Download Prevention and Management of Exposure to Communicable Diseases

This is an Interior Health CONTROLLED document. A copy of this document in paper form is not controlled and
should be checked against the electronic file version to ensure accuracy
Administrative
Code: AV Workplace Health and Safety
AV0900 - PREVENTION AND MANAGEMENT OF OCCUPATIONAL EXPOSURE TO
COMMUNICABLE DISEASES
1.0
PURPOSE
To provide a safe and healthy work environment as far as practicable through implementation of
communicable disease prevention, education, surveillance, monitoring, and post exposure
management for all Interior Health employees.
2.0
DEFINITIONS
Education
Includes informing employees of their obligations under this policy and
educating them about risks, preventive measures and appropriate
procedures following work-related exposure.
Employee
Includes individuals employed with Interior Health while engaged in an
IH work activity
Exposure
Exposures may occur when an employee is in direct or indirect contact
with a patient/resident/client or co-worker who has a, unknown,
suspected or known infection with a communicable disease. Contact
refers to needle-stick injuries, splashes, airborne droplets, contact with
nasal or throat secretions or close contact during
examinations/treatment.
Personal Protective
Equipment (PPE)
PPE is equipment worn by a worker to minimize exposure to specific
occupational hazards. Examples of PPE include masks, gloves, gowns,
as well as, eye and foot protection.
Proof of Immunity
Day/month/year of a vaccination or a laboratory serological result or, in
the case of Varicella, a statutory declaration of history of disease.
Screening
Includes verbal and documented health history taking, examination of
documented evidence and/or laboratory serological tests to determine
current or previous infection and/or vaccination status regarding a
communicable disease.
Vaccination
The safe and appropriate administration of vaccines by licensed
professionals.
Workplace Health
and Safety (WHS)
A health authority department which provides preventative services to
employees of Interior Health. This includes Immunity Screening and
immunization recommendations for employees based on their risk of
exposure to communicable diseases. Provides immunization clinics and
Tuberculosis (TB) screening in many Interior Health sites, and referral
to other services when needed. Provides education to employees and
employers on policy and preventative measures.
Policy Sponsor: VP, Human Resources and Organizational Development
1 of 8
Policy Steward: Manager Health & Wellness
Date Approved: April 2003
Date(s) Reviewed-r/Revised-R: August 2004 (R) December
2009 (R) February 2015 (R)
This is an Interior Health CONTROLLED document. A copy of this document in paper form is not controlled and
should be checked against the electronic file version to ensure accuracy
Administrative
Code: AV Workplace Health and Safety
Workplace Health
Call Centre (WHCC)
3.0
A Provincial Call Centre that offers occupational health services to
assist employees and employers in the management of exposures,
including blood or body fluid and communicable disease, collection of
health history information, reporting of potential and actual exposures,
and preventative immunity screening and recommendations. Phone
1.866.922.9464 and follow the teleprompts.
POLICY
1. Interior Health is committed to providing a safe and healthy work environment for all
employees of the health authority. This commitment includes a protocol for screening,
surveillance, education, vaccination and outbreak management that will minimize the risk to
patients/residents/clients and employees from communicable diseases. Screening, education
and vaccination are incorporated into the recruitment and orientation process for new
employees.
2. In the event of an exposure/outbreak of a vaccine-preventable communicable disease,
employees may be excluded from work for the period of communicability. An employee may
be excluded with pay if there are medically documented contraindications to receiving the
vaccine (i.e. pregnancy is a contraindication for a live vaccine) and/or known severe reaction
to the vaccine or any of its components. See Appendix B for disease specific exclusions for ill
employees.
3. The BC Centre of Disease Control (BCCDC) recommends vaccination of non-immune
employees in order to protect themselves as well as susceptible patients, residents, clients
and co-workers. In the event of an exposure/outbreak of a vaccine-preventable communicable
disease, employees may be excluded from work for the period of communicability.
4. All employees must report their immunization and communicable disease history to Workplace
Health. New employees must report by calling the WHCC (1.866.922.9464) within two weeks
of hire.
5. Employees who have worked for the health authority for at least 3 months should report their
vaccinations except influenza (on-line self-report) to Occupational Health Nurse call line 1866-899-7999.
6. In accordance with IH Policy AU1100 Student Placement and Volunteer VD0700 –
Communicable Disease Outbreak, Interior Health will ensure that all agreements with
contracted employers and academic institutions will contain the provision that their workers
and students will have documented evidence of screening and vaccination histories consistent
with the provisions of this document.
7. All employees are to receive orientation to communicable disease policy and procedures
through reviewing this policy, site specific education, and by reviewing the disease specific
information found in Appendix B of this policy.
8. Roles and Responsibilities of Interior Health employees in the management of Communicable
Disease are described in Appendix A.
4.0
PROCEDURES
1.
Post Exposure Follow-up Procedure
a) Infection Control Practitioner will notify the Workplace Health Call Center, Communicable
Disease Unit and Public Health of the potential exposure to a communicable disease.
Policy Sponsor: VP, Human Resources and Organizational Development
2 of 8
Policy Steward: Manager Health & Wellness
Date Approved: April 2003
Date(s) Reviewed-r/Revised-R: August 2004 (R) December
2009 (R) February 2015 (R)
This is an Interior Health CONTROLLED document. A copy of this document in paper form is not controlled and
should be checked against the electronic file version to ensure accuracy
Administrative
Code: AV Workplace Health and Safety
b) Communicable Disease Unit may call a case conference to review the exposure with
Public health, Infection control, Medical Health Officer (MHO) and others as appropriate.
c) The Workplace Health Call Center will telephone and send an email to the managers
using their Interior Health email address to review the exposure criteria.
d) Managers or their designate will make a list and contact all employees who potentially
meet the exposure criteria for a communicable disease exposure. The manager will
ensure employees are notified as soon as reasonably possible and advised to call the
WHCC at 1-866-922-9464.
e) Employees call the Workplace Health Call Center as soon practicable within normal
business hours at 1-866-922-9464 to review their contact with the case and receive
recommendations for post exposure follow up or treatment.
f)
For Tuberculosis (TB) exposures the WHS Occupational Health Nurse will organize
follow-up testing for all exposed employees. See Appendix C for Post Exposure TB
Procedures.
g) The WHS Occupational Health Nurse will follow-up as guided by the MHO for
extraordinary exposures.
h) Managers will complete an investigation as per WorkSafeBC Regulation.
2.
Exceptions:
1.
Gastrointestinal(GI) Outbreak: Refer to IH GI Outbreak Guidelines for Health Care
Facilities
a) Infection Control Practitioner will contact the Workplace Health Call Center (WHCC)
when there is a GI exposure.
b) WHCC will send the unit manager a poster to put up in their work area advising
employees to WHCC if they develop a GI illness related to the exposure.
c) Employees will call the WHCC and Early Absence Reporting Line (EARL) to report their
illness and must remain off work until 48 hours after the symptoms resolve.
2.
Respiratory Outbreak:
a) Refer to Prevention and Control of Respiratory Outbreaks in Residential Care
Settings (Oct 2014).
5.0
REFERENCES
BCCDC Communicable Disease Manual - Communicable Disease Control Chapter (dates vary
per disease).http://www.bccdc.ca/dis-cond/comm-manual/CDManualChap1.htm
Interior Health Infection Prevention & Control Manual (September 2013).
http://inet.interiorhealth.ca/QPS/IPC/Pages/default.aspx
Controlling Exposure: Protecting Workers from Infectious Disease
http://www.worksafebc.com/publications/health_and_safety/by_topic/assets/pdf/bk129.pdf
Retrieved Jan 19, 2015
BC Public Health Act Part 3- Preventing Disease and Other Health Hazards
http://www.bclaws.ca/EPLibraries/bclaws_new/document/ID/freeside/00_08028_01#part3/
Retrieved Oct 24, 2014
Policy Sponsor: VP, Human Resources and Organizational Development
3 of 8
Policy Steward: Manager Health & Wellness
Date Approved: April 2003
Date(s) Reviewed-r/Revised-R: August 2004 (R) December
2009 (R) February 2015 (R)
This is an Interior Health CONTROLLED document. A copy of this document in paper form is not controlled and
should be checked against the electronic file version to ensure accuracy
Administrative
Code: AV Workplace Health and Safety
Interior Health Authority (October 2014) Respiratory Infection (RI) Outbreak Guidelines
http://insidenet.interiorhealth.ca/QPS/IPC/Documents/Respiratory%20Infection%20(RI)%20Outbr
eak%20Guidelines.pdf Retrieved Nov 6, 2014
WorkSafeBC Occupational Health and Safety Regulation
Retrieved Jan 27, 2015
http://www2.worksafebc.com/publications/OHSRegulation/Part3.asp#SectionNumber:3.4
Retrieved Jan 21, 2015
Policy Sponsor: VP, Human Resources and Organizational Development
4 of 8
Policy Steward: Manager Health & Wellness
Date Approved: April 2003
Date(s) Reviewed-r/Revised-R: August 2004 (R) December
2009 (R) February 2015 (R)
This is an Interior Health CONTROLLED document. A copy of this document in paper form is not controlled and
should be checked against the electronic file version to ensure accuracy
Administrative
Code: AV Workplace Health and Safety
APPENDIX A – Roles and Responsibilities in the Management of Communicable
Diseases
Senior Executive Team are responsible for:

ensuring that employees are advised of the required standards of conduct and understand the
consequences of non-compliance;

ensuring that all possible breaches of the Policy directive are thoroughly investigated;

based on the results of an investigation, ensuring that appropriate action is taken;

ensuring that confidential information is handled with caution and discretion; and

delegating authority and responsibility, where applicable, to apply this Policy within IH.
Supervisors and managers are responsible for:

applying this Policy within their area(s) of responsibility;

notifying all employees by phone or via their Interior Health email that have had unprotected
contact with a patient who has a communicable disease;

advising exposed employee to call the WHCC to report their exposure incident;

ensuring that all employees adhere to the control of communicable disease requirements as
outlined in the policy;

ensuring that employees are provided with the information, instruction, training, supervision and
PPE necessary to enable them to comply with Interior Health’s policies and procedures for
preventing the spread of communicable diseases;

participating as required in facility risk assessment(s) for occupational exposure to communicable
diseases; and

ensuring that confidential information is handled with caution and discretion.
Medical Health Officer or Physician Designate for Infectious Disease is responsible for:

reviewing and confirming the communicable disease exposure; and

providing consulting and supportive services in the management of the communicable disease
exposure.
Infection Control is responsible for:

being familiar with this policy and procedures;

informing employees of infection prevention and control policy/procedure and the use of
appropriate PPE through employee orientation and education;

collaborating with WHCC regarding confirmation of diagnosis, lab results and possible work
restrictions or reassignments for exposed/infected employees;

working with manager to identify internal and external contacts (i.e. BC Ambulance); and

completing the Communicable Disease Notification Tool and forward to the WHCC and the
Communicable Disease Unit (CDU).
Policy Sponsor: VP, Human Resources and Organizational Development
5 of 8
Policy Steward: Manager Health & Wellness
Date Approved: April 2003
Date(s) Reviewed-r/Revised-R: August 2004 (R) December
2009 (R) February 2015 (R)
This is an Interior Health CONTROLLED document. A copy of this document in paper form is not controlled and
should be checked against the electronic file version to ensure accuracy
Administrative
Code: AV Workplace Health and Safety
Communicable Disease Unit is responsible for:

being familiar with this policy and procedures;

collaborating with the WHCC and WHS on confirmation of diagnosis, laboratory results,
treatment/prophylaxis recommendations, and possible work restrictions for exposure/outbreaks
and outbreak status of communicable disease as required.
Workplace Health Call Centre (WHCC) is responsible for:

receiving employee immunity status information through WHCC and document in WHITE
database;

providing new employee assessment of immune status, recommendations for immunization and
screening based on BCCDC guidelines for Healthcare Worker Immunization;

providing counselling and referral to employees in regard to occupational exposures; and

collaborating with the CDU and MHOs.
Workplace Health and Safety (WHS) are responsible for:

being familiar with this policy and procedures;

coordinating the facility risk assessments for occupational exposure to communicable diseases;

ensuring that employees are given adequate information, education, and where appropriate, pre
and post-test counseling to make informed decisions in regard to screening and vaccinations;

providing accessible immunization and TB screening in accordance with BCCDC and Interior
Health policy and guidelines;

documenting and maintaining the confidentiality of all communicable disease screening and
serological testing of employees;

maintaining the WHITE data base and providing reports of non confidential information to
managers as required;

consulting with employees and managers as requested;

collaborating with the WHCC, CDU, Public Health and Infection Control under the direction of the
MHO; and

providing immunization records to employees when requested.
Employees are responsible for:

being familiar with this policy and procedures;

contacting the WHCC to report their immunization and communicable disease history within two
weeks of hire;

being aware of their own communicable disease and vaccination status to minimize the risk of
transmitting infectious diseases to patients/residents/clients and co-workers; and

reporting immunization history when new vaccinations are received.
Policy Sponsor: VP, Human Resources and Organizational Development
6 of 8
Policy Steward: Manager Health & Wellness
Date Approved: April 2003
Date(s) Reviewed-r/Revised-R: August 2004 (R) December
2009 (R) February 2015 (R)
This is an Interior Health CONTROLLED document. A copy of this document in paper form is not controlled and
should be checked against the electronic file version to ensure accuracy
Administrative
Code: AV Workplace Health and Safety
Appendix B: Disease specific information













Conjunctivitis (pink eye)
Gastrointestinal Illness - Norovirus
Influenza
Measles (Rubeola)
Methicillin-Resistant Staphylococcus Aureus (MRSA)
Mononucleosis (mono)
Mumps
Pertussis
Rubella (German measles)
Scabies
Shingles (Herpes Zoster)
Tuberculosis
Varicella
Policy Sponsor: VP, Human Resources and Organizational Development
7 of 8
Policy Steward: Manager Health & Wellness
Date Approved: April 2003
Date(s) Reviewed-r/Revised-R: August 2004 (R) December
2009 (R) February 2015 (R)
This is an Interior Health CONTROLLED document. A copy of this document in paper form is not controlled and
should be checked against the electronic file version to ensure accuracy
Administrative
Code: AV Workplace Health and Safety
Appendix C: Post Exposure TB Screening
Employees who have been exposed to someone with infectious TB are advised to call the Workplace
Health Call Center 1-866-922-9464 to determine if they meet the screening criteria and get a referral for
TB skin testing.
TB skin tests are given to determine if an employee has been infected with TB germs.
 It takes between 2 and 8 weeks after the exposure before the TB skin test reacts as positive (5
mm induration after a contact). It is important to know if the TB skin test is from the current
exposure as medication used to give preventative treatment will depend if the drug is effective
against the strain.
 Whenever possible a baseline TB skin test should be done to determine if there is a conversion
from negative to positive skin test with the exposure. A baseline can be considered established
if given within a year of the current exposure
 Employees who have been exposed to someone with infectious TB are advised to call the
Workplace Health Call Center 1-866-922-9464 to determine if they meet the screening criteria
and get a referral for TB skin testing.
For employees who have no history of a TB skin test, have a negative TB skin test, or have a nonreactive IGRA (TB blood test):


A baseline TB skin test is recommended as soon as possible after exposure if the employee has
not had a baseline skin test within the past year.
A repeat skin test should be given 8-12 weeks after the last date of exposure.
For employees who have had previous TB disease, have a positive TB skin test, or a positive IGRA (TB
blood test):


Occupational Health Nurse will review history and symptoms and send employee for a TB chest
x-ray 4 months post exposure or sooner if symptoms develop.
Employees who require ongoing post exposure follow-up such as repeat chest x-rays or
medication will be referred to their family doctor and the local Public Health nurse for follow up.
Policy Sponsor: VP, Human Resources and Organizational Development
8 of 8
Policy Steward: Manager Health & Wellness
Date Approved: April 2003
Date(s) Reviewed-r/Revised-R: August 2004 (R) December
2009 (R) February 2015 (R)