adults over 10 years who have completed their primary course of diphtheria tetanus vaccine.
Who is eligible?
Who is eligible?
Vaccine Side effects
Who is eligible?
Who is eligible?
Who is eligible?
HCW Exposure to VPD in the workplace
1. Infection Control Guidelines for the Prevention of Transmission of Infectious Diseases in the Health Care Setting. Communicable Diseases Network Australia. Australian Government Publishing Services 1996, http://www.health.gov.au/internet/wcms/publishing.nsf/
2. Infection Control Guidelines for the Prevention of Transmission of Infectious Diseases in the Health Care Setting. Communicable Diseases Network Australia. Australian Government Publishing Services 2004, http://www.health.gov.au/internet/wcms/publishing.nsf/
3. The Australian Immunisation Handbook 8th Edition, National Health and
NOTE: The NHMRC Australian Immunisation Handbook 9th Edition is in draft and available. Once this document is endorsed, information in the new edition will precede the 8th edition.
Dr Peter Flett
This circular last updated: Tuesday, 8 May 2007 at 9:12am