View Entire Collection
By Clinical Topic
Diabetes – Summer 2012
Future of Nursing Initiative
Heart Failure - Fall 2011
Influenza - Winter 2011
Nursing Ethics - Fall 2011
Trauma - Fall 2010
Traumatic Brain Injury - Fall 2010
Fluids & Electrolytes
Immunization recommendations for healthcare personnel were updated in a 2011 report by the U.S. Advisory Committee on Immunization Practices. The recommendations apply to all paid and unpaid persons working in healthcare settings who might come into contact with patients or infectious materials. The recommendations apply to all healthcare settings including persons who provide home healthcare and hospice.
Infection prevention, the protection of our patients and healthcare personnel (HCP) from communicable diseases, is a crucial function of all healthcare organizations, including home health agencies and hospices. In November 2011, the U.S. Advisory Committee on Immunization Practices (ACIP) issued a report updating the 1997 summary of recommendations for vaccinations of HCP. These recommendations can assist home healthcare and hospice administrators and infection preventionists to update their policies and procedures to reflect best immunization practices (Centers for Disease Control and Prevention [CDC], 2011a).
The definition of HCP has broadened to include all paid and unpaid people who may have contact with patients, body substances, or contaminated equipment. In home care and hospice this includes a variety of people, paid and unpaid, who go into the home or come into contact with patients in other ways. This includes all staff, including people who are in direct healthcare positions such as nurses, home health aides, therapists, social workers, and family educators. It also includes students, trainees, volunteers, transportation personnel, hospice volunteers, home meal delivery staff, and anyone else coming into contact with patients. The goal is to protect both HCP and patients from preventable infection.
Vaccines recommended for HCP include:
* Hepatitis B,
* seasonal influenza (Figure 1),
* varicella (Figure 2), and
* meningococcal in certain circumstances (see Box 1 for links to CDC information about these diseases).
Of these vaccines, only Hepatitis B is mandated to be made available at the employer's expense (U.S. Department of Labor, 1991). However, state and local requirements may vary and should be reviewed before updating immunization policies. For example, New York, Oklahoma, and Rhode Island mandate all hospital personnel have proof of measles immunity, which could affect hospital-associated home care agencies and hospices in those states (CDC, 2011a). The main changes in the 2011 report from 1997 regarding HCP vaccination recommendations are noted below.
Regardless of vaccination history, HCP and trainees at high risk for chronic Hepatitis B should be tested for Hepatitis B surface antigen (HBsAg) and Hepatitis B core antibody/Hepatitis B surface antibody to determine infection status. People with chronic Hepatitis B virus (HBV) are the main reservoir for continued transmission in the United States (Institute of Medicine, 2010). Testing for HBsAg is the primary means to identify chronic HBV infection. High risk for chronic infection would include people born in geographic regions with HBsAg prevalence of >=2%, born in United States but not vaccinated as infants and whose parents were born in geographic regions with HBsAg prevalence of >=8%, injection-drug users, men who have sex with men, and those with elevated liver blood tests (alanine aminotransferase [ALT]/aspartate aminotransferase [AST]) of unknown etiology (CDC, 2011b)."For those who are unvaccinated, blood should be drawn for testing before the first dose of vaccine is administered, and vaccination should be administered during the same health-care visit" (CDC, 2011a, p. 7). Despite Occupational Safety and Health Administration-mandated availability, the Hepatitis B vaccination rate among HCP is only about 75% while the Healthy People 2020 goal is 90% (CDC, 2011a).
The CDC has recommended that all HCP receive an annual influenza vaccination since 2006 and the ACIP has recommended that all persons aged >=6 months in the United States receive an annual influenza vaccination since 2010 (CDC, 2006; CDC, 2011e). (See Figure 3.) In addition, they encourage healthcare agencies to institute programs to increase the flu vaccination rate by providing influenza vaccine at no cost to personnel, and to monitor and report staff influenza vaccination rates regularly (CDC, 2011a). Not only is influenza an occupational hazard but HCP are also considered a source of disease transmission to all patients, but especially to the vulnerable including those who cannot be vaccinated, those who respond poorly to vaccine, or those for whom antiviral medication is contraindicated. Vaccinating HCP has been a challenge, with multiple reasons cited for refusal of the vaccine. For example, during the 2010-2011 flu season, coverage for influenza vaccination among HCP was estimated at only 63.5%. However, when employers required vaccination, the rate increased to 98.1%. Increased vaccination rates also resulted when employers offered vaccination onsite, free of charge, and for multiple days (CDC, 2011c).
HCP are at higher risk of infection with measles and healthcare sites have been associated with measles outbreaks in recent years (CDC, 2011a). Therefore, it is recommended that all HCP have presumptive evidence of immunity to measles, mumps, and rubella documented and available at the worksite. Presumptive evidence for measles and mumps includes two doses of measles, mumps, rubella (MMR) at least 28 days apart (or live measles and live mumps vaccine), or laboratory evidence of immunity or confirmation of disease. Birth before 1957 had been considered presumptive evidence of immunity but research suggests some HCP born before 1957 lack measles immunity. Therefore, the current recommendation is HCP born before 1957 that lack laboratory evidence of disease or immunity should consider vaccination with two doses of MMR (CDC, 2011a). History of measles is no longer presumptive evidence of immunity (CDC, 2011a). HCP born before 1957 without laboratory evidence of mumps immunity or disease are also recommended two doses of MMR (CDC, 2011a). Presumptive evidence of rubella immunity includes only one dose of MMR, or laboratory evidence of immunity, or laboratory evidence of disease, or birth before 1957 (CDC, 2011a).
Pertussis is a highly contagious disease that can infect people of any age. Immunity to the pertussis vaccine normally wanes within 5 to 10 years from the most recent dose (CDC, 2010). A single dose of Tdap (tetanus-diphtheria-pertussis) should be administered as soon as possible to HCP of any age who have not previously received it regardless of the date of any prior tetanus/diphtheria (Td) vaccinations. Thereafter, Td would be administered every 10 years for booster vaccination against tetanus and diphtheria because Tdap is not licensed for multiple administrations (CDC, 2011a). Recent epidemics demonstrate the need for pertussis immunity. More than 9,000 cases of pertussis were reported in California in 2010, the most cases reported in 63 years. The number dropped in 2011 to just below 3,000, although no deaths have occurred since October 2010 (California Department of Public Health, 2012). Outbreaks also occurred in Michigan and Ohio in 2010 and 2011. The CDC warns that pertussis is endemic in the United States with periodic epidemics every 3 to 5 years and frequent outbreaks (CDC, 2011d).
HCP should have evidence of immunity to varicella documented at the worksite. Criteria for immunity to varicella were recently established and include documentation of two doses of vaccine, laboratory evidence of disease or immunity, or documented diagnosis of varicella or shingles by a healthcare provider (CDC, 2011a).
HCP with certain splenic disorders, clotting deficiencies, or HIV infection should receive two doses of meningococcal vaccine. Some HCP at high risk will need revaccination every 5 years (CDC, 2011a).
Home healthcare and hospice organizations should review their immunization practices and policies to meet current guidelines that are designed to protect both HCP and patients. Acquisition of this recent report, titled Immunization of Health-Care Personnel: Recommendations of the Advisory Committee on Immunization Practices (ACIP), is a must. It can be freely accessed at http://www.cdc.gov/mmwr/pdf/rr/rr6007.pdf. Besides the brief summary of major changes discussed above, the report also provides background information about each disease, vaccine safety and effectiveness data, pre- and postexposure recommendations, as well as other valuable information for home healthcare and hospice infection control programs.
California Department of Public Health. (2012). Pertussis report. Retrieved from http://www.cdph.ca.gov/programs/immunize/Documents/PertussisReport1-6-2012.pdf[Context Link]
Centers for Disease Control and Prevention. (2006). Influenza vaccination of health care personnel: Recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Advisory Committee on Immunization Practices (ACIP). Morbidity and Mortality Weekly Report, 55(RR-10), 1-42. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5510a1.htm[Context Link]
Centers for Disease Control and Prevention. (2010). Pertussis (Whooping cough). Retrieved from http://www.cdc.gov/pertussis/clinical/index.html[Context Link]
Centers for Disease Control and Prevention. (2011a). Immunization of health-care personnel: Recommendations of the Advisory committee on Immunization Practices (ACIP). Morbidity and Mortality Weekly Report, 60(7), 1-45. Retrieved from http://www.cdc.gov/mmwr/pdf/rr/rr6007.pdf[Context Link]
Centers for Disease Control and Prevention. (2011b). Testing and public health management of persons with chronic Hepatitis B virus infection. Retrieved from http://www.cdc.gov/hepatitis/HBV/TestingChronic.htm[Context Link]
Centers for Disease Control and Prevention. (2011c). Influenza vaccination information for health care workers. Retrieved from http://www.cdc.gov/flu/healthcareworkers.htm#how-many[Context Link]
Centers for Disease Control and Prevention. (2011d). Pertussis (whooping cough) outbreaks. Retrieved from http://www.cdc.gov/pertussis/outbreaks.html[Context Link]
Centers for Disease Control and Prevention. (2011e). Prevention and control of influenza with vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2011. Morbidity and Mortality Weekly Report, 60(33), 1128-1132. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6033a3.htm[Context Link]
Institute of Medicine. (2010). Hepatitis and liver cancer: A national strategy for prevention and control of Hepatitis B and C. Washington, DC: National Academics Press. [Context Link]
U.S. Department of Labor. (1991). Bloodborne pathogens: The standard. Federal Register, 60, 64175-64182. Retrieved from http://wonder.cdc.gov/wonder/prevguid/p0000419/p0000419.asp[Context Link]
Back to Top