Download Communicable Disease Immunisation Risk Assessment for Care

Care home staff communicable diseases risk assessment and
immunisations
The information in this document should be read in conjunction with, and for the most
recent updates, the Department of Health’s online publication:
Immunisation of Infectious Diseases (The Green Book), Chapter 12 - Immunisation of
healthcare and laboratory staff
Good infection prevention and control (IPC) is essential to ensure that people who use
health and social care services receive safe and effective care. Appropriate
immunisation of staff is an important element of IPC and helps protect the health of the
care home staff, their families and residents. This document includes information
regarding the statutory duty of registered care homes in staff immunisations. An
immunisation risk assessment template is included to help identify staff immunisation
needs. The assessment process should include staff education and awareness of
immunisations and the implications of refusal of recommended immunisations.
Information for post exposure management is not included in this document. Post
exposure incident advice should be sought immediately via an occupational health
service or the exposed individual’s GP or via local Accident and Emergency department.
Further information on post exposure management can be found via resources in the
reference section of this document and on page 20 of the document below:
Department of Health (2013) Prevention and Control of Infections in Care Homes
Health and Social Care Act 2008 Code of Practice on the Prevention and Control
of Infections and Related Guidance.
Criterion 10 of the act states that registered providers should have systems in place to
manage the occupational health needs of staff in relation to infection. Further
information on criterion 10 can be found via page 31 of the document below:
The Health and Social Care Act 2008 Code of Practice on the prevention and control of
infections and related guidance
The act states that care homes polices should include the protection of staff and should
include:
 health screening for communicable diseases
 how exposure to infections will be managed
 risk assessment of the need for immunisations
 the responsibilities of staff to report episodes of illness
 the circumstances under which staff may need to be excluded from work.
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Occupational Health Service
The Health and Social Care Act acknowledges that small adult social care services that
are not part of a large organisational structure may not have their own occupational
health service. In such circumstances registered providers should ensure that they have
access to occupational health services/advice when required i.e. through their insurance
company, a general practitioner or an occupational health agency. These services will
are paid for by the provider.
GPs do not have an obligation to provide occupational health services or occupational
immunisations as part of their NHS responsibility. Therefore it is not usually appropriate
for registered providers to direct employees to their GP for immunisations required for
occupational purposes.
What constitutes an occupational health service?
The Health and Social Care Act 2008 states that occupational health services for staff
should include:
 Risk based screening for communicable diseases and assessment of immunity to
infection after a conditional offer of employment and ongoing health surveillance;
 Offers of relevant immunisations and have arrangements in place for regularly
reviewing the immunisation status of care workers and providing vaccinations to
staff as necessary in line with the Department of Health Green Book.
 A risk assessment and appropriate referral after accidental occupational exposure
to healthcare sharps, blood and body fluids.
 Management of occupational exposure to infection, which may include provision
for emergency and out-of-hours treatment, possibly in conjunction with accident
and emergency services and on-call infection prevention and control specialists.
This should include a specific risk assessment following an exposure prone
procedure.
Who requires an immunisations risk assessment?
All staff should:

complete a pre-employment health assessment and give information regarding
residence overseas, previous and current illness and relevant immunisations.

have an immunisation risk assessment

have their immunisation risk assessment reviewed if they change their role
Immunisation Risk Assessment Template
The immunisation risk assessment template provided below should be used as guidance
only to indicate a need for further occupational assessment with regards to
immunisations. The risk assessment template is not intended to replace a full
occupational risk assessment or a pre-employment health questionnaire. Staff
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Infection Prevention and Control Team January 2017
undertaking the immunisation risk assessment should be
appropriately placed and trained to do so.
The key to risk assessment in the workplace is whether there is an excess risk as
compared to that of the ordinary population in the local community. For further
information on risk assessment in the workplace see:
http://www.hse.gov.uk/risk/fivesteps.htm
Care Home Communicable Diseases Immunisations
Please see the relevant chapters in the Department of Health’s online publication Immunisation of Infectious Diseases (The Green Book) for more detailed information
and for updates on the communicable diseases discussed below:
Immunisation of Infectious Diseases (The Green book)
Influenza
The objective of the seasonal influenza immunisation programme is to protect those who
are most at risk of serious illness or death should they develop influenza. Immunisation
reduces transmission and also reduces disruption to services that provide essential
care. Groups who are offered immunisation include:



health and social care staff who are directly involved in the care of their patients
or clients
Those living in long stay residential care homes or other long stay care facilities
where rapid spread is likely to follow the introduction of infection and cause high
morbidity and mortality
Individuals living in residential accommodation for those with learning difficulties
NB The green book states non-clinical staff do not routinely require Influenza
immunisation. However all care home staff should be included in risk assessment and
may require influenza immunisation if risks of transmission involvement to vulnerable
individuals has been identified.
Hepatitis B
Hepatitis B immunisation provides a minimum of three doses of hepatitis B vaccine for
individuals who are at high risk of exposure to the hepatitis B virus. Staff (including
students and trainees) who may have direct contact with patient’s blood, blood-stained
body fluids or tissues, and staff who are at risk of injury from blood contaminated sharp
instruments, or being deliberately injured or bitten by patients are recommended to have
Hepatitis B immunisation.
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Varicella
The aim of varicella immunisation is to protect those at most risk of serious illness from
Varicella. This is done by immunising specific individuals who are in regular or close
contact with those at risk. All staff who have contact with residents should be included
in risk assessment and this includes staff not directly involved in care such as: catering
staff, cleaners, receptionists etc. Those with a definitive history of Varicella can be
considered protected. Staff with a negative or uncertain history of chickenpox or shingles
should be serologically tested and vaccine offered to those without varicella zoster
antibody.
BCG
The aim of the BCG immunisation programme is to immunise those at increased risk of
developing severe disease and/or of exposure to TB infection. People in occupational
groups who are more likely than the general population to come into contact with
someone with TB includes:


Healthcare workers who will have contact with patients or contact with clinical
materials
Staff of care homes for the elderly
Unvaccinated, tuberculin-negative individuals aged below 35 years old in the above
occupations are recommended to receive BCG. There are no data on the protection
afforded by BCG vaccine when it is given to adults aged 35 and over. However there are
likely to be categories of healthcare workers who are at particular risk of TB, and should
be part of the clinical risk assessment when the use of BCG is being considered for a
healthcare worker over 35 years of age.
MMR
MMR is recommended when protection against measles, mumps and/or rubella is
required. MMR vaccine can be given irrespective of a history of measles, mumps or
rubella infection or vaccination. Although not generally considered an occupational risk,
MMR vaccination is important for care home staff own benefits. However the protection
of staff is especially important due to the risk of transmission of measles or rubella to
vulnerable groups/residents.
Satisfactory evidence of protection would include
documentation of:


Having received two doses of MMR, or
Positive antibody tests for measles and rubella
Diphtheria, tetanus and polio
Although not generally considered an occupational risk, all staff in healthcare settings
should be up to date with their routine immunisations.
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Further advice
Further advice can be obtained via the Infection Prevention and Control Team:
0113 8434511
[email protected]
Acknowledgements
This document has been adapted with previous permission from the Bradford and
Airedale NHS Trust Immunisations Risk Assessment for Care Homes Care Staff:
Guidance on Immunisation Requirements for Registered Care Home Providers.
References
Department of Health (2007). Immunisation against infectious disease. (The Green
Book) https://www.gov.uk/government/collections/immunisation-against-infectiousdisease-the-green-book (Accessed 21/01/17)
Department of Health (2008). The Health and Social Care Act 2008: Code of practice for
health and adult social care on the prevention and control of infections and related
guidance
Department of Health (2013). Prevention and control of infection in care homes –
an information resource
General Practitioners Committee (2005). Hepatitis B immunisation for employees at risk:
guidance for GPs
Health and Safety Executive (2001). Blood-borne viruses in the workplace: guidance for
employers and employees
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Communicable Disease Immunisation Risk Assessment for Care Home Staff
Staff name: ___________________________
Date ___________
Yes No
Influenza
Does the staff member provide direct care to
residents?
NB The green book states non-clinical staff do
not routinely require Influenza immunisation.
However all care home staff should be included
in risk assessment and may require influenza
immunisation if risks of transmission involvement
to vulnerable individuals has been identified.
Hepatitis B
Has the staff member previously had hepatitis B
infection?
Has the staff member previously had hepatitis B
immunisation?
Does the staff member provide direct care for
persons with known hepatitis B infection?
Completed by ___________________________
Not
What further action is
known necessary?
Action Action Complete
by
by
who? when?
If yes, staff should be offered
annual seasonal influenza
immunisation.
Refer to occupational health.
If yes, refer to occupational
health for assessment.
If yes, refer to occupational
health for antibody titre check
to check level of immunity.
If no, continue with Hep B risk
assessment.
If yes, hepatitis B
immunisation is
recommended – refer to
occupational health.
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Does the staff member have direct contact with
any patient’s blood, blood-stained bodily fluids or
tissues?
Does the staff member handle sharps, for
example, needles, cannulae, lancets which may
be contaminated with the blood of others?
Is the staff member in regular contact with
individuals who exhibit any of the following
behaviours:
 Taking objects into mouth
 Sharing food
 Dribbling or spitting
 Scratching or biting
 Self-mutilation
 Unhygienic toilet habits
Is the staff member at risk of small injuries
inflicted by others which result in broken skin?
Varicella (Chickenpox/shingles)
Has the staff member previously had chickenpox
or shingles infection?
NB. A history of chickenpox is a less reliable
predictor of immunity in individuals born and
raised overseas and routine testing should be
considered
If yes, hepatitis B
immunisation is
recommended – refer to
occupational health.
If yes, hepatitis B
immunisation is
recommended – refer to
occupational health.
If yes, hepatitis B
immunisation is
recommended – refer to
occupational health.
If yes, hepatitis B
immunisation is
recommended – refer to
occupational health.
If yes, and there is a definitive
recorded history, no further
action is needed – the staff
member can be considered to
be protected.
If no or uncertain history, refer
to occupational health for
serological testing.
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Bacillus Calmette-Guérin vaccine (BCG)
Has the staff member previously had BCG
immunisation?
If yes and there is a definitive
recorded history, no further
action is needed.
If no or unknown and the staff
member is aged 35 years and
under refer to occupational
health for assessment.
Consider referring over 35
year olds healthcare workers
who’s category is at particular
risk of TB.
Measles, mumps and rubella (MMR)
Has the staff member previously been fully
vaccinated against measles, mumps and
rubella?
If yes, and there is a definitive
recorded history, no further
action is needed – the staff
member can be considered to
be protected.
If no, immunisation is
recommended – refer to
occupational health.
Diphtheria, tetanus and polio
Has the staff member previously been fully
vaccinated against diphtheria, polio and tetanus?
If yes, and there is a definitive
recorded history, no further
action is needed – the staff
member can be considered to
be protected.
If no, immunisation is
recommended – refer to
occupational health.
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Assessment Notes
Date and Signature
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