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Health Care Worker Immunisation Guidelines

PURPOSE

The purpose of this document is to describe the Department of Health's (DOH) policy for the routine immunisation of Health Care Workers (HCWs), including student HCWs.

PRINCIPLES

Health care workers (HCWs) may acquire vaccine-preventable diseases (VPDs) from patients or other HCWs and transmit these VPDs to other patients or HCWs.

In addition to the use of infection control precautions, immunisation of HCWs helps to prevent transmission of VPDs between patients and HCWs.

Health Care Services (HCSs) should ensure that all HCWs, including student HCWs, are fully vaccinated against key VPDs (e.g. hepatitis B, measles) before they come in contact with potentially infectious patients or blood or other body substances.

In addition, some HCWs have more exposure to certain VPDs than others and should also be vaccinated against these additional VPDs.

VACCINATION PROGRAMS

Database

HCSs should maintain a database that:

• Contains a record for each HCW of:
  • Laboratory-confirmed VPD infections,
  • VPD antibody and skin test (e.g. Mantoux) results, as appropriate,
  • Vaccinations, including the brand name and batch number of each vaccine, and
  • Refused vaccinations.
• Is secure and accessible by authorised personnel at any time.
• Is updated whenever a new HCW infection, test, or vaccination occurs.

Management

A nominated doctor should take responsibility for staff immunisation. If written standing orders for vaccines are signed by the nominated doctor, then a trained nurse may administer those vaccines. Administration of BCG vaccine should only be done by a doctor or nurse with appropriate training and experience.

The Health Care Service should provide HCW screening, testing and database maintenance.

The DOH currently provides the following vaccines and items for the vaccination of HCWs:

• MMR (Measles-Mumps-Rubella) vaccine,
• dT (Adult Diphtheria-Tetanus) vaccine,
• OPV (Oral Polio Vaccine),
• PPD (Purified Protein Derivative) for Mantoux testing and BCG (Bacille Calmette-Guerin) vaccine
• Adult Immunisation Record Cards.

Consent

Consent must be obtained and recorded for each HCW screening test or vaccination. Verbal consent is sufficient provided that it is recorded by the interviewer that consent was obtained.

If a recommended screening test or vaccination is refused by a HCW, then this refusal must be recorded on the HCW database.

Personal record

Every HCW should maintain a personal screening test result and vaccination record. Adult Immunisation Record Cards can be obtained from the hospital or by phoning the DOH on 9222 2056.

ROUTINE IMMUNISATION

Direct Care Staff

HCWs who are likely to have close physical contact with patients during the course of their employment, should be fully immunised against hepatitis B, influenza, measles, mumps, rubella, varicella, diphtheria, and poliomyelitis.

HCWs should be screened for tuberculosis according to Operational Circular OP 1553/02, Tuberculosis and Health Care Workers.

HCWs who have an increased risk of occupational exposure to hepatitis A should be fully immunised against hepatitis A.

HCWs who work with young infants (e.g. maternity, nursery staff) should be fully immunised against pertussis.

Laboratory and Research Staff

Laboratory and research staff should be immunised against a variety of diseases which include hepatitis B, influenza, measles, mumps, rubella, varicella, diphtheria, and poliomyelitis. In addition, they should be vaccinated against other vaccine preventable diseases that they may be exposed to in their specific workplace, e.g. meningococcal disease, hepatitis A, typhoid, Q Fever, rabies, Japanese Encephalitis, and plague.

VACCINATION RECORDS

See the National Health and Medical Research Council's Australian Immunisation Handbook 8th Edition, 2003², for more information about vaccines.

Diphtheria-Tetanus

• Record at least 3 doses of diphtheria-tetanus vaccine (dT) given at minimum monthly intervals.
• Offer three doses of dT vaccine at minimum monthly intervals to HCWs without proof of vaccination.
• Offer dT vaccine at 50 years of age if dT booster not given in the previous 10 years.
• If unsure of immunisation status offer immunisation.

Poliomyelitis

• Record at least 3 doses of Oral Polio Vaccine (OPV) or Inactivated Polio Vaccine (IPV) given at minimum monthly intervals.
• Offer three doses of OPV or IPV vaccine at minimum monthly intervals to HCWs without proof of vaccination.
• OPV should not be given to HCWs who could transmit OPV viruses to immunosuppressed contacts. IPV can be used instead of OPV if necessary.
• If unsure of immunisation status offer immunisation.

Measles-Mumps-Rubella

• Record serological immunity or at least two doses of measles vaccine given after 12 months of age and at least one month apart for persons born since 1970. Persons born prior to 1970 are considered immune but should not be refused MMR vaccination if requested.
• Offer two doses of measles-mumps-rubella (MMR) vaccine at minimum monthly intervals to HCWs without proof of serological immunity or vaccination.
• In general, pregnant or immunosuppressed HCWs should not be vaccinated with live vaccines including MMR.
• If unsure of immunisation status offer immunisation.

Varicella (chickenpox)

• Record history of clinical chickenpox or shingles or two doses of varicella vaccine given a minimum of one month apart. A history of chickenpox or shingles is highly predictive (> 90%) of immunity to varicella.
• Offer serological screening to HCWs with no definitive history of chickenpox or shingles (about 50% of this group will be non-immune).
• Offer two doses of varicella vaccine a minimum of one month apart to non-immune HCWs.
• A small percentage of healthy vaccinees (< 5%) will develop a rash after the vaccine. These vaccinees should be excluded from contact with high risk patients, e.g. neonates and immunosuppressed patients, until all the rash vesicles have crusted.
• In general, pregnant or immunosuppressed HCWs should not be vaccinated with live vaccines including varicella.

Hepatitis B

• Record serological immunity to hepatitis B.
• Offer three doses of hepatitis B vaccine at one and two month minimum intervals to unvaccinated HCWs.
• Offer serological testing three months after the third dose of vaccine. If a protective anti-HBs antibody level is not reached following the third dose of vaccine, HBsAg carriage should be investigated.
• HCWs who do not have adequate anti-HBs antibody levels after three doses of vaccine should be offered an additional double dose of vaccine or a further three single doses of vaccine at monthly intervals with serological testing two weeks after each dose. Persistent non-responders should be informed about the need for hepatitis B immunoglobulin (HBIG) within 48 hours of parenteral exposure to hepatitis B.
• Booster doses of hepatitis B vaccine are no longer recommended. Similarly, once adequate antibody levels have been documented once, serological testing does not need to be repeated.

Influenza

• Record one dose of influenza vaccine before winter each year.

Tuberculosis

• Record tuberculosis screening results according to Operational Circular OP 1553/02, Tuberculosis and Health Care Workers.

Other vaccines

• For information on other vaccines that may be appropriate to HCW with specific exposure risks (eg hepatitis A, typhoid) see the Australian Immunisation Handbook².

Dr Gary Dowse
ACTING DIRECTOR
COMMUNICABLE DISEASE CONTROL DIRECTORATE

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