CROSS REFERENCE: IPAC VII-20, II-20 ORIGINATOR: Occupation Health, Safety & Wellness APPROVED BY: Operations Committee BACKGROUND ORIGINAL DATE APPROVED: March 1995 DATE REVIEWED/REVISED: October 2013 DATE OF IMPLEMENTATION: September 22, 2014 Page 1 of 6 Influenza is a serious contagious disease spread by droplet transmission through close contact with an infected individual. According to the National Advisory Committee on Immunization, there are approximately four thousand deaths per year in Canada from influenza and its complications. Infected individuals are highly contagious and can transmit influenza prior to the onset of symptoms. Some individuals infected with influenza may develop few or no respiratory symptoms but may be shedding virus, i.e., transmitting it and potentially infecting others. Among vaccine-preventable diseases, influenza causes more deaths than all others combined. Hospitalized patients are generally more vulnerable to influenza than members of the general population. Influenza in vulnerable groups, especially the elderly, the very young and the immune-suppressed, is associated with significant morbidity and mortality. Influenza infection is a major contributor to hospitalizations during winter. Healthcare workers are a source of influenza in healthcare settings. Vaccination of healthcare workers will reduce their risk of getting influenza and spreading it to patients. The most effective strategy for preventing influenza is annual vaccination. Influenza vaccine is safe and effective. In addition to vaccination, there are several important infection control measures that help to prevent influenza transmission, including hand hygiene, cough etiquette, restrictions on work and visiting, the use of anti-viral medications, and rapid identification and management of ill patients. The wearing of masks can serve as a method of source control of infected healthcare workers who may not have symptoms. Masks may also protect unvaccinated healthcare workers from as yet unrecognized infected patients or visitors with influenza. While all these infection control measures are essential components of a comprehensive prevention program, vaccination remains the cornerstone of efforts to control influenza transmission. PURPOSE The purpose of this policy is to protect employees, physicians, volunteers and patients, from influenza infections. It is one component of a broader influenza prevention and control strategy. POLICY STATEMENT
CROSS REFERENCE: IPAC VII-20, II-20 Page 2 of 6 North York General Hospital, is committed to workplace and patient safety and supports the prevention and control of communicable diseases. This hospital will make every reasonable effort to identify potential risks and minimize them through developing and implementing the appropriate Occupational Health and Safety and Infection Prevention and Control programs. All individuals covered by this Policy must be vaccinated annually against influenza, or wear a mask during the Vaccination Required Period in areas where patients are present and patient care is delivered, in accordance with this Policy. SCOPE COVERED INDIVIDUALS This policy applies to all persons who carry out activities at this hospital, including employees, physicians and other credentialed professionals, volunteers, students/trainees, and contract workers (e.g. agency providers). For the purpose of this policy, these individuals will be referred to as Covered Individuals. ROLES AND RESPONSIBILITIES Employer Commit to support the influenza program, including appropriate operational and financial support to administer vaccine and monitor program implementation Communicate expectations to all Covered Individuals and internal and external stakeholders Determine the annual Vaccination Required Date and Vaccination Required Period (see Definitions below) in consultation with TAHSN partners and Toronto Public Health (TPH) Incorporate policy requirements into external contracts and affiliation agreements Honour collective agreements that contain influenza vaccine clauses by incorporating this healthcare worker influenza policy with any and all existing collective agreement language regarding influenza and vaccination. Hospital Management (Managers, Supervisors, Unit Coordinators, Directors, Senior Leaders) Monitor to ensure all Covered Individuals adhere to this policy Ensure all direct reports comply with this policy Ensure collective agreements containing influenza vaccine clauses are adhered to Occupational Health, Safety & Wellness Administer influenza vaccine and optimize vaccine accessibility including collaboration with the Outpatient Pharmacy Maintain influenza immunization records and track immunization rates Report healthcare worker influenza immunization rates to TPH as required
CROSS REFERENCE: IPAC VII-20, II-20 Page 3 of 6 COVERED INDIVIDUALS All Covered Individuals must be vaccinated against influenza by the Vaccination Required Date, or wear a mask during the Vaccination Required Period in all areas where patients are present and patient care is delivered. In addition, the following protocols apply: All Covered Individuals who are vaccinated against influenza must wear, or have on their person, an identifier indicating their influenza immunization status provided by the hospital for the duration of the Vaccination Required Period. For example, an influenza sticker may be attached to the back of a name tag; or a laminated card, or lanyard of a different colour, may indicate immunization status, etc. All Covered Individuals who receive influenza vaccination by a provider other than the organization s Occupational Health, Safety & Wellness department or the hospital Outpatient Pharmacy, must advise the hospital of their influenza immunization status in a manner acceptable to the hospital before the annual Vaccination Required Date. All Covered Individuals who are not able to demonstrate that they have received influenza immunization in the current season, regardless of vaccination status, are required to wear a mask in accordance with this Policy. Exceptions may be made for healthcare workers whose duties require exclusion, such as speech pathologists, music therapists, and staff who work with a person who is deaf and reads lips. Individuals required to wear a mask will be responsible for replacing it as necessary in accordance with the hospital s protocols. Masks will be provided by the hospital. (Refer to Personal Protective Equipment Policy IV-d-11 link) All Covered Individuals must continue to abide by the hospital s infection control practices, including adherence to routine practices and additional precautions, to prevent the transmission of communicable diseases, including influenza. All Covered Individuals must participate in training as required. PROCEDURE All individuals covered by this Policy must be vaccinated annually against influenza or wear a mask during the Vaccination Required Period in areas where patients are present and patient care is delivered in accordance with this Policy as outlined below, but not limited to: Ambulatory and inpatient areas; Direct patient care activities, including patient transport; Patient care location where patient contact and/or exposure may occur, such as hallways in patient care areas; Holding areas or waiting rooms; Some parts of nursing stations; Patient transport elevators;
CROSS REFERENCE: IPAC VII-20, II-20 Page 4 of 6 Patient transport hallways with access to procedure areas; Patient registration offices, security and visitor access desks; Jobs, roles and tasks with patient interaction, such as patient registration and case management; Environmental Services; Delivery of dietary services and food trays; Volunteers working with patients; Persons who perform in-room repairs (rooms with patients in them) and/or maintenance. Masks are not required in areas as outlined below, but not limited to: Break rooms; Public elevators; Cafeteria; Outside of facility; Employee entrances; Public hallways, where exposure is unlikely, or risk is no greater than in the community; Work areas that preclude patient contact, such as bench areas within the lab, dark rooms, equipment-processing areas, kitchen or supply warehouses; Non-clinical or office settings. Institutional Influenza Outbreak During an institutional influenza outbreak, this mask-wearing requirement is suspended and standard processes regarding influenza outbreak management and the use of anti-viral medications will apply. OHSW and IPAC monitor the organization for influenza outbreaks and IPAC will declare an outbreak. When an outbreak is declared, the hospital may require only immunized Covered Individuals (with documented immunization with the most current influenza vaccine at least two (2) weeks prior) to continue to work in the outbreak area. Covered Individuals who currently do not meet this requirement will be offered influenza immunization in addition to appropriate antiviral prophylaxis for 14 days after vaccination while immunity is still developing (or until the outbreak is declared over, if this happens within 14 days). Covered Individuals are fit to work upon starting a course of appropriate antiviral prophylaxis. Covered Individuals who decline influenza immunization must take antiviral prophylaxis until the outbreak is declared over. Covered Individuals are fit to work upon starting a course of appropriate antiviral prophylaxis.
CROSS REFERENCE: IPAC VII-20, II-20 Page 5 of 6 In case of a mismatch between the vaccine strain and the outbreak strain of influenza, all Covered Individuals working in the outbreak area or unit must take antiviral prophylaxis, regardless of their vaccination status. Covered Individuals are fit to work upon starting a course of appropriate antiviral prophylaxis. However, except in cases of documented medical contraindication, an Covered Individual who has not been immunized with the current influenza vaccine and who declines antiviral prophylaxis shall be restricted to work outside the outbreak area and shall be restricted from providing patient care or carrying on activities where they have a potential to acquire or transmit influenza. The same applies to immunized Individuals who decline antiviral prophylaxis in the case of a mismatch between the vaccine strain and the outbreak strain of influenza. If reassignment is not possible, the Covered Individual may take an unpaid leave of absence or use their banked lieu time or vacation credits. Compliance Any Covered Individual found in violation of this policy may be subject to remedial and/or disciplinary action, up to and including termination of employment, cancellation of contract and/or revocation of privileges.
CROSS REFERENCE: IPAC VII-20, II-20 Page 6 of 6 DEFINITIONS Vaccination Required Date The date established annually by the employer, in consultation with TAHSN partners and TPH, after which all persons covered under this policy are required to be vaccinated against influenza or wear a mask in accordance with this Policy. The Vaccination Required Date will usually be no later than the first week of December. Vaccination Required Period A period of time determined among TAHSN hospitals in consultation with Toronto Public Health (TPH). The Vaccination Required Period will begin on the Vaccination Required Date and will normally extend until the end of March. This period may vary somewhat with seasonal epidemiology and occasional novel strains of influenza. During the Vaccination Required Period, Covered Individuals will be required to be vaccinated against influenza or wear a mask in accordance with this Policy. Mask Includes a surgical or procedure mask supplied by the hospital. An N95 respirator is not required for the purpose of this policy. Patient Care Location Patient care location is where patients (residents/clients) are present and patient care is delivered, in accordance with this Policy, and including: Any building, property, or site owned, leased, rented or operated by the hospital where there are patients, residents or clients who are receiving care; Any patient/client/resident home or other location where Covered Individuals interact with the patient/client/resident in the course of his/her work for the hospital. The above does not include any location designated by the hospital to be excluded from the definition of Patient Care Location.