Policy No: IC05 Version: 8.0 Name of Policy: Staff Immunisation Policy Effective From: 18/08/2015 Date Ratified 15/07/2015 Ratified Infection Prevention & Control Committee Review Date 01/07/2017 Sponsor Expiry Date 14/07/2018 Withdrawn Date Director of Nurse, Midwifery & Quality / Joint Director of Infection Prevention & Control Unless this copy has been taken directly from the Trust intranet site (Pandora) there is no assurance that this is the most up to date version This policy supersedes all previous issues
Version Control Version Release 1.0 Feb 2002 2.0 Author / Reviewer Ratified by/authorised by Date Changes (Please identify page no.) 3.0 4.0 5.0 April 2008 Dr Hudson IPCC 30/11/2007 6.0 March 2010 Dr Hudson C Hobson Consultant Microbiologist/ Specialist Nurse 17/02/2010 7.0 28/06/2012 C Hobson/ S J Hudson Practitioner Infection Prevention & Control Committee 24/05/2012 New Trust format Minor amendments: 6.3 Varicella information relating to employees who are parents of children in Tot s and Toddlers Nursery, or working in this area to provide immunity status 6.7 MMR as above 9 Monitoring compliance with the policy 8.0 18/08/2015 C Hobson/ S J Hudson Infection Prevention & Control Committee Frequency The audit will be carried out on a yearly basis. 17/4/15 New Trust Format 6.3 Removed statement Varicella information relating to employees who are parents of children in Tot s and Toddlers nursery, or working in this area to provide immunity status 6.8 In addition to vaccination being offered within the Occupational Health department Matrons and other Nurse Specialists perform annual staff influenza vaccination in wards and departments. Staff Immunisation Policy V8 2
Contents Section Page 1 Introduction... 4 2. Policy scope... 4 3. Aim of policy... 4 4 Duties (Roles and responsibilities)... 4-6 5 Definitions... 6 6 Immunisations... 6 6.1 Hepatitis B... 6 6.2 Tuberculosis... 6 6.3 Varicella... 7 6.4 Tetanus... 7 6.5 Diphtheria... 7 6.6 Poliomyelitis... 8 6.7 MMR... 8 6.8 Influenza... 8 6.9 Hepatitis... 8 6.10 Other immunisations... 9 7. Training... 9 8. Equality and diversity... 9 9. Monitoring compliance with the policy... 10 10. Consultation and review... 10 11 Implementation of policy (including raising awareness)... 10 12 References... 10 13 Associated documentation (policies)... 10 Staff Immunisation Policy V8 3
Staff Immunisation Policy 1 Introduction Healthcare workers are potentially exposed to many infections through the course of their work. Under the Health and Safety at Work act (1974) (HASAWA) the Trust has a duty of care to ensure the health, safety and welfare of all employees whilst at work. The Control of Substances Hazardous to Health Regulations (1994) (COSHH) require that a risk assessment is made of the exposure of workers to biological agents, and employers have a duty to bring into effect measures necessary to prevent harm to workers and others who may be exposed. Where a risk of infection is recognised, and where effective vaccines are available to staff who are not already immune, immunisations will be offered. Immunisation is one of several measures designed to prevent harm, and cannot replace or is not a substitute for general measures such as needlestick prevention and hand cleaning. Under the regulations the Trust is required to undertake a risk assessment to determine which pathogens staff may be exposed to. This assessment should take into account the local epidemiology of the disease; the nature of the material handled, the frequency of contact with infected or potentially infected material, the facilities including containment measures and the nature and frequency of any patient contact. 2 Policy scope This policy relates to vaccinations offered to Healthcare workers who are identified as being at risk of infection and where effective vaccines are available 3 Aim of policy Gateshead Health NHS Foundation Trust has prepared this policy in order to meet its statutory obligations and aims to prevent the transmission of infections by the provision of vaccinations (where available) to employees who are at risk. 4 Duties (roles and responsibilities) Trust Board The Trust recognises its responsibility to comply with the COSHH regulations and the Health and Safety at Work Act (1974), and the need for employers to assess the risks to staff and others. Heads of Department Managers will ensure staff are protected against infectious diseases. Managers will ensure staff are allowed reasonable time to attend the Occupational Health Department for vaccination. Managers will conduct risk assessments to determine what infections staff are potentially exposed to, and keep relevant records. They must also forward this information to the Occupational Health Department. Managers are trained in risk assessment, and should be aware of the infections that may pose a threat to staff in their area. Should managers have any concerns they should contact the Occupational health and Safety Department for advice. Training is available in the form of risk assessment training and COSHH training. Staff Immunisation Policy V8 4
In exceptional circumstances satisfactory immunity may not be achievable. This may require redeployment or job restriction as advised with joint discussion with Occupational Health and infection control. Health assessment for laboratory staff should take into account the local epidemiology of the disease, the nature of the material being handled, the frequency of contact with infected or potentially infected material, the laboratory facilities including containment measures, and the nature and the frequency of any patient contact. Staff considered to be at risk of exposure to pathogens should be offered pre-exposure immunisation as appropriate. In order for this to be established managers will need to provide the above information so Occupational Health can ensure that the correct immunisations are offered to staff. Occupational Health Department Pre-employment medical The Occupational Health Department will ensure that a review of immunisation needs of all new employees will be carried out at pre-employment health interview, and staff considered to be at risk of exposure to pathogens will be offered routine pre-exposure immunisations as appropriate and boosters at the intervals recommended by the Department of Health. This decision will take into account the safety and efficacy of available vaccines for the individual. Staff not considered at risk will not routinely be offered immunisation, although post exposure prophylaxis may occasionally be indicated. Existing staff The Occupational Health and Safety Department will ensure that an effective immunisation program is in place and all employees at risk of infectious diseases will be offered vaccination against those diseases where a vaccine is available. The Occupational Health Department will advise employees what vaccines they need, the reasons why vaccination is advisable, obtain consent from the employee and explain the implications and associated risks of refusing vaccinations. Occupational health may need to make managers aware about the outcome of the immunisation to allow appropriate decisions to be made about potential work restriction. Employee Responsibility Health Care workers have a duty of care towards their patients which includes taking reasonable precautions to protect them from communicable diseases. They also have a duty under HASAWA to cooperate with measures taken by their employer to protect their health. Immunisation of health care workers 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 health care and laboratory staff Allow for efficient running of services without disruption. Employees should carefully consider attending for the vaccines that they have been advised to have. Staff Immunisation Policy V8 5
Employees should ensure that they attend for vaccinations at the correct time to increase the chances of them being effective and inform the occupational health and safety department as soon as possible if they are unable to attend an appointment. Employees should discuss with Occupational Health nurses /doctor their reasons for not accepting the recommended vaccines to enable this to be documented in their occupational health records, and so the Trust can be informed of any restrictions that need to be put in place and any risk this may pose. The most effective method for preventing infections is by adoption of safe working practices. Immunisation should never be regarded as a substitute for good working practice. Where staff refuses vaccination restrictions may be placed on their job activities. Staff must also remember that the Trust has an absolute duty to prevent harm under COSHH. 5 Definitions In this policy the definition of a Health Care Worker is staff involved in direct patient care with regular clinical contact. This includes doctors, dentists, nurses, and professions allied to medicine. Students and trainees in these disciplines and some volunteers who are working with patients must also be included. Non-clinical ancillary staff are those who may have social contact with patients but are not directly involved in patient care. This group includes receptionists, ward clerks, porters, cleaners, and some volunteers. Laboratory staff (including mortuary staff) are those who regularly handle pathogens or potentially infected specimens. In addition to technical staff, this may include cleaners, porters, secretaries, and receptionists in laboratories. 6 Immunisations 6.1 Hepatitis B Hepatitis B vaccination is recommended for health care workers, non-clinical staff, and laboratory and pathology staff who may have direct contact with patient s blood or blood stained fluids. This includes any staff who are at risk of injury from blood contaminated sharp instruments, or of being deliberately injured or bitten by patients. Antibody levels for hepatitis B should be checked six to eight weeks after the completion of a primary course of vaccine. Such information allows appropriate decisions to be made concerning post exposure prophylaxis following known or suspected exposure to the virus. Staff requiring hepatitis B vaccination will be offered a course of three injections and if immunity level is satisfactory a booster dose will be offered five years later. Where clinically indicated, it may be necessary to have an initial course of four vaccinations, or a repeat course a vaccination, if antibody levels show to be below 10 iu/ml. Occupational health nurses will advise staff off their individual requirements 6.2 Tuberculosis BCG vaccination is recommended for health care workers who may have close contact with patients or clinical materials, laboratory and pathology staff who will have contact with patients, clinical material or derived isolates. Unvaccinated, tuberculin negative individuals aged under 35 years in these occupations are recommended to receive BCG. There is no data on the protection afforded by BCG vaccine when it is given to adult aged 35 years and over. Staff Immunisation Policy V8 6
However, the British Thoracic Society guidelines, Control and prevention of tuberculosis in the United Kingdom: Code of Practice 2000, and guidance produced by NICE, Tuberculosis: Clinical diagnosis and management of tuberculosis, and measures for its prevention and control (2006) recommend that all health care workers should have a BCG irrespective of age who Are previously unvaccinated (that is without adequate documentation or a characteristic scar), and Will have contact with patients or clinical materials, and Are Mantoux negative Therefore staff over the age of 35 will be advised of the lack of evidence for the specific age group and the potential side effects of the vaccine and offer immunisation on an optional basis. 6.3 Varicella Varicella vaccine is recommended for susceptible health care workers who have direct patient contact and non-clinical staff who have regular patient contact but are not necessarily involved in direct patient care. Those with a definite history of chicken pox or herpes zoster can be considered protected. Health care workers, and non-clinical staff with a negative or uncertain history of chicken pox or herpes zoster should be serologically tested and vaccine only offered to those without VZ antibody. 6.4 Tetanus All health care workers, non-clinical staff and laboratory and pathology staff should be up to date with their routine immunisations. A total of five doses of vaccine at the appropriate intervals are considered to give satisfactory long term protection. Tetanus was given as part of the primary immunisation of infants nationally from 1961. Adults who have never been immunised against tetanus should receive three doses of tetanus containing product with an interval of one month between each dose. Td/IPV (Tetanus/ Diphtheria/ Inactivated polio vaccine) is recommended. The first booster dose should be given five years later (Td/IPV), and a second booster dose of Td/IPV should be given ten years after the first booster dose. 6.5 Diphtheria All health care workers, non-clinical staff and laboratory and pathology staff should be up to date with their routine immunisations. A total of five doses of vaccine at the appropriate intervals are considered to give satisfactory long term protection. Immunisation against Diphtheria on a national scale was introduced in the 1940 s. Adults who have never received a primary course of Diphtheria should receive three doses of Diphtheria containing product with an interval of one month between each dose. Td/IPV (Tetanus/ Diphtheria/ Inactivated polio vaccine) is recommended. The first booster dose of Td/IPV should be given five years later, and a second booster dose of Td/IPV should be given ten years after the first booster. Individuals who may be exposed to diphtheria in microbiology laboratories and clinical infectious disease units should be tested and, if necessary, given a booster dose of a diphtheria containing vaccine. An antibody test should be performed at least three months after immunisation to confirm protective immunity, and then boosters will be given at ten year intervals thereafter. In the case of Laboratory and pathology staff, where a history of diphtheria is not available, the primary course should be completed, and a booster five years later, then ten yearly after that. Staff Immunisation Policy V8 7
6.6 Poliomyelitis All health care workers, non-clinical staff and laboratory and pathology staff should be up to date with their routine immunisations. A total of five doses of vaccine at the appropriate intervals are considered to give satisfactory long term protection. Routine immunisation with Inactivated Poliomyelitis vaccine was introduced in 1956. The introduction of polio immunisation was accompanied by mass campaigns targeted at all individuals aged less than 40. Those who have never been immunised against polio should receive a primary course of an IPV containing product with an interval of one month between each dose. Individuals born before 1962 may not have been immunised or may have received a low potency polio vaccine; No opportunity should be missed to immunise them. The first booster dose should be given five years after their last dose. The second booster dose should be given ten years after the first booster dose. In addition lab workers who regularly handle faecal specimens, who are likely to be exposed to polio viruses, should be offered a polio booster every ten years. This will be risk assessed by the manager of these staff. 6.7 MMR All health care workers, non-clinical staff and laboratory and pathology staff should be up to date with their routine immunisations. MMR vaccine is especially important in the context of the ability of staff to transmit measles or rubella infections to vulnerable groups. While health care workers may need MMR vaccination for their own benefit, they should also be immune to measles and rubella in order to assist in protecting patients. Satisfactory evidence of protection would include documentation of: Having received two doses of MMR, or Positive antibody tests for measles and rubella. If there is an unreliable history of MMR, then the employee will be assumed as unimmunised and a blood test taken to check immunity. Those who show no immunity to rubella, mumps or measles will be offered two doses of MMR one month apart. 6.8 Influenza Influenza vaccine is highly effective in preventing influenza in staff and may also reduce the transmission of influenza to vulnerable patients. Influenza vaccine is therefore recommended for health care workers directly involved in patient care, who should be offered influenza immunisation on an annual basis. In addition to vaccination being offered within the Occupational Health department Matrons and other Nurse Specialists perform annual staff influenza vaccination in wards and departments. The Trust Board will provide guidance on which groups of staff will be offered vaccination on an annual basis. 6.9 Hepatitis A Laboratory and pathology workers, and staff who frequently come into contact with raw untreated sewage should be immunised against this, and should be identified following a local risk assessment. Staff Immunisation Policy V8 8
6.10 Other immunisations The following vaccinations will only be offered to staff handling or conducting research on the specific organisms and those working in higher risk settings, such as reference laboratories or infectious disease hospitals. They will be offered following local risk assessment to those staff considered at risk: Japanese encephalitis Cholera Meningococcal ACW135Y Smallpox Tick-borne encephalitis Typhoid Yellow fever Anthrax vaccine is also recommended for those who work with the organism, or those who handle specimens from potentially infected animals. Rabies vaccination is recommended for those who work with the virus, or handle specimens from imported primates or other animals that may be infected. 7 Training Occupational Health nursing staff will carry out the vaccinations and must be trained to the following standards Registered first level nurses with current NMC registration in accordance with the NMC Code of Conduct. Staff must have attended: A training session on the recognition and management of anaphylaxis Have attended a Basic Cardiopulmonary Resuscitation training session within the last year Individuals must be working in the clinical field on a daily basis and individually named. Annual attendance at a resuscitation training session and management of anaphylaxis update. Regular drug updates on specific PGD topics 8 Equality and diversity The Trust is committed to ensuring that, as far as is reasonably practicable, the way provide services to the public and the way we treat our staff reflects their individual needs and does not discriminate against individuals or groups on any grounds of any protected characteristic (Equality Act 2010). Staff Immunisation Policy V8 9
9 Monitoring compliance with the policy The policy would be measured using the monitoring and audit method described below. Standard/process/issue To ensure all staff are assessed correctly at preemployment stage and offered the correct vaccinations and for their proposed job, and to ensure all necessary immunity s are checked for their place of employment and their job. Monitoring and audit Method By Committee Frequency The audit will The The results The audit will look at a Occupational of the audit be carried selection of Health will be shared out on a pre-employment Department within the yearly basis medicals carried will Occupational out over the last undertake Health nursing 12 months to an annual team, as well ensure all audit of the as the Infection vaccines policy Prevention and required for the Control post are offered Committee and previous vaccinations are explored and evidence of these gained where necessary 10 Consultation and review The policy will be reviewed by the Occupational Health Nurses and Consultant Microbiologist using the most recent guidance issued by the Department of Health. 11 Implementation of policy (including raising awareness) All new Occupational Health Nurses will be trained on the issues raised in the policy and existing nursing staff will be updated as Department of Health changes are passed. Annual updates are placed in the Trust Newsletter to raise awareness of the signs and symptoms of Tuberculosis. Comms raise staff awareness of annual flu vaccination campaigns. New staff are advised at preemployment medical what immunisations are required for the post and how they can receive these. Existing staff will be made aware of any changes in guidance which will require them to seek further information from Occupational Health 12 References Green book -Immunisation against infectious disease. Updated chapters from -GOV.UK website. NICE Guidance. Tuberculosis Clinical Diagnosis and Management of Tuberculosis, and Measures for its prevention and Control. CG117 13 Associated documentation None. Staff Immunisation Policy V8 10