Complete record keeping among issues to consider

Work restrictions and foreign travel, too

The U.S. Centers for Disease Control and Prevention's recent compilation of immunization guidelines for health care workers includes considerations regarding record keeping, catch-up vaccination programs, work restrictions for susceptible employees after exposure, outbreak control, and vaccines indicated for foreign travel.1

Complete immunization records should be maintained for each HCW, reflecting documented disease and vaccination histories, as well as immunizing agents administered during employment. Records should be updated when each immunization is given.

The CDC urges health care facilities to consider implementing catch-up vaccination programs for HCWs who already are employed, in addition to immunization programs for newly hired workers.

"This strategy will help prevent outbreaks of vaccine-preventable diseases," the guidelines state.

Emphasizing the importance of HCW education to the success of immunization programs, the CDC recommends that reference materials be available to assist in answering questions about diseases, vaccines, and toxoids, as well as about the institution's program or policy. Goal acceptance can be furthered by conducting educational workshops or seminars several weeks prior to initiating vaccine programs.

Postexposure work restrictions for non-immune HCWs range from limiting contact with high-risk patients to complete exclusion from duty. (See Table 5, inserted in this issue.)

Ensuring that all HCWs who have direct patient contact are fully immunized is the best and most cost-effective outbreak control strategy. Hospitals are encouraged to develop comprehensive policies and protocols for managing and controlling outbreaks of vaccine-preventable diseases.

Additional vaccines not routinely recommended for U.S. HCWs may be indicated for those who travel to other regions of the world to perform research or health care work. Vaccinations against diseases such as hepatitis A, poliomyelitis, Japanese encephalitis, meningococcal disease, plague, rabies, typhoid, or yellow fever should be considered when indicated for foreign travel. Elevated risks can result from exposure to those diseases in health care settings or from circumstances unrelated to patient care.

Reference

1. Centers for Disease Control and Prevention. Immunization of health-care workers: Recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR 1997; 46(No. RR-18):1-42.