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6/22/2017 » 6/25/2017
2017 OSAP Annual Conference

FAQ - Occupational Health & Latex Allergy - 2016
 FAQ - Occupational Health & Latex Allergy - 2016

 

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Hep B vaccinations have to be offered or declined, but what about MMR and TDAP? Do we need to document immunity? Are they required or recommended?

The 2003 CDC guidelines for infection control in dentistry states as follows:

Immunization Programs

DHCP are at risk for exposure to, and possible infection with, infectious organisms. Immunizations substantially reduce both the number of DHCP susceptible to these diseases and the potential for disease transmission to other DHCP and patients (5,17). Thus, immunizations are an essential part of prevention and infection-control programs for DHCP, and a comprehensive immunization policy should be implemented for all dental health-care facilities (17,18). The Advisory Committee on Immunization Practices (ACIP) provides national guidelines for immunization of HCP, which includes DHCP (17). Dental practice immunization policies should incorporate current state and federal regulations as well as recommendations from the U.S. Public Health Service and professional organizations (17) (Appendix B).

On the basis of documented health-care–associated transmission, HCP are considered to be at substantial risk for acquiring or transmitting hepatitis B, influenza, measles, mumps, rubella, and varicella. All of these diseases are vaccine-preventable. ACIP recommends that all HCP be vaccinated or have documented immunity to these diseases (5,17). ACIP does not recommend routine immunization of HCP against TB (i.e., inoculation with bacille Calmette-Guérin vaccine) or hepatitis A (17). No vaccine exists for HCV. ACIP guidelines also provide recommendations regarding immunization of HCP with special conditions (e.g., pregnancy, HIV infection, or diabetes) (5,17).

Immunization of DHCP before they are placed at risk for exposure remains the most efficient and effective use of vaccines in health-care settings. Some educational institutions and infection-control programs provide immunization schedules for students and DHCP. OSHA requires that employers make hepatitis B vaccination available to all employees who have potential contact with blood or OPIM. Employers are also required to follow CDC recommendations for vaccinations, evaluation, and follow-up procedures (13). Nonpatient-care staff (e.g., administrative or housekeeping) might be included, depending on their potential risk of coming into contact with blood or OPIM. Employers are also required to ensure that employees who decline to accept hepatitis B vaccination sign an appropriate declination statement (13). DHCP unable or unwilling to be vaccinated as required or recommended should be educated regarding their exposure risks, infection-control policies and procedures for the facility, and the management of work-related illness and work restrictions (if appropriate) for exposed or infected DHCP.  1

The CDC has specific recommendations for healthcare worker immunization which can be accessed here:
http://www.cdc.gov/vaccines/adults/rec-vac/hcw.html    2

ACIP has also published specific recommendations for healthcare worker immunization which can be accessed here:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6007a1.htm    3

Additionally, each state can adopt these recommendations as part of their regulatory code. Further state specific information can be accessed here:
http://www.cdc.gov/phlp/publications/topic/vaccinationlaws.html  4

The US Department of Labor – Occupational Safety and Health Administration (OSHA), currently has been processing an expanded proposed infectious diseases rule. Further information can be accessed at:
https://www.osha.gov/dsg/id/index.html     5

It is recommended that if you have further questions regarding the requirements for healthcare worker immunizations in your state, that you contact your state public health agency (i.e., state health department) for further information.

Resources

1)     Kohn WG, Collins AS, Cleveland JL, Harte JA, Eklund KJ, Malvitz DM, Centers for Disease Control and Prevention (CDC). Guidelines for infection control in dental health-care settings—2003. MMWR Recomm Rep 2003;52(RR-17):1-61. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm    Accessed on May 2, 2016.

2)     US Centers for Disease Control and Prevention. Recommended Vaccines for Healthcare Workers. http://www.cdc.gov/vaccines/adults/rec-vac/hcw.html  Accessed on May 2, 2016.

3)     US Centers for Disease Control and Prevention. Immunization of Health-Care Personnel: Recommendations of the Advisory Committee on Immunization Practices (ACIP). http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6007a1.htm     Accessed on May 2, 2016.

4)     US Centers for Disease Control and Prevention. Vaccination Laws. http://www.cdc.gov/phlp/publications/topic/vaccinationlaws.html    Accessed on May 2, 2016.

5)     US Department of Labor – Occupational Safety and Health Administration. Infectious Diseases Rulemaking. https://www.osha.gov/dsg/id/index.html     Accessed on May 2, 2016. 

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