OCCUPATIONAL HEALTH SERVICE

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Hugo Nicholson
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1 OCCUPATIONAL HEALTH SERVICE Immunisation Policy S Strapp OH Nurse Manager Review date: August 2016

2 Contents 1 Introduction 2 Policy Statement 3 Purpose 4 Roles and Responsibilities a) The University b) Managers/Program Leaders/Heads of Year c) Occupational Health service d) Students 5 Immunisation Program 6 Exposure Prone Procedures (EPP) 7 Universal Precautions 8 Management of Students who are non-responders to Hepatitis B vaccine 9 References

3 1 Introduction For their own protection and that of patients/service users all University students working in clinical or other high risk areas will be offered immunisation against certain infectious diseases and screening for tuberculosis. This policy aims to give information and guidance to both managers and students on the required screening and vaccinations required to prevent the spread of certain infectious diseases to others they work with or the patients/service users who they provide care for. The Health Act (2006) states that Occupational Health services must include health screening for Communicable diseases, the management of health care associated infections and the provision of relevant vaccinations so that health care workers are free and protected from exposure to communicable infections during the course of their work. Health Clearance for Tuberculosis, Hepatitis B, C and HIV: New health care Workers (DOH 2007) states that all new health care workers (including student midwives) who perform exposure prone procedures will be non infectious for HIV (antibody negative) Hepatitis B (negative) and Hepatitis C (antibody negative). 2 Policy Statement It is the duty of each NHS organisation to keep in place arrangements for the monitoring and improving the quality of health and social care provided by and for that organisation. The University of Chester is committed to this policy and its principles to prevent the spread of infectious diseases. This policy applies to those students who have chosen to study a health or social care pathway 3 Purpose All students entering health and social care professions have a professional duty to ensure that take reasonable steps to avoid putting the health of others at risk. The purpose of this procedure is based on national guidance and provides a framework for managers and students to identify the risks associated with certain infectious diseases and the appropriate action to take to protect themselves and their patients/service users. The range of screening and immunisation offered will depend on the risk to the student including the extent of contact with patients, service users or clinical material obtained from patients/service users.

4 4 Roles and Responsibilities a) The University The Health and safety at Work Act (1974) and the Management of Health and safety at Work Regulations (1999) states that the University has a legal duty to protect the health of its staff and students. The Control of Substances Hazardous to Health Regulation (2002) states that the University has a legal duty to assess the risk of infection and take appropriate precautions to protect health. b) Managers/Program Leaders/Heads of Year To carry out risk assessments for their departments and identify any additional work practices which may pose a significant risk. To ensure that Occupational Health staff have access to all new entry students during induction. To ensure that students are able to attend Occupational Health appointments. c) Occupational Health Service To recommend immunisation against infectious diseases based on current evidence based guidance. To review the immunisation history of individuals via the pre-placement questionnaire or pre-placement interview; informing the individual whether an update of their immunisations is necessary. To ensure immunisations are delivered by appropriately qualified practitioners who have attended annual immunisation and vaccination training programs and working under current General written Instructions. To maintain records according to departmental protocols and relevant legislation. d) Students To ensure they take reasonable care of their own health and safety. To attend Occupational Health to have their vaccinations updated, for their own protection and that of other students and patients. To keep a personal record of their immunisation history. Managers have the right to be informed if students are non-immune to micro-biological agents e.g. TB.

5 5 Immunisation program. Evidence of freedom from and immunity to the following infections listed in the table below will be ascertained. In cases where individuals are assessed as non-immune to certain infections, vaccination will be provided. Immunisation Indication Student group Evidence required Hepatitis B Measles (MMR) Rubella Varicella Mantoux skin test T Spot test Tuberculosis (BCG) Hepatitis C Human Immunodeficiency Virus (HIV) antibodies antibodies/incomplete primary course antibodies antibodies/past medical history No BCG scar No BCG scar/documented pos No BCG scar/negative EPP group EPP group Clinical students undertaking exposure prone procedures Clinical students undertaking exposure prone procedures documented evidence from Occupational Health documented evidence from Occupational Health/GP documented evidence from Occupational Health/GP past medical history BCG scar/positive BCG scar/positive BCG scar/positive Laboratory report Laboratory report Hepatitis B sag EPP group Clinical students undertaking exposure prone procedures Laboratory report

6 6 Exposure-Prone Procedures Patients/service users may acquire Hepatitis B or C or HIV from an infected health care worker who performs exposure-prone procedures (EPP) on patients. Consequently new student Midwives will require additional health screening/clearance to establish that they are not chronically infected with Hepatitis B, C or HIV and free from infection before admission to the program and at the latest before they go out in practice. These measures are not intended to prevent those who are infected with blood borne viruses from training or working in health care but to restrict them from working in areas where their infection may pose a risk to patients in their care. 7 Universal Precautions Protection of students at risk is increased by active immunisation; however this does not negate the importance for all students to adopt the standard principles of infection control e.g. safe handling and disposal of sharps and effective hand washing, to reduce the risk of occupational exposure to infection. 8 Management of students who are non responders to Hepatitis B vaccine One reason for failure to respond to the Hepatitis B vaccine (<10ml U/mL anti-hbs) is pre-existing hepatitis B infection. Vaccine non-responders who perform exposure-prone procedures must be tested, with informed consent, for evidence of hepatitis infection (HbsAg). Thereafter they are required to undergo annual testing for markers of infection. An alternative manufacturers Hepatitis B vaccine (Fendrix)will be offered after failure to convert to immunity after two standard courses of vaccine. Students found to be infected with Hepatitis B should be managed according to current Department of Health guidance. Vaccine non-responders who do not perform exposure-prone procedures will be counselled by an Occupational Health Nurse Adviser about possible reasons for their non-response, offered testing for HbsAg, and further alternative manufacturers vaccine.

7 9 References Chief Medical Officer. (2003) Protecting Women against Rubella: switch from Rubella vaccine to MMR. Department of Health. (2007) Health Clearance for Serious Communicable Diseases: New Health Workers. Department of Health. (2003) Guidance on the Management of HIV/Aids Infected Health Workers and Patient Notification. Department of Health (2002) Hepatitis C Infected Health Workers. HSC. (2002/10) Department of Health. (2006) (green book) Immunisation against Infectious Diseases. Department of Health. (2006) The Health Act: Code of Practice for the Prevention and Control of Health Associated Infections. HSC (93)40. Protecting Health Workers and Patients from Hepatitis B. Chief Medical Officer, Professional Letter. (2003) Chicken Pox (Varicella) Immunisation for Health Workers.

Pre-employment Health Assessment Questionnaire

Pre-employment Health Assessment Questionnaire (for use from 1 October 2010) University Occupational Health Service 10 Parks Road Oxford OX1 3PD Telephone: (01865) 282676 Fax: (01865) 282678 (+44 1865