Occupational Health. Control of Measles, Mumps, Rubella and Varicella

Transcription

1 Occupational Health Control of Measles, Mumps, Rubella and Varicella Please be advised that the Trust discourages the retention of hard copies of policies and procedures and can only guarantee that the policy on the Trust Intranet is the most up to date version (The most recent version of this template is available electronically on the Trust intranet/frequently Used Forms/Integrated Governance. Please use this template in conjunction with the Trust SOP for Approval of MCHFT Guideline / Policy) Document Type: Policy Clinical Version: 3 Date of Issue: April 2018 Renewal by: April 2021 Lead Director: Post Responsible for Update: Approval Committee: Approved by them in the minutes of: Distribution to: Director of Nursing and Quality Lead Nurse Occupational Health Infection Prevention and Control 27 th March 2018 All Trust staff via the Trust Intranet

2 Contents: Heading Page Heading (Insert Title) Number Number Contents / Risk rating 2 1 Introduction / Purpose 3 2 General Document (Insert title) 3 3 Definitions 12 4 Associated Documents 12 5 Duties 13 6 Consultation and Communication with 13 Stakeholders 7 Implementation 14 8 Education and training 14 9 Monitoring and review References / Bibliography Appendices 17 Risk Rating Who will be affected by Trust Employees this procedure? Is there an existing risk No assessment related to this procedure? If No is one required? No Yes Date completed If Yes does it require updating? Yes / No Yes Date completed Raw Risk Rating (no control measures in place) Final Risk Rating (control measures in place) A Consequence (1-5) B Likelihood of Occurrence (1-5) C Risk rating (A x B = C) Name: KEITH WILLIMASON Date: Page 2 of 20

3 1 Introduction / Purpose This procedure will support the health and safety of patients and staff. Its aim is to provide a safe working environment, which will reduce risk of harm associated with measles, mumps, and rubella and varicella disease. It is recognised that the risk of virus transmission from staff to patients and viceversa is minimal providing effective and consistent infection prevention and control procedures are followed. The protection of healthcare workers is especially important in the context of their ability to transmit virus infection to vulnerable groups. Whilst immunity to measles, mumps, rubella and varicella is important for healthcare workers own health they should be immune for the protection of vulnerable patients. It is the policy of the Trust that no-one will be discriminated against on grounds of age, disability, gender, gender re-assignment, marital status, race (including colour, nationality and ethnic or national origins), religion or belief or sexual orientation. The Trust will provide interpretation services or documentation in other mediums as requested and necessary to ensure natural justice and equality of access. Purpose To ensure a standardised approach is undertaken by all competent authorised personnel undertaking assessment of staff on behalf of Cheshire Occupational Health Service. This procedure compliments the overarching Occupational Vaccination Policy and will be the reference document for pre-employment screening of healthcare workers for measles, mumps, rubella and varicella it will also be used in the event of incidence of disease during employment. 2 Process Most individuals born before the introduction of the MMR vaccine in 1988 will have natural immunity to measles, mumps and rubella due to childhood illness. Similarly most individuals will have history of childhood chickenpox infection Measles: Measles is a highly contagious airborne pathogen which spreads through respiration. The virus is present in respiratory secretions, and can be passed from person-toperson via aerosol droplets containing virus particles, such as those produced by a coughing patient. Once transmission occurs, the virus infects the epithelial cells of its new host, and may also replicate in the urinary tract, lymphatic system, conjunctivae, blood vessels and central nervous system. The incubation period for measles usually last for 4-12 days (during which the individual is usually asymptomatic) infected people remain contagious form appearance of the first symptoms until 3-5 days after the rash appears. Page 3 of 20

4 The classical symptoms of measles include fever for approximately 3-days, cough, coryza (runny nose) and conjunctivitis (red eyes). Fever can reach 40 o C. The characteristic measles rash is described as a generalised, maculopapular erythematous rash that begins several days after the fever starts. The rash starts on the head before spreading to cover most of the body. The rash often causes itching. The rash will change colour from red to dark brown before disappearing. Generalised Immunosuppression follows measles infection and may predispose patients to complications ranging from the common les serious diarrhoea and vomiting and bacterial otitis media to bronchopneumonia and encephalitis. Complications are usually more severe amongst adults and very young children especially if they are poorly nourished or chronically ill. The fatality rate form measles for healthy adults and children in UK is low. In Immunocompromised individuals the fatality rate can reach approximately 30%. Measles Vaccination: Vaccination of an individual who is already immune because of past exposure or immunisation is harmless. Immunity against measles can be confirmed by measuring IgG antibody in the blood. Non-clinically based staff born before 1970 are generally considered immune due to childhood exposure. However data has estimated that 5% of adults born before 1970 may be susceptible to measles. All clinical staff or clinically based administrative staff should have satisfactory evidence of protection against measles. Satisfactory evidence of protection would include documentation of: Having received 2-doses of MMR vaccine or Positive IgG or IgM antibody test for measles Clinically based staff that are unable to provide documentary evidence of any of the above will be required to have 2-doses of MMR vaccination according to Occupational Health Department Human Medicines Regulations Exemption- Medicines Information Monograph. A 2 nd dose of vaccine will protect the 10% who do not respond to the first dose therefore post vaccination serology is not necessary. Patients at significant measles risk include: Neonatal and children s wards Maternity Special Care baby Unit, Intensive Care Unit Immunocompromised patients due to: HIV, oncology, chemotherapy and immune disorders. Refusal: Healthcare workers who refuse vaccination should be counselled regarding measles infection. They should be reminded of their professional obligation and legal Page 4 of 20

5 obligation to protect themselves and others. They should be reminded of their duty of care towards patients which includes taking all reasonable precautions to protect themselves from communicable disease. If they continue to refuse this should be noted in the employees OH record and referral made to the Consultant in Occupational Medicine who will make a decision on suitability for job role. Post exposure prophylaxis and advice following exposure to measles: Immediately, In the event of exposure to measles either at work or elsewhere the member of staff must inform the Occupational Health Department. Threshold for measles exposure times For healthy immunocompetent persons if there has been face to face contact of any length of time or where exposure for 15 minutes or longer in the same room has occurred. Cases are considered to be infectious from 4-days prior to rash onset until 4-days after rash onset. (Appearance of rash being day zero, therefore 9-days in total). Immunocompromised individuals are likely to excrete the virus for prolonged periods and should be managed as they are infectious for the duration of the illness. If there is satisfactory evidence of protection/immunity (i.e. IgG antibody positive or documented evidence of 2-doses of MMR vaccine or medically confirmed previous diagnosis of measles) then they can continue working. However they must be reminded of the symptoms and advised to cease working immediately and contact Occupational Health should they develop symptoms of: if they develop fever, and prodromal symptoms of measles or A fever for at least one day, and at least one of the following-cough, coryza(running nose) or conjunctivitis( red eyes) If the healthcare worker is not immune or there is no evidence of immunity they should be excluded from work form the 5 th Day after 1 st exposure until the 21 st day after last exposure, returning on the 22 nd day. If there is no evidence of immunity status in the current occupational health record a blood sample should be taken for measles IgG (3-days post initial exposure to avoid possibility of false negatives or equivocal results). The healthcare worker can resume working if: IgG is positive They are asymptomatic after 21-days post exposure They develop measles symptoms then they can return to work on the 5 th day after appearance of the rash. MMR vaccine should be used to protect susceptible contacts from suspected measles as vaccine-induced measles antibody develops more rapidly than that following natural infection. Healthcare workers who demonstrate no immunity following serological testing or there is doubt about immunity and there has been significant exposure then the Page 5 of 20

6 MMR vaccine should be administered promptly. (Ideally within 3-days of exposure). MMR will not exacerbate the symptoms of disease if the individual is incubating the virus or cause ill-effects if the individual is already immune. In high risk areas e.g. neonatal, oncology or Immunocompromised patient areas exclusion of susceptible individuals should be considered even if they have received MMR within the 3-day period; following discussion with the Consultant in Occupational Medicine and Consultant Microbiologist. Human Normal Immunoglobulin should be considered ideally within 6-days if susceptible healthcare workers (pregnancy, HIV Immunocompromised) are ineligible for MMR vaccination. This can only be done following discussion with the HPA and the Consultant Microbiologist. The final decision whether HNIG will be prescribed rests with the Consultant in Occupational Medicine following consideration of risks and benefits. Administration of MMR vaccine following measles equivocal/non-immune serology with anecdotal history of MMR vaccination Serological testing following MMR vaccination is not required as 2-doses of MMR vaccine provides almost guaranteed 100% immunity against measles, mumps and rubella. Performing serology tests for measles IgG on individuals with anecdotal history of MMR vaccination will often result in equivocal or non-immune results. This anomaly is thought to be due to the assay test for measles IgG being set at a high level and usually as a measure for individuals who have gained immunity naturally following infection. The sensitivity would have to be lowered to always detect individuals who have immunity via vaccination only. If a healthcare worker cannot provide documented evidence of immunity either serological evidence of positive antibodies or 2-doses of MMR then MMR vaccination should be administered according to PGD. Healthcare workers with documented evidence of equivocal results for measles that have anecdotal history of MMR vaccination should be considered immune. A note should be made in the individuals OH notes. Healthcare workers with anecdotal history of MMR vaccination with serological testing showing non-immune status should receive 1-dose of MMR. The OH Nurse must document that a booster MMR vaccine has been administered. 2.2 Rubella Rubella may be a mild illness involving a low-grade fever, malaise, coryza (running nose) and mild conjunctivitis (red eyes). Lymphadenopathy involving post-auricular and sub-occipital glands may precede the rash. Rubella rash is usually transitory, erythematous and mostly seen behind the ears and on the face and neck. Clinical diagnosis is unreliable as the rash is often fleeting and can occur in other viral illnesses. A significant proportion of rubella illness can be subclinical. Page 6 of 20

7 Frequently adults infected with rubella can have symptoms of transient polyarthralgia or polyarthritis, (especially in women). Central nervous system complications are more common in women. Thrombocytopenia is unusual in adults. Rubella is of greatest danger to the foetus. Almost 90% of infants born to mothers infected in the first trimester of pregnancy will develop congenital rubella syndrome. Rubella is transmitted person-to-person by respiratory droplets, or direct contact with the nasopharyngeal secretions of an infected person or with the nasopharyngeal secretions or urine of an infant with congenital rubella syndrome. The rubella incubation period is usually 14 to 17-days with a maximum range of 21- days. The infectious period is considered to be 7-days before rash onset and at least 7- days after rash onset. Infants with congenital rubella syndrome can continue to be infectious for 1-year or more. Immunisation: Vaccination with MMR of an individual who is already immune because of past exposure or immunisation is harmless. Satisfactory evidence of immunity against rubella infection should be sought for all clinical healthcare workers and laboratory workers. Satisfactory evidence of rubella protection includes documentation of: Having received 2-doses of MMR vaccine, or Positive antibody test for rubella or Staff who are unable to provide the above documentary evidence should be vaccinated with 2-doses of MMR according to the Occupational Health Service Human Medicines Regulations Exemption-Medicines Information Monograph for MMR. Although a single dose of rubella containing vaccine can provide % protection 2-doses should be given to ensure satisfactory protection. Post vaccination serological testing is not required. Refusal: Healthcare workers who refuse vaccination should be counselled regarding rubella infection. They should be reminded of their professional obligation and legal obligation to protect themselves and others. They should be reminded of their duty of care towards patients, which includes taking all reasonable precautions to protect themselves from communicable disease. If they continue to refuse this should be noted in the employees OH record and referral made to the Consultant in Occupational Medicine who will make a decision on suitability for job role. Post exposure prophylaxis and advice following exposure to rubella: Employees exposed to rubella must inform the Occupational Health Service immediately. Page 7 of 20

8 Vaccination with MMR is not advised, as antibody response does not develop fast enough to provide effective prophylaxis after exposure. For healthcare workers who have no immunity to rubella MMR vaccination should be given to prevent further infections. However they should be advised that any rubella like illness that may develop shortly after exposure is likely to be due to natural infection and exposure. Individuals without documented evidence of immunity (as above) should be considered as susceptible and considered for exclusion form duty form 7-21 days post exposure. Returning on the 22 nd day post-exposure. (Discuss with Consultant in Occupational Medicine) Human immunoglobulin is not recommended as there is no evidence that it is effective. Susceptible pregnant or immunocompromised staff that have been exposed should be referred to the Consultant in Occupational Medicine who will liaise with their principal treating physician as necessary. 2.3 Mumps Mumps is an acute viral illness caused by a paramyxovirus. It is usually characterised by bilateral parotid swelling, although it may present with unilateral swelling. Parotitis may be preceded by several days of non-specific symptoms such as fever, headache, malaise, myalgia and anorexia. Mumps virus frequently affects the nervous system and may be symptomatic or asymptomatic. Meningism (headache, photophobia, neck stiffness) occurs in up to 15% of cases and mumps viruses are often identified in the cerebrospinal fluid. Neurological complications, including meningitis and encephalitis, may precede or follow parotitis and can also occur in its absence. Before the introduction of the measles, mumps and rubella (MMR) vaccine in 1988, mumps occurred commonly in school-age children, and more than 85% of adults have evidence of previous mumps infection. Mumps is spread by airborne or droplet transmission. The incubation period is around 17 days, with a range of 14 to 25 days. Mumps is communicable from six to seven days before to nine days after the onset of parotitis. Asymptomatic and in-apparent cases can also be infectious. Immunisation: Vaccination with MMR of an individual who is already immune because of past exposure or immunisation is harmless. Satisfactory evidence of immunity to mumps would include: Documented evidence of administration of 2-doses of MMR vaccine. Positive antibody test for measles and rubella. Born before 1988 with history of previous infection. Page 8 of 20

9 Staff who are unable to provide the above evidence should be vaccinated with 2- doses of MMR according to the Occupational Health Service Human Medicines Regulations Exemption-Medicines Information Monograph for MMR. Although a single dose of MMR vaccine provides between 61% and 91% protection against mumps; a second dose is required to ensure protection. Antibody testing for mumps is not required for any category of healthcare worker. Refusal: Healthcare workers who refuse vaccination will be permitted to work without restriction however should be counselled regarding mumps infection. Post exposure prophylaxis and advice following exposure to mumps: Individuals exposed to mumps must inform the Occupational Health Service immediately. Exclusion of contacts is not normally required, as approximately 85% of the adult population will have natural immunity. Confirmed cases of mumps should be excluded from work for nine days or until parotid swelling goes down, whichever is sooner. Vaccination with MMR is not advised, as antibody response does not develop fast enough to provide effective prophylaxis after exposure. However susceptible contacts should be considered for immunisation with MMR vaccine to prevent further infection. They should be advised that any mumps like illness following immunisation is likely to be due to natural infection and exposure. Human Immunoglobulin is not effective in preventing mumps. 2.4 Varicella Caused by varicella zoster virus (VZV), which is a member of the herpes virus family. Primary infection will result in chickenpox. A mild illness may precede the onset of a rash. Adults may have 1 to 2 days mild fever and malaise prior to onset of the rash. Chickenpox rash is generalised, pruritic, and rapidly progresses from macules to papules to vascular lesions, before crusting. The rash usually consists of numerous lesions; appearing first on the scalp, moving to the trunk, and then the extremities, highest concentration of rash will be on the trunk. The rash is selflimiting generally lasting for 4 to 5-days. Lifelong immunity usually results from primary Varicella infection a second occurrence of chickenpox is uncommon but may occur in the Immunocompromised. The virus establishes latency in the dorsal root ganglia during primary infection. Reactivation results in shingles. Page 9 of 20

10 VZV enters the body through the respiratory tract and conjunctiva. Person-toperson transmission occurs primarily by direct contact with individuals with varicella and very occasionally by airborne spread from respiratory secretions. Spread from zoster lesions is rare although the lesions do contain virus. The incubation period is 10 to 14 days from exposure with a range of 10 to 21 days. Incubation will likely be prolonged in immunocompromised individuals. Individuals are most contagious from 1-2 days before the rash starts and this persists until crusting of lesions. Immunisation: As well as reducing the exposure of vulnerable patients to clinical staff with varicella. Immunisation will also avoid the need to exclude susceptible staff from work following exposure. Evidence of satisfactory immunity to Varicella would be: A definite history of varicella infection. Documented evidence of vaccination with 2-doses of varicella vaccine. VZV IgG positive Patients at significant risk from Varicella include: Neonates and children Maternity Immunocompromised (oncology, haematology, HIV). Healthcare workers caring for the above groups with uncertain or unknown histories should undergo serological testing for Varicella IgG. Routine testing of those born overseas should be carried out, as history is a less reliable indicator of immunity. Where results of IgG are negative or equivocal 2-doses of varicella vaccine should be given according to Occupational Health Human Medicines Regulations Exemption-Medicines Information Monograph for varicella vaccine. Serological testing following immunisation is not required. Vaccinated healthcare workers should be advised that they may develop a localised or generalised rash following varicella vaccination and should contact Occupational Health to discuss fitness for work if this occurs. All varicella vaccine associated rashes should be referred to the Consultant in Occupational Medicine for determination whether the rash is due to vaccination or coincidental wild-type chickenpox. Samples from rashes following vaccine should be sent to the HPA for investigation. Illness associated with rash can be treated with Acyclovir. If the rash is generalised and consistent with vaccine-associated rash (popular or vesicular) the healthcare worker should avoid patient contact until all lesions have crusted. Healthcare workers receiving the vaccine need not be excluded from patient contact unless a rash develops. Where the rash is localised and can be covered by clothing the healthcare worker can continue working in clinical areas. Page 10 of 20

11 Healthcare workers caring for pregnant or immunocompromised patients will require individual risk assessment (involving the Consultant in Occupational Medicine) to determine whether they can continue working or whether temporary redeployment or exclusion needs to be considered. Refusal: Healthcare workers who refuse vaccination or blood testing should be counselled regarding Varicella infection. They should be reminded of their professional obligation and legal obligation to protect themselves and others. They should be reminded of their duty of care towards patients, which includes taking all reasonable precautions to protect themselves from communicable disease. If they continue to refuse (dependent on job role) they will be referred to the Consultant in Occupational Medicine who will determine their fitness for job role. Post Exposure advice and prophylaxis following exposure Unvaccinated healthcare workers who do not have definite history of varicella infection should be tested for VZV IgG. If this is negative they should be excluded from work from 8 days after initial exposure to 21 days. There is evidence that administration of varicella vaccine within 3-days of exposure may be effective in preventing chickenpox. The healthcare worker will require assessment by the Occupational Health Service to determine the benefits of vaccination. If the healthcare worker develops chickenpox or shingles they must inform the Occupational Health Department. The healthcare worker will be excluded from work until clinically well and the skin lesions are dry and crusted and no new lesions are forming. Clinically well healthcare workers (non-high risk areas) with localised herpes zoster on a part of the body that can be covered with a dressing or clothing should be allowed to continue working. Healthcare workers in high-risk areas will require individual risk assessment to determine if they can continue working or whether temporary redeployment or exclusion will be required. There is a minor risk that vaccinated individuals or those with a definite history of varicella may develop the disease. These individuals should not be excluded after exposure however they should be instructed to contact Occupational Health for assessment should they become unwell, have a fever or develop a rash prior to further patient contact. Varicella zoster immunoglobulin should be considered for individuals that fulfil all of the following criteria: Significant exposure to chickenpox or herpes zoster A clinical condition that increases the risk of severe varicella illness i.e. immunosuppression, pregnancy No antibodies to varicella zoster virus. Exposure has been within the last 10-days. Page 11 of 20

12 The decision to administered VZIG will only be made following discussion between the Consultant in Occupational Medicine, the individual s primary physician and the Consultant Microbiologist. 3 Definitions Measles: also known as rubeola is a disease caused by a paramyxovirus, specifically a virus of the genus Morbillivirus. Mumps: Mumps is an acute viral illness caused by a paramyxovirus. It is usually characterised by bilateral parotid swelling. Rubella: also known as German measles is a RNA virus classified as a Rubivirus and part of the Togaviridae family. Varicella: also known as chickenpox or shingles is caused by varicella zoster virus, which is a member of the herpes virus family. MMR: Measles, mumps, rubella vaccine 3.1 Policy A policy is a statement of Trust intent for a given issue and gives a clear position statement for the Trust s customers and employees on its values and beliefs (Parsley & Corrigan 1999). A policy is a must do ; there should be no deviation from the actions as defined in the policy. Any deviation must be discussed and approved by the Strategic Integrated Governance Committee. 3.2 Guideline A guideline is an overview of processes either clinical or non-clinical, to be undertaken in certain conditions. A guideline gives practical guidance as to how to deliver best practice but allows for professional initiative and informed decision making. Any deviation from a Trust guidance document, along with the reasons why, must be documented in the Health Records. 3.3 Clinical Pathway / Standard Operating Procedure (SOP) A Clinical Pathway / SOP is a working document detailing the current agreed working practice that takes account of all the areas that are applicable to the management of a process in an individual setting 4 Associated Documents Occupational Health Service Operational Policy Occupational Vaccination Policy Venepuncture Procedure Occupational Health Pre-placement Health Screening Procedure Communicable Disease, Isolation, Notification and Surveillance Policy Infection Prevention and Control Policies and Procedures Varicella Zoster Protocol Occupational Health Consent Procedure Immunisation against infectious disease available the Green Book 2006 at: Page 12 of 20

13 5 Duties 5.1 Duties within the Organisation Director of Workforce and Organisation Development Has board level responsibility for the Occupational Health Service and offers assurance to the board that the Occupational Health Service is working within national best practice guidelines Consultant in Occupational Medicine Will be aware of their responsibilities under this procedure and provide expert advice to the Trust on its implementation Occupational Health Service Manager Is responsible for the operational management and delivery of the Occupational Health Service Lead Nurse for Occupational Health Will ensure that all staff operating under this procedure have received adequate training and instruction and are deemed competent Has responsibility and accountability to ensure that the occupational health service meets it obligations under relevant national guidelines Will ensure all IgM confirmed measles and rubella occupational exposures involving staff are reported to the Health Protection Agency Occupational Health Nurse Advisors Will ensure that they are aware of their responsibilities under this procedure Will attend an external accredited vaccination course and annual update Will escalate to the Consultant in Occupational Health any scenario that is not covered in this procedure Will vaccinate according to Patient Group Directions for MMR and Varicella Infection Prevention and Control Service/Microbiologist Will inform Occupational Health of all known workplace measles, and rubella exposure incidents involving employees All Employees: Are aware of their duties under this procedure. Will report any workplace or social measles, mumps, rubella or varicella exposure incidents to Occupational Health immediately. Will adhere to Occupational Health advice regarding exclusion from work following exposure. 6 Consultation and Communication with Stakeholders Page 13 of 20

14 This document has been distributed for comments to: Cheshire Occupational Health Service clinical staff Health & Safety Lead Head of HR Management Consultant in Occupational Medicine Occupational Health Service Manager Staff side chair JCNC Head of Nursing Infection Prevention and Control Consultant Microbiologist Executive Infection Prevention and Control Group (Mid Cheshire Hospitals Foundation Trust ) membership, for approval Infection Prevention and Control Committee, (East Cheshire NHS Trust) for information Governance.policies@mcht.nhs.uk must be included in the consultation process for all policies 7 Implementation Implementation of this policy is a mandatory requirement for all Occupational Health Service clinical staff that have responsibility for the assessment and management of healthcare workers vaccinations, pre-placement health screening, and health surveillance. Implementation of this policy and associated Occupational Health policies and procedures should ensure essential functions of the Occupational Health Service in protecting public health are achieved (Therefore successfully meeting NHS Employers, NHS Health at Work, Public Health England, SEQOHS and the Care Quality Commission requirements.) It also ensures the Trust is following best practice with respect to health and safety and infection prevention and control. This policy will be available on the Trust intranet. Due to the advisory and supportive function of the Occupational Health Service the implementation and review of its policies, procedures and protocols is and ongoing and consistent process. 8 Education and Training All authorised personnel will undertake training appropriate to their level of responsibility within this policy with only Occupational Health Nurses and the Consultant in Occupational Medicine interpreting results. Training updates will be provided in accordance with any current or changes to current occupational health guidelines including: o National Institute for Clinical Excellence (NICE) Page 14 of 20

15 o o o Health Safety Executive (HSE) Public Health England SEQOHS standards All Occupational Health clinical staff must adhere to this policy and carry out their responsibilities under it in order to achieve the objectives outlined in section 2 of this document. All staff will undertake mandatory and specialized training for ongoing personal development. Training needs will be identified through appraisal and annual training needs analysis. The Clinical Lead Nurse for the Occupational Health Service will communicate changes in practice to all Occupational Health clinical staff through departmental meetings or more frequently if urgency dictates. Specific training to assist the Occupational Health staff in the implementation of this procedure is delivered in the following ways: Accredited Courses: All Occupational Health Service clinical staff requires current registration with their respective governing bodies (NMC/GMC). The consultant and senior nursing staff also hold additional specialist qualifications in the Occupational Health specialty Practical Updates: Covering the practical application of policies and procedures and good Occupational Health delivery Yearly Training Needs Analysis: A yearly training plan is completed according to training needs identified via appraisal for the entire OH Service staff Continuing Professional Development: Occupational Health nursing staff will keep their training/development up-to-date as appropriate to satisfy the Nursing and Midwifery Council s requirements for revalidation in order to: Support clients and colleagues Enhance care Develop clinical practice Reduce risk Develop personally through education 9 Monitoring and Review The table below must be completed in the document to demonstrate effective monitoring of all documents. Standard/process/issue required to be monitored Process for monitoring e.g. audit Monitoring and Audit Responsible individual /group Frequency of monitoring Responsible committee Page 15 of 20

16 Consistency of application by OH clinical staff. Audit Lead Nurse for OH Following breaches of policy or outbreak SICC 9.1 Action Plan The MCHFT Trust Gap Analysis/Action Plan must be used to demonstrate effective monitoring of all documents. This can be found on the intranet in frequently used forms. 9.2 Audit Proforma The MCHFT Audit proforma must be used to demonstrate effective monitoring and implementation of planned actions. This can be found on the intranet in frequently used forms. 10 References / Bibliography 1. Immunisation against infectious disease the green book 2006, update Health and safety at work act Regulation 7: The control of substances hazardous to health 2002 (biological agents) 11 Appendices All Appendices must be in numerical order 1, 2, 3 etc. and positioned before the mandatory appendices below. A B C Version Control Document Communication / Training plan Equality Impact and Assessment Tool Page 16 of 20

17 APPENIDX A - Control Sheet This must be completed and form part of the document appendices each time the document is updated and approved. Date dd/mm/yy VERSION CONTROL SHEET Version Author Reason for changes OH Specialist Nurse New Policy Lead Nurse OH New policy format Minor grammatical changes throughout document Lead Nurse OH Minor changes to job title, change of reference from PGD to Human Medicines Regulations Exemption-Medicines Information Monograph Page 17 of 20

18 APPENDIX B - Training needs analysis Communication/Training Plan (for all new / reviewed documents) Goal/purpose of the Information communication/training plan Target groups for the All OH Staff communication/training plan Target numbers 6-10 Methodology how will the 1:1 peer support and instruction communication or training be carried out? Communication/training delivery Shadowing and mentoring Funding Not applicable Measurement of success. Learning No reported breaches of policy outcomes and/or objectives Review effectiveness learning outputs Issue date of Document Start and completion date of communication/training plan Support from Learning & Development N/A Services For assistance in completing the Communication / Training Plan please contact the MCHT Learning and Development Services Page 18 of 20

19 Appendix C Equality Impact Assessment Please read the Guide to Equality Impact Assessment before completing this form. The completed assessment is to form part of the policy/proposal/business case appendices when submitted to governance-policies@mcht.nhs.uk for consideration and approval. POLICY/DOCUMENT/SERVICE SECTION A A Does the document, proposal or service affect one group less or more favourably than another on the basis of: Yes/ No Justification & data sources. Include nature of impact. Also record provisions already in place to mitigate impact. 1 Race, ethnic origins (including gypsies and travellers) or nationality Yes HCW from tropical country of origin will be required to undergo VZ serology, as history will be deemed unreliable. 2 Sex No No impact identified. 3 Transgender No No impact identified. 4 Pregnancy or maternity Yes Vaccination with live virus VZ or MMR will not be given to pregnant women. Pregnant women will be considered for post exposure prophylaxis following exposure. 5 Marriage or civil partnership No No impact identified. 6 Sexual orientation including lesbian, gay and bisexual people No No impact identified. 7 Religion or belief No No impact identified. 8 Age No It is recognised that persons born before 1988 will likely have natural immunity to measles, mumps, and rubella and therefore not be subject to much of this procedure 9 Disability - learning disabilities, physical disability, sensory impairment and mental health problems No This document and associated information leaflets can be made available in other formats e.g. large print, audio on request. It is recognised that persons who are immunocompromised will be subject to increased restriction under the terms of this procedure for their safety. 10 Economic/social background No No impact identified. B Human Rights are there any issues which may affect human rights Page 19 of 20

20 1 Right to Life No No impact identified. 2 Freedom from Degrading Treatment No No impact identified. 3 Right to Privacy or Family Life No No impact identified. 4 Other Human Rights (see guidance note) No No impact identified. Date: 31 ST Jan 2018 Name: Keith Williamson Signature: Job Title: Clinical Lead Nurse for OH Date: 31 st Jan 2018 Name: Leigh Haslam Signature Job Title: Senior OH Nurse Page 20 of 20

21 Where an impact has been identified in Section A, please outline the actions that have been agreed to reduce or eliminate risks in Section B. If there are no impacts identified in Section A, completion of Section B is not necessary. SECTION B Please expand tables below as necessary SECTION B NUMBER A1-10, B1-4 NATURE OF IMPACT EVIDENCE STAKEHOLDER INVOLVEMENT ACTION COST LEAD TIMESCALE RISK SCORE Page 1 of 20