Health care worker vaccination and infectious diseases screening

Employees and other personnel providing services or attending clinical practicum in public health facilities must provide the facility with evidence of their immune status.

University students undertaking health-related courses have been instructed to obtain evidence of their immune status and many will attend their GP for this information. It is in the interests of the GP to know their own immune status and GPs who provide services in hospitals are required to make this information available to the health service.

The NSW Health vaccination and infectious diseases screening requirements are outlined in Circulars 2002/97 and 2001/71 (copy available from Gae Mcdonald at the division). The current edition of the Australian Immunisation Handbook is a necessary supplement to the circular.

The following information provides abridged guidelines as to what is required to ensure health care workers meet pre-requisites to attending practicum or providing services in the NRAHS.

The following principles should be considered when developing a health care worker’s vaccination/ screening program:

Live vaccines (eg. MMR and varicella) must be given at the same time or separated by a month.
Mantoux (TST) results are not valid when attended less than a month after administration of a live vaccine.
Documented evidence, for the purposes of this program, includes a written record.
To prevent repeated requests for information from your surgery, provide the health care worker with a record of vaccination/ screening and impress upon them they will need to retain the information.

EXPOSURE PRONE PROCEDURES (EPPS) are those procedures characterised by the potential for direct contact between the skin of the health care workers and sharp surgical instruments, needles or sharp tissues (spicules of bone or teeth) in body cavities or in poorly visualised or confined body sites (including the mouth).

Minimum requirements	Evidence of immunity and other considerations
Immunity to hepatitis B	3 doses of vaccine and post vaccination antiHBs result > 10.
	Evidence of hepatitis A immunity not routinely required by NRAHS however combined hepatitis A & B vaccine may be appropriate.
Immunity to measles, mumps and rubella	Documentation of 2 doses of MMR vaccine or positive serology (IgG) to all 3 diseases.
	Health care workers without evidence of immunity should have 2 doses of MMR, 1 month apart.
Immunity to diphtheria and tetanus	Primary vaccination and appropriate booster doses. Serological testing is not appropriate.
	Administration of an adult vaccine containing pertussis (eg Boostrix) should be considered when there is potential for contact with infants, if >5 years since last ADT.
Immunity to varicella (chickenpox)	Reliable history of chickenpox or shingles is accepted as evidence of immunity.
	If history negative or uncertain, serological screening should be attended (IgG).
	Health care workers with negative serology (IgG) should have 2 doses of vaccine, 1 month apart.
Immunity to polio	Primary vaccination.

Infectious diseases	Screening conditions
Tuberculosis (TB)	Screening must be attended by a chest clinic to exclude active TB and to provide a valid Mantoux (TST) result.
	Chest xray and BCG are not routinely required.
	NRAHS Chest Clinic contact number - 6620 2232.
HIV	Annual HIV serology must be attended for health care workers performing exposure prone procedures* (EPPs).
	HIV positive health care workers cannot perform EPPs.
Hepatitis C (HCV)
	Annual HCV serology must be attended for health care workers performing exposure prone procedures* (EPPs).
	HCV positive health care workers cannot perform EPPs.
Hepatitis B (HBV)	Annual HBV serology must be attended for non-immune health care workers performing exposure prone procedures* (EPPs).
	HBeAg/HBV DNA positive health care workers cannot perform EPPs.

Further information can be obtained from Sue Devlin, communicable diseases CNC, NRAHS Public Health Unit on 6620 2280, or email SUED@nrhs.health.nsw.gov.au.

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