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Clinical Staff Health & Safety

Pre-Employment Health Screening and Immunisation

To ensure the health and immune/immunisation status of prospective clinical staff and paid volunteers is current and appropriate at the time of employment so that they are not unnecessarily exposed to infection.

Process

The organisation encourages and supports current clinical staff and volunteers to ensure their health and immune/immunisation status is current and appropriate so that they and/or patients are not unnecessarily exposed to infection.

All prospective clinical staff and volunteers who have patient contact are screened and assessed by definite history, vaccination and/or serological evidence via the online Clinical Services Personnel Immunisation form. The form can be found on the intranet in the Human Resources Directorate section under immunization.

Category A staff and volunteers are required to provide evidence of vaccination history and/or immunity before employment/rostering.

The organisation maintains and regularly updates immune status/immunisation records of all clinical staff and volunteers during their employment.

Further reading and guidance can be found in HR policy Immunisation located on Connect.

Definitions

The following vaccine preventable disease (VPD) risk categories can be used to guide MRSA and vaccination requirements:

Risk CategoryStaff

Category A:

Direct contact with blood or other body substances

All clinical staff, volunteers and students, maintenance staff who service equipment, those who are responsible for cleaning and disposal of contaminated materials including waste

Category B:

Indirect contact with blood or other body substances

Includes staff who rarely have direct contact with patients or with blood or body substances. These staff may be exposed to droplet or airborne VPDs but are unlikely to be at risk of blood-borne diseases.

Category C:

Minimal Patient Contact

Other staff groups that have no greater exposure to VPDs than the general public (e.g. Administrative positions)

Screening of Staff by Contact Category

Risk ConditionCategory ACategory BCategory C
Skin conditions YesYesYes
MRSA YesNoNo
Diphtheria/Tetanus YesYesYes
Measles-Mumps-Rubella (MMR) YesYesYes
Whooping Cough (Pertussis) YesYesNo
Chicken pox (Varicella) YesYesNo
Hepatitis B YesNoNo
Tuberculosis YesNoNo
Influenza YesYesYes
Hepatitis A NoNoNo

Personal Medical History

All prospective clinical staff and volunteers who have direct patient contact are health screened and assessed by definite history and/or required to provide vaccination or serological evidence to the following:

  • Exfoliative and weeping skin conditions
  • Latex allergy
  • Immune disorders (including medications such as immunosuppressants)
  • Methicllin-Resistant Staphylococcus aureus (MRSA)
  • Diphtheria-tetanus
  • Measles-Mumps-Rubella (MMR)
  • Whooping cough (Pertussis)
  • Chicken Pox (Varicella)
  • Hepatitis B
  • Tuberculosis
  • Influenza
  • Hepatitis A.

Skin Conditions (Non-Infectious)

All prospective clinical staff and volunteers with either shedding and/or weeping skin conditions (allergic eczema, psoriasis and exfoliative dermatitis) or damaged skin may be readily colonised by micro-organisms (e.g. MRSA). These clinical staff may not be harmed by these micro-organisms but may spread them widely to patients. Staff will be advised of the problems posed by their skin conditions and to seek medical attention.

MRSA Screening

Further reading and guidance can be found in HR policy MRSA Screening located on their intranet site.

Immunisation

Each individual has a responsibility to ensure their immunisation status is current and appropriate. Vaccination and/or screening is undertaken by the preferred provider identified by Workforce Services.

Further reading and guidance can be found in HR policy Immunisation located on their intranet site.

Metropolitan Perth

Any clinical staff who wish to have vaccinations should contact Workforce Services to arrange for immunisation.

Regional WA

Any paid volunteer who wishes to have vaccinations should contact their Regional Manager or Assistant Regional Manager in country areas to arrange for vaccination. Clinical staff should contact Workforce Services to arrange for immunisation.

Contact Criteria

Diphtheria/Tetanus – Category A Clinical Staff/Volunteers

  • Record a history of having received a primary course of at least 3 doses of diphtheria-tetanus vaccine (dT). Immune clinical staff/volunteers should be strongly advised to undertake dT booster doses 10 and 20 years after the primary course.
  • Clinical staff/volunteers who reach the age of 50 years without receiving a booster dose of tetanus-containing vaccine in the previous 10 years, are strongly advised to undertake a further dose dT or preferably diphtheria-tetanus-pertussis (dTpa), if a booster dose of pertussis-containing vaccine, had not been given previously, to protect against pertussis (whooping cough).
  • Unvaccinated prospective clinical staff/volunteers are strongly advised to undertake 3 doses of dT containing vaccine at minimum monthly intervals. The first of these doses should be dTPa to provide boosting to natural immunity from exposure to pertussis.
  • All immunisation records are to be submitted confidentially by the employee/volunteer to Workforce Services.

Measles – Category A, B and C Clinical Staff/Volunteers

  • All prospective clinical staff/volunteers must provide a record of documented history of having received a primary course of least 2 doses of measles-containing vaccine administered at least one month apart or documented serological (i.e. blood test) evidence of immunity to measles.
  • Prospective clinical staff/volunteers without a definite documented history of measles vaccination must undergo blood testing at the earliest opportunity to determine immunity. Non-immune clinical staff/volunteers must undertake 2 doses of measles-mumps-rubella (MMR) vaccine at minimum monthly intervals, unless pregnant or immunosuppressed.
  • All immunisation records are to be submitted confidentially by the employee/volunteer to Workforce Services.

Mumps and Rubella (German Measles) - Category A and B Clinical Staff/Volunteers

  • Record a documented vaccination history of having received a rubella-containing vaccine or documented serological (blood test) evidence of immunity to rubella.
  • Non-immune male and female prospective staff/volunteers are strongly advised to undertake MMR vaccination for their own protection and to avoid transmitting rubella to pregnant fellow employees/volunteers.
  • Testing for immunity to rubella should be undertaken 2 months after vaccination and revaccinated if remain non-immune.
  • All immunisation records are to be submitted confidentially by the employee/volunteer to Workforce Services.

Whooping Cough (Pertussis) – All Category A and B Clinical Staff/Volunteers

  • Record a documented history of having received a primary course of at least 3 doses of pertussis-containing vaccine.
  • Non-immune prospective clinical staff/volunteers are strongly advised to undertake a primary course of pertussis-containing vaccine at minimum two monthly intervals.
  • A single booster dose (given as dTpa) is strongly advised for prospective clinical staff/volunteers have not previously had a documented booster dose of dTpa.
  • All immunisation records are to be submitted confidentially by the employee/volunteer to Workforce Services.

Chickenpox (Varicella Zoster) – Category A and B Clinical Staff/Volunteers

  • Record a definite history of having had chickenpox/shingles, documented history of having received 2 doses of varicella vaccine or documented serological (blood test) evidence of immunity to chickenpox.
  • Prospective clinical staff/volunteers without a definite history of chicken pox or shingles are advised to undergo blood testing at the earliest opportunity to determine immunity. Non-immune clinical staff/volunteers are strongly advised to undertake 2 doses of varicella vaccine at minimum monthly intervals, unless pregnant or immunosuppressed.
  • All immunisation records are to be submitted confidentially by the employee/volunteer to Workforce Services.

Hepatitis B – Category A Clinical Staff/Volunteers

  • Record a documented history of having received a primary course of 3 doses of hepatitis B vaccine or documented serological (blood test) evidence of immunity post hepatitis B vaccination or having had previous hepatitis B infection.
  • Non-immune prospective clinical staff/volunteers are strongly advised to undertake 3 doses of hepatitis B vaccine at an interval of 1 to 2 months between the first and second dose with a third dose 2 to 5 months after the second dose.
  • Serological (blood) testing to confirm immunity is undertaken 1 - 2 months after the third dose of vaccine. If protective antibody levels are not reached following the third dose of vaccine, hepatitis B carriage (HBsAg) should be investigated.
  • Clinical staff/volunteers who do not have adequate hepatitis B antibody levels are strongly advised to undertake a further 3 single doses of vaccine at monthly intervals with serological (blood) testing four weeks after the last dose.
  • Persistent non-responders are informed about the need for hepatitis B immunoglobulin (HBIG) within 48 hours of parenteral exposure to hepatitis B.
  • Booster doses of hepatitis B vaccine are no longer recommended. Serological (blood) testing does not need to be repeated following initial testing post vaccination.
  • All immunisation records are to be submitted confidentially by the employee/volunteers to Workforce Services.

Tuberculosis – Category A Clinical Staff/Volunteers

  • Record a documented history of baseline TB screening (results from previous tests are transferable to all subsequent workplaces).
  • Prospective clinical staff/volunteers at risk of future occupational exposure to TB or have a history indicating risk for prior TB infection (i.e. country of birth has a high TB incidence, residence and/or work in a high incidence country for more than 6 months, past history of work or personal contact with TB) and who have never had a Tuberculin skin or equivalent test performed or are at risk of active or latent TB infection are strongly advised to attend the preferred provider identified by Workforce Services. 
  • All screening records are to be submitted confidentially by the employee/volunteer to Workforce Services.
  • BCG vaccine is no longer recommended for health care workers.

Influenza

  • Influenza vaccination is strongly advised each year (March – May). Vaccination is provided by SJA as part of the annual ongoing clinical staff/volunteers health immunisation program.

Hepatitis A*

  • Record a documented history of having received a primary course of 2 doses of hepatitis A vaccine or 3 doses of combined hepatitis A/B vaccine.
  • Hepatitis A vaccination is only indicated for clinical staff/volunteers who live with or make frequent visits to remote Indigenous communities in WA, who are in regular contact with untreated sewerage and carers of the intellectually disabled.
  • All immunisation records are to be submitted confidentially by the employee/volunteer to Workforce Services.

References

Department of Health Government of Western Australia. Tuberculosis control program policy documents. Available from http://www.health.wa.gov.au/acc/tb/hp.cfm 

Department of Health Government of Western Australia. (OD 0478/13). Infection prevention and control of Methicillin-resistant Staphylococcus aureus (MRSA) in Western Australian healthcare facilities. Perth, Australia: Department of Health Government of Western Australia.

Department of Health Government of Western Australia. OD 0388/12. Health care worker immunisation policy. Perth, Australia: Department of Health Government of Western Australia.

Department of Health Government of Western Australia. OD 0342/11. Tuberculosis and health care workers. Perth, Australia: Department of Health Government of Western Australia.

Department of Health Government of Western Australia. OD 0294/10. Infection prevention and control of influenza-like illnesses in Western Australian healthcare facilities. Perth, Australia: Department of Health Government of Western Australia.

Department of Health Government of Western Australia. OD 0237/09. Hepatitis B vaccination program. Perth, Australia: Department of Health Government of Western Australia.

Department of Health Government of Western Australia. OP 1800/04. Guidelines for health care workers with herpes lesions. Perth, Australia: Department of Health Government of Western Australia.

National Health and Medical Research Council. (2013). The Australian immunisation handbook (10th ed.). Canberra, Australia: Australian Government Publishing Service.

National Health & Medical Research Council and the Australian Commission on Safety and Quality in Healthcare. (2010). Australian guidelines for the prevention and control of infection in healthcare. Canberra, Australia: Commonwealth of Australia.

Key Terms & Links

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Directorate
Clinical Services

Responsible Manager
Head of Clinical Services

Date

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