AV1300 STAFF INFLUENZA IMMUNIZATION AND EXCLUSION POLICY

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1 AV1300 STAFF INFLUENZA IMMUNIZATION AND EXCLUSION POLICY 1.0 PURPOSE To help ensure that those at greatest risk of complications and death from influenza are optimally protected through the appropriate use of influenza vaccine. 2.0 DEFINITIONS Antiviral Medication: Health Care Facility: Health Care Worker (Direct Care): Health Care Worker (Support Staff): Incubation Period: Medication (drugs) capable of preventing or treating viral infection. Oseltamivir (Tamiflu) is currently recommended as chemoprophylaxis against influenza. Oseltamivir is effective against both influenza A and B. At this time there is no change to the PHAC recommendation, made in November 2006, that health care providers in Canada not prescribe amantadine for the treatment or prevention of influenza during the current influenza season (Canada Communicable Disease Report, July 2008, para. 15). Until this profile changes and health authorities are officially notified, Amantadine is no longer recommended for the treatment or prophylaxis of influenza. Any facility providing ongoing care to groups of individuals, especially frail or elderly persons. This includes acute and residential care facilities. Any person carrying out paid or unpaid work in a health care facility within or through one of its auxiliary sites or in a client s home and has direct patient/resident/client contact including persons who undergo training or volunteer for any period of time between October to April. This includes but is not limited to all IH Health Care Workers regardless of their site of employment. Any person carrying out paid or unpaid work in a health care facility or one of its auxiliary sites (including persons who volunteer or undergo training for any period of time between October to April) and does not have direct contact with patients/residents/clients. The time interval between the initial contact with an infectious agent and the first appearance of symptoms associated with the infection. The incubation period of influenza is 4 days; duration of virus shedding is usually not more than 5 days after onset of symptoms. A person with influenza sheds virus for three to five days on average. If this virus infects someone else, it will take one to four days for the new case to show symptoms (PICNet, 2007, p. 49). Influenza: Influenza is a viral infection of the respiratory system. Policy Sponsor: Vice President, People and Clinical Services 1 of 9

2 Symptoms of influenza include fever, cough, sore throat, muscle ache, extreme fatigue and headache. Unlike the common cold and most other respiratory viruses commonly called "the flu", influenza virus infection can result in severe illness, pneumonia and even death. Influenza-Like Illness (ILI) or Respiratory Infection (RI) Case Definition for Respiratory Infection prior to Lab Confirmation: Influenza Outbreak: Influenza Vaccine: Transmission of Influenza: Medical Contraindication to Influenza Immunization: New or worsening cough and fever greater than 38 degrees Celsius, or a temperature that is abnormal for that individual. Additional symptoms may include myalgia, runny nose, sore throat, headache (Prevention and Control of Respiratory Outbreaks in Residential Care Settings, 2008, p. 4). An ILI or RI outbreak is defined as two or more cases of ILI/RI occurring in a unit/ facility area within a 7-day period amongst staff and/or residents. Influenza vaccine is prepared from killed influenza virus. It stimulates the formation of immunity (antibodies) against three strains of influenza virus likely to be circulating that season. Once vaccinated, the body requires approximately two weeks (14 days) to build antibodies to combat the influenza virus. Influenza is spread from person to person by inhalation of tiny droplets produced when a person infected with influenza coughs, sneezes, laughs or sings. It can also be spread by contact with infected respiratory secretions through articles such as bedrails, facial tissue or utensils. Influenza vaccine should not be given to persons who have had an anaphylactic or shock-like reaction to a previous dose of influenza vaccine or with known anaphylactic or shock-like reaction to eggs or any other component of the vaccine. Anaphylactic reaction consists of rapid onset of hives, swelling of the mouth and throat, difficulty breathing and shock. It is rare following influenza immunization. 3.0 POLICY Interior Health is committed to protecting patients/residents/clients, and staff from the potentially debilitating and sometimes fatal complications of influenza. Influenza vaccine is safe and effective and is the single most important way to prevent influenza-related complications and death. This policy has been developed to promote annual influenza vaccination of the staff and patients/residents/clients of Interior Health (IH). Immunization of health care staff is critical to the care of vulnerable clients in order to achieve the best protection for them. All staff members are advised they will be given leave without loss of pay to attend an Influenza Immunization Clinic when it is at their worksite. Policy Sponsor: Vice President, People and Clinical Services 2 of 9

3 As part of their duty to care for patients/residents/clients, health care workers are strongly encouraged to receive influenza immunization. Non-immunized staff assist in the spread of influenza and pose an unacceptable risk to patients/residents/clients and co-workers during outbreaks. Their exclusion under the authority of the local Medical Health Officer, during an outbreak, is a legitimate way to protect patients and is supported by the BC Communicable Disease Policy Committee, the Health Act Communicable Disease Regulations, and Community Care & Assisted Living Act: Adult Care Regulations. Staff who decline immunization for a medical reason will be required to provide appropriate documentation from their physician to the site designated Occupational Health Nurse Consultant (Those who do not provide this documentation shall be considered to not have valid medical contraindications for the purposes of applying the exclusion policy). See Prevention and Control of Respiratory Outbreaks in Residential Care Settings (2008, September) Appendix N Employee Influenza Immunization Medical Exemption Form. Exclusion In the event of a facility outbreak, staff who are not immunized and who are unwilling to take antiviral medication will be excluded from work without pay. Staff who choose to take antiviral medication do so at their own expense. In addition to promoting annual influenza vaccination for prevention purposes, this program also provides mechanisms for identifying, preventing and controlling influenza outbreaks. See accompanying guideline document Prevention and Control of Respiratory Outbreaks in Residential Care Settings (2008, September) located on the Workplace Health and Safety Web page at: Prevention and Control of Respiratory Outbreaks.doc For the purposes of this policy, staff includes all employees, physicians, volunteers, and students who, as part of their duties, perform service for Interior Health. Objectives a) Immunization of Health Care Workers It is the expectation that health care workers will be immunized against influenza as a measure to prevent the spread of influenza to vulnerable populations and as part of their duty to care. The long-term objective set by the Ministry of Health Services and Interior Health is to have at least 80% of health care workers in residential care and 60% of acute care and community health care staff vaccinated. b) Immunization of Residents The objective set by the Ministry of Health Services and Interior Health is to have at least 90% of all residents vaccinated. c) Outbreak Management Policy Sponsor: Vice President, People and Clinical Services 3 of 9

4 4.0 PROCEDURES There are three objectives in relation to influenza outbreaks in health care settings: The rapid identification of outbreaks Implementation of appropriate control measures to contain and shorten the duration of the outbreak To reduce morbidity and mortality in affected persons Responsibilities Senior Management Endorse and provide necessary resources to support Interior Health s Staff Influenza and Exclusion Policy and Program. Manager /Supervisor Ensure staff are made aware of the Staff Influenza and Exclusion Policy and exclusion procedures. Model behaviour consistent with responsibility of duty of care. Attend and promote influenza in-service programs. Encourage employees to be immunized. Review staff influenza reports regularly and encourage non-immunized staff to take vaccine. Employee Become knowledgeable about vaccine by attending influenza in-service programs. Obtain yearly immunization; forward written documentation of vaccination given offsite to Occupational Health Nurse Specialist/Influenza Program RN. Report any Influenza Like Illness (ILI)/Respiratory Infection to your supervisor. Occupational Health Nurse Specialist/Influenza Program RN Support and promote IH s Staff Influenza and Exclusion policy. Collaborate with Infection Control Practitioner, Public Health Nursing to develop and deliver educational programs on influenza prevention. Collaborate with other HSA influenza team members (Infection Control Practitioner, Public Health Nursing, Medical Health Officer, Communications, Operations Management) to deliver influenza program in area of responsibility. Publicize influenza program. Collaborate with Infection Control Practitioner to minimize impact of outbreak situation, Coordinate immunization clinics in area of responsibility. Compile annual influenza records and provide to managers for use in outbreak situations and to Public Health for reporting to the Ministry of Health. Policy Sponsor: Vice President, People and Clinical Services 4 of 9

5 Infection Control Practitioner Collaborate with other HSA influenza team members (Occupational Health Nurse Specialist/Influenza Program RN, Public Health Nursing, Medical Health Officer, Communications, Operations Management) to deliver influenza program in area of responsibility. Collaborate with Occupational Health Nurse Specialist/Influenza Program RN, Public Health Nursing to develop and deliver educational programs on influenza prevention. Support and promote Interior Health s Staff Influenza and Exclusion Policy. Coordinate outbreak management response in facilities. Ensure infection control guidelines are followed through development and distribution of relevant materials and information. Public Health Nursing Collaborate with other HSA influenza team members (Infection Control Practitioner, Occupational Health Nurse Specialist/Influenza Program RN, Medical Health Officer, Communications, Operations Management) to deliver influenza program in area of responsibility. Collaborate with Infection Control Practitioner, Occupational Health Nurse Specialist/Influenza Program RN to develop and deliver educational programs on influenza prevention. Support and promote Interior Health s Staff Influenza and Exclusion Policy. Coordinate ordering and distribution of influenza vaccine. Compile and submit influenza immunization data to Ministry of Health for residents, and staff. Coordinate and offer immunization clinics in the community that any IH staff may attend. Medical Health Officer Consultation to facility management for outbreak management. Responsible for declaring an outbreak and responsible for declaring outbreak over. Policy Sponsor: Vice President, People and Clinical Services 5 of 9

6 MANAGEMENT OF STAFF EXCLUSION DURING AN INFLUENZA A and B OUTBREAK Five step Human Resources Guide Step one If an influenza outbreak is suspected, the facility Manager immediately contacts Medical Health Officer, Infection Control Practitioner and Occupational Health Nurse Specialist/Influenza Program RN Step two If Medical Health Officer declares Influenza Outbreak: 1. Manager of the site to review staff immunization records and contact the Occupational Health Nurse Specialist/Influenza Program RN.. 2. Occupational Health Nurse Specialist/Influenza Program RN to offer influenza vaccine to all non immunized staff without medical contraindication to vaccine. Step three Manager to contact Human Resources Consultant/Advisor and appropriate scheduling office regarding reassigning staff from or to other sites if required. Human Resources Representative advises local union officers of current situation and requirements. Step four Staff continue working if: Immunized more than 14 days prior to onset of outbreak and free of influenza like illness (ILI) or Respiratory Infection (RI) symptoms. Immunized staff may be assigned to any worksite whether or not an outbreak exists. Staff excluded from work (contact scheduling) as follows: Staff must self report any influenza like (ILI) or RI symptoms. All staff with ILI/RI symptoms should be excluded from work at all facilities for at least 5 days from symptom onset or until symptom free, whichever is longer. Entitled to sick benefits as per terms and conditions of employment. Non immunized staff with NO influenza like illness (ILI) excluded from working at outbreak facility with no pay unless: a) Taking Antiviral medication as recommended (protects staff during outbreak period). b) Takes Antiviral medication as recommended and obtain vaccine (provides immunity for the remainder of the influenza season). Non-immunized staff that have been exposed to influenza but have not developed respiratory infection symptoms are restricted from working (no pay) at non-outbreak facilities for at least four days following the exposure. Non-immunized, excluded staff members must not have developed respiratory infection symptoms and must wait one incubation period (four days) from the last day of work at the outbreak facility prior to working in a non-outbreak facility (PICNet, 2007, p. 51). Staff with proof of valid medical contraindications to both influenza vaccine and antivirals who are excluded from outbreak facility during an outbreak, will be reassigned if possible; if not possible, they will be excluded from outbreak facility with pay. Policy Sponsor: Vice President, People and Clinical Services 6 of 9

7 Step five If exclusions critically compromise staffing levels, contact Medical Health Officer and discuss options. Policy Sponsor: Vice President, People and Clinical Services 7 of 9

8 Interior Health Authority Page 8 of 9 AV01300 Staff Influenza Immunization and Exclusion Policy Revised September 2008

9 5.0 REFERENCES 1. BC Communicable Disease Policy Committee FINAL October 10, 2007, retrieved on August 18, 2008 from 0POLICY% pdf 2. BC Communicable Disease and OHSAH Influenza and the Healthcare Workforce: Identifying Barriers and Facilitators to Vaccine Uptake in BC, May 23, Canadian Communicable Disease Report (July 2008). National Advisory Committee on Immunization (NACI): Statement On Influenza Vaccination for the Season, Volume 34 ACS-3July /index-eng.php 4. Community Care & Assisted Living Act: Adult Care Regulations. B.C. Reg 538/80. Retrieved on August 19, 2008 from 5. HEABC letter to CEOs dates September 22, Ministry of Health, BC Communicable Disease Policy Committee (September 26, 2006) 7. Potter J, Stott DJ, Roberts MA et al. "Influenza vaccination of health care workers in long term care hospitals reduces the mortality of elderly patients." J. Infect Dis. 1997;Jan; 175: Provincial Infection Control Network BC (2007). PICNet Reference For Respiratory Outbreak Prevention & Control Guidelines, June The Health Act. Health Act Communicable Disease Regulations. B.C. Reg4/83. Retrieved on August 18, 2008 from Wilde JA, McMillan JA, Serwint J. "Effectiveness of influenza vaccine in health care professionals - a randomized trial". JAMA. 1999; 281(10): Workplace Health and Safety Policy AV1300 Staff Influenza Immunization and Exclusion September Policy Sponsor: Vice President, People and Clinical Services 9 of 9 Policy Steward: Manager Employee Health and Wellness Date Approved: October 2003 Date(s) September 2008 (R)

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