PIC Education Committee- Online Educational Modules


Healthcare Workers and Immunizations


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General Information:

Healthcare workers should be up-to-date on their immunizations to protect themselves, their families and their patients. Hospital-acquired, or nosocomial, infections can occur readily because healthcare workers come into contact with various infectious agents, can themselves become ill and infect others, and because patient’s immune systems are often particularly vulnerable. Vaccine-preventable diseases such as influenza and pertussis can be spread before a healthcare worker develops symptoms of the disease and, therefore, can be unknowingly spread. Other vaccine-preventable agents, such as hepatitis B virus, can live in the environment and be spread by poor environmental sanitation or infection control practices even by a healthcare worker who is not ill. Cases of nosocomial infections transmitted to patients by the personnel caring for them have been documented. It is estimated that about 1.7 million hospital-acquired infections and 99,000 consequential deaths occur each year.

The diseases that healthcare workers should be immune to include hepatitis B, influenza, pertussis, measles, mumps, rubella, varicella and tuberculosis (TB). Employers must provide hepatitis B vaccine to employees who may be exposed to blood or other infectious agents as mandated by the Occupational Safety and Health Act. Influenza vaccine and TB screening should be offered annually.

In addition to being immunized, healthcare workers can protect their patients through other infection control measures including frequent hand washing, using sterile techniques, and staying home when ill.

The hesitation of some healthcare workers to receive an annual influenza vaccine has led to debate regarding the rights of individuals versus the responsibilities of professionals. In the past, only about one-third of healthcare workers have followed the recommendation to get a yearly influenza vaccine. Many hospitals have started special programs to get more healthcare providers immunized and these have helped to increase immunization rates; however, some people do not feel they should be required to get the vaccine. Since institutions may be liable if a patient gets influenza from one of their healthcare providers, institutions may begin to require the vaccine for their employees, move them to non-patient care areas during influenza season or require the use of masks for un-immunized employees.

TO LEARN MORE ABOUT THE TOPICS COVERED IN THIS SECTION, PLEASE VISIT THE FOLLOWING:

Diseases and Vaccines:
http://www.phillyimmunize.org/vpdvstudy.php
Hospital-Acquired Infections:
www.who.int/csr/resources/publications/whocdscsreph200212.pdf
http://www.cdc.gov/ncidod/dhqp/hai.html 
Influenza Vaccine and Healthcare Workers:
http://www.nfid.org/influenza/professionals_workersflu.html
http://www.nfid.org/pdf/publications/hcwmonograph.pdf 
Occupational Safety and Health:
www.osha.gov

Specific Information: 
Vaccines Needed for Healthcare Workers:
Because of the high exposure rates to communicable and infectious diseases and their potential spread of diseases to vulnerable populations , healthcare workers are recommended  to have immunity to certain diseases or receive particular vaccines.  

  • Hepatitis B -- The Occupational Safety and Health Act “mandates that Hepatitis B vaccine be made available at the employer’s expense to all health-care personnel who are occupationally exposed to blood or other potentially infectious materials” The vaccine includes a three-dose intramuscular series with the first dose administered immediately, the second in one month, and the third dose at five months after the second.  To learn more about hepatitis B, go to (link to VPDV module.)  
  • Influenza -- The influenza vaccine is reformulated annually, and healthcare workers are recommended to receive it every year.  To learn more about influenza, go to (link to VPDV module).

  • Pertussis (As part of the tetanus-diphtheria-acellular pertussis or Tdap vaccine) – Adults, and healthcare workers in particular, have been the cause of numerous pertussis outbreaks including those in NICUs. To learn more about pertussis, go to (link to VPDV module).
  • Measles, Mumps, and Rubella -- Healthcare workers should be immune to these three infectious viruses either by disease history, serology, or vaccination history. It is easy to misdiagnose these diseases, so serology or vaccination history are preferred. To learn more about measles, mumps or rubella, go to (link to VPDV module).
  • Varicella: Healthcare workers should be immune to varicella. Immunity should be confirmed by serology or vaccination status. To learn more about the varicella virus, go to (link to VPDV).
  • Tuberculosis (TB): Screening for tuberculosis is recommended annually. TB is caused by the bacteria Mycobacterium tuberculosis and is found in a patient’s lungs. If left untreated, TB can be fatal. It is transmitted by airborne droplets and is extremely contagious. The signs and symptoms of TB include generalized weakness, weight loss, fever, night sweats, coughing, chest pain, and possibly blood in the sputum. While not everyone who carries the bacteria will develop active TB, they will test positive in future screenings.

It is suggested that healthcare workers, like other adults, be up-to-date on vaccines recommended for adults in the population. Some vaccines are recommended only for subpopulations of adults. The adult immunization schedule can be found at http://www.cdc.gov/vaccines/recs/schedules/default.htm#adult. Some of these include hepatitis A, pneumococcus, and varicella zoster. To learn more about these vaccines and the diseases they prevent, go to (link to VPDV module).
Immunization Records-- Healthcare workers should maintain an updated copy of all health records including documented disease exposure and vaccination history. Healthcare institutions will likely require copies of immunization history as a condition of employment. 

Responsibility of Professionals:
In accordance with the “do no harm” policy adapted by many healthcare providers, it is necessary for healthcare workers to protect the health of their patients. This includes using sterile techniques, frequent hand-washing, and other infection control measures. It also means not transmitting diseases to your patients because you are ill. Getting immunized and staying home when you are ill are important steps in protecting the health of your patients. The non-immunized health care worker or one for whom immunity has waned places patients at risk for acquiring illness.  
Hospital-acquired infections- also known as nosocomial infections, are infections that are acquired within the hospital following admission for a reason other than that infection. Patients develop these “nosocomial infections” due to decreased immunity and increased medical procedures and invasive techniques. These infections often develop at surgical sites, in the urinary or respiratory tracts, in vascular catheters, or in the blood (septicemia).  

    • It is estimated that in the United States, about 1.7 million hospital acquired infections and 99,000 consequential deaths occur each year.

 Individual Responsibility versus Individual Rights:
Do healthcare workers have the right not to be immunized thereby placing their patients at risk of encountering vaccine-preventable diseases or should the government allow employees to maintain their individual rights? Some healthcare workers feel they should be able to refuse immunizations. However, it is important to remember that working in a healthcare setting increases your risk of getting certain diseases, so while immunizations are important in protecting your patients, they are also meant to protect you, your family and your co-workers. 

Occupational Safety and Health Act of 1970- This Act, issued by the Department of Public Health, provides the necessary guidelines to aid in lowering or preventing disease and injury among health care workers by stating that the nation will ensure “safe and healthful working conditions for every working man and woman in the Nation and to preserve our human resources by providing medical and other criteria that will ensure, insofar as practicable, that no workers will suffer diminished health, functional capacity, or life expectancy as a result of their work experience” (Directory of Occupational Safety and Health Information For Hospitals, 1998).  

A Closer Look: Influenza Vaccine
Recently, there has been debate about whether healthcare workers can and should be required to get an annual influenza vaccine as a condition of employment. Data suggests that when left to decide on their own, only about 36% of healthcare workers get an annual influenza vaccine.

Influenza and Professional Responsibilities:
Because influenza has been transmitted from hospital workers to patients, healthcare organizations have made an extreme effort to improve their vaccination rates through various programs and on-site vaccine clinics. While these efforts have increased healthcare worker immunization rates, there is still a significant percentage of healthcare workers who do not get their annual influenza vaccine. Because these efforts have not succeeded and institutions may be liable if a patient succumbs to a hospital-acquired infection, in the future, employees may be required to receive an annual influenza vaccine, wear masks, or be moved to a non-patient care area during influenza season.  

Influenza and Individual Rights and Responsibilities:
During influenza season, individuals who did not receive their annual vaccine are more likely to catch and transmit influenza to those with whom they are in contact, including their patients, their own families, and their co-workers. Despite this, some individuals may still not wish to get the influenza vaccine. These healthcare workers should pay extra attention to other infection control measures and should stay home if they are ill during influenza season. 

TO LEARN MORE ABOUT THE TOPICS COVERED IN THIS SECTION, PLEASE VISIT THE FOLLOWING:
Diseases and Vaccines:
http://www.phillyimmunize.org/vpdvstudy.php
Tuberculosis and the Screening Process:
http://www.cdc.gov/tb/pubs/tbfactsheets/tb.htm 
Hospital-Acquired Infections:
www.who.int/csr/resources/publications/whocdscsreph200212.pdf
http://www.cdc.gov/ncidod/dhqp/hai.html 
Influenza Vaccine and Healthcare Workers:
http://www.nfid.org/influenza/professionals_workersflu.html
http://www.nfid.org/pdf/publications/hcwmonograph.pdf 
Occupational Safety and Health:
www.osha.gov

 

UPDATED: July 2009

 

 

 

©2006 Philadelphia Immunization Coalition