This document applies to
All Horizon
Fredericton Area
Miramichi Area
Moncton Area
Saint John Area
Upper River Valley Area
Horizon Health Network Policy & Procedure Manual
Immunization of Personnel POLICY All employees and non-employee personnel are required to comply with immunization and communicable disease surveillance requirements. All new employees (as a condition of employment), medical staff, students, FacilicorpNB personnel, volunteers, and others who have direct patient contact are required to: • Provide acceptable proof of immunization/immunity against red measles, rubella, varicella (chicken pox), pertussis (whooping cough) and hepatitis B. • Provide acceptable proof of tuberculosis (TB) screening. • Agree to undergo post-exposure evaluation as necessary. All current employees are offered immunizations to maintain appropriate immunity during their employment. For current employees with direct patient contact, refusal to comply with appropriate immunizations will require change in placement and limit future placement opportunities. Exemptions to this policy for medical reasons are assessed on a case by case basis, having regard for potential risks to the individual and to patients; whether risks can be mitigated to an acceptable level; and options available in the event of an outbreak or exposure. DIRECTLY AFFECTED All employees, medical staff, students, FacilicorpNB personnel, volunteers, and others who have direct patient contact. PROCEDURE 1. Before performing service within a Horizon owned or operated facility, employees and nonemployee personnel providing direct patient care agree to complete appropriate immunizations, or provide documentation to Employee Health confirming they have: • Had a series of Hepatitis B immunization and laboratory documentation of immunity. • Proof of initial documentation of a 2-step tuberculin skin test (TST) as well as any additional testing within the preceding 12 months, if previous TST records are not available, screening will be provided. • Proof of 2 measles, mumps and rubella (MMR) vaccinations, or documentation of laboratoryconfirmed mumps, and serological evidence of immunity to measles and rubella or a valid contraindication to the MMR vaccine. NOTE:
This is a CONTROLLED document. Any document appearing in paper form is not controlled and should ALWAYS be checked against the electronic version prior to use. Printed on: 23/07/2014
Policy Number: Section: Issued by: Approved by:
HHN-OD-000 Organizational Development VP Organizational Development EMT 17-10-2012
Date: Original Date: Revision Date(s):
23 04 2012 17-10-12 Page 1 of 3
Immunization of Personnel
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• Proof of tetanus, diphtheria and/or pertussis vaccination within past 5 years. • Proof of 2 doses of varicella vaccine or serological evidence of immunity to varicella. 2. Employee Health meets with all new and current employees as necessary, and in the absence of acceptable documentation, provides the following interventions as required: Hepatitis B Employee Health initiates Hepatitis B immunization and arranges for serological testing at the completion of the vaccine series to establish antibody response, and the need for booster doses as required if the first course failed to provide protection. Where there is failure to seroconvert following the second series, Employee Health reviews the results of the blood work with the employee, discusses the need for additional caution when working with blood and body fluid, and provides information on alternate post-exposure treatment regimes. Note: Non-employee personnel may be offered this vaccination based on work being performed or if an occupational blood and body fluid exposure has occurred. Measles/Mumps/Rubella Employee Health provides a requisition for appropriate blood work or vaccination as required. Tuberculin Skin Test (TST) (a diagnostic tool for tuberculosis) If TST records are not available Employee Health provides testing for employees and nonemployee. Persons who test positive or are a previously known positive responder will be referred to a physician and are required to have documentation of a chest x-ray (within the past 12 months) or a negative Interferon Gamma Release Assay for latent tuberculosis infection (IGRA) test. Employee Health conducts post-exposure evaluation & intervention for all at risk employees and non-employee personnel. Tetanus/Diphtheria/Pertussis One adult Tdap vaccination is provided upon employment and then at five year intervals. Varicella Employee Health provides a requisition for appropriate blood work or provides vaccination as required. Influenza Annual influenza vaccination is strongly recommended for all employees and non-employee personnel. When influenza precautions are required to prevent noscomial transmission as directed by Infection Prevention and Control, those who have not received the current influenza vaccine must wear a surgical mask at all times when within 6 feet of a patient. Individuals not complying with these requirements are not eligible to work. Employee Health will provide the names of vaccinated and unvaccinated employees to the managers for the protection of patients.
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DEFINITIONS Employee - a person, including a salaried physician, who is hired by Horizon Health Network for a wage, salary, fee or payment to perform work but does not include an independent contractor and its representatives. Non-Employee Personnel – a term which collectively refers to all individuals, other than employees, who provide services to Horizon (paid or unpaid) and/or require access to Horizon facilities or other infrastructure (e.g. network access). This includes, but is not limited to, independent contractors and their representatives, Medical Staff, students and volunteers. Medical Staff - those medical practitioners appointed to Horizon Health Network who are granted privileges by the Board of Directors, and shall include all members of the dental profession who have been granted privileges at Horizon Health Network. (Some physicians may also be employees of the RHA based on the contract they have with the organization) Others - individuals, other than employees, contractors, Medical Staff, students and volunteers, who provide services to Horizon, paid or unpaid, and/or require access to Horizon facilities, information or networks. Students - individuals who attend an accredited educational institution and are involved in practicums and placements within Horizon Facilities. Volunteers - approved individuals or groups who provide services to benefit Horizon Health Network and our patients; who freely give their time, effort and talents without payment; spiritual care providers, Foundations, auxiliaries and other organizations approved to provide services to our patients without remuneration from Horizon. Acceptable Proof of Immunization – completed health assessment form signed by a physician, an immunization record form or a provincial immunization record. RELATED DOCUMENTS Immunization Policy (HHN-CP-000) REFERENCES Esolen, L.M., Kilheeney, K.L, & Merkle, R.E. (2011). An alternate approach to improving healthcare worker influenza vaccination rates. Infection Control and Hospital Epidemiology, 32(7),703705. Loeb, M., Dafoe, N., Mahony, J., John, M., Sarabia, A., Glavin, V., Webby, R., Smieja, M., Earn, D., Chong, S., Webb, A., & Walter, S. (2009). Surgical mask vs N95 respirator for preventing influenza among health care workers. Journal of American Medical Association, 302(17), 1865-1871. Public Health Agency of Canada (2006). Canadian Immunization Guide (7th ed.). Ottawa: Ministry of Health Public Health Agency of Canada (2007). Canadian Tuberculosis Standards(6th ed.). Ottawa: Ministry of Health Public Health Agency of Canada (2010). Guidelines for the prevention and control of mumps outbreaks in Canada. CCDR 2010; 36(S1): 1-46. Public Health Agency of Canada (2010). National Advisory Committee on Immunization: Varicella vaccination two-doses recommendations. CCDR 2010; 36(ACS-8):1-26 Public Health Agency of Canada (2011). National Advisory Committee on Immunization: Statement on seasonal influenza vaccine for 2011-2012. CCDR 2011; 37(ACS-5): 1-55.