EMPLOYEE HEALTH: COMMUNICABLE DISEASE SCREENING

Effective Date: 
Sun, 09/01/2002
Reviewed: 
Wed, 08/10/2011
Revised: 
Mon, 12/19/2016
Policy: 

Objectives of the Student Health Center employee health communicable disease-screening program are:

  • To protect staff and students from avoidable communicable disease exposure
  • To comply with professional and current State and Federal employee health guidelines and standards

Employee health policies, specific to the work area and job function, apply to all Health Center employees, including student workers, temporary workers, interns, volunteers, and independent contractors. Employees whose primary assignment is not within the Health Center (e.g. Health Promotion outreach workers & CAPS) are excluded from communicable disease screening except as required by Federal, State and local mandates).

These objectives are accomplished through the joint efforts of the Medical Director, the Infection Control Committee, and the clinical staff of the Student Health Center.

Immunizations and screenings are provided at no charge to these employees.

The Employee Health Nurse is directly responsible for implementation of the program in collaboration with the Infection Control Committee Chair and the Clinical Operations Coordinator.

The hiring supervisor is responsible for informing newly hired employees of the Communicable Disease Screening Policy; and for informing the Employee Health Nurse of newly hired employees, student employees and temporary workers.

Procedure: 

New Employee Hepatitis B screening & immunization

All employees (including student workers, interns, temporary agency, independent contractors, & volunteers) who provide direct patient care and are therefore at risk for blood-borne pathogen exposure (physician, mid-level practitioner, nursing, medical assistant, laboratory, radiology, Pharmacists) are screened for hepatitis B immunity, as soon as possible upon hire.

Acceptable forms of documented hepatitis B immunization history include:

  1. Immunization records provided by employee showing 3 doses of hepatitis B vaccine and a hepatitis B surface antibody titer, done within 1-2 months post vaccine series , showing immunity to hepatitis B.    If the employee has not had a post vaccine series titer, one will be offered to them at no charge.  If the result is negative, the 3 shot series and post titer will be repeated. 
  2. Positive hepatitis B surface antibody titer results provided by employee.

If documented immunization history is unknown or unavailable, the employee must receive titers to establish immunity or is required to receive the Hepatitis B immunization series, both at no charge or sign a waiver declining immunization.

For Hepatitis B non-immune employees, the current CDC guidelines will determine the course of action with any exposure.

 

New Employee Aerosol Transmissible Disease (ATD) screening and immunization

All employees (including student workers, interns, temporary agency, independent contractors, & volunteers) whose  job duties may place them at risk for occupational exposure to aerosol transmissible disease (physician, nurse practitioner, physician assistant, nursing, medical assistant, laboratory, radiology, pharmacy, dietitian, clerical) are required to  show vaccination &/or immunity to the following ATD at time of hire:

  1. Measles, Mumps, Rubella
  2. Varicella
  3. Pertussis
  4. Tuberculosis

Measles, Mumps, Rubella, Varicella, & Pertussis Immunity

Acceptable forms of documented immunity for:

1.  Measles, Mumps, Rubella include:

a.  Health care provider confirmed case of Measles, Mumps, Rubella

b.  Documentation of two doses of live measles & mumps vaccine separated by greater than or equal to 28 days and at least one dose of live Rubella vaccine

c.  Positive titers

2.  Varicella include:

a.  Documentation of two varicella vaccines

b.  Employee written statement confirming history of varicella disease, reviewed by a UCSC healthcare provider (i.e. Employee Health Nurse)

c.  Positive titers

3.  Pertussis include:

a.  Documentation of vaccination of 1 lifetime Tdap.  

If documented immunization history is unknown or unavailable, the employee may, at no cost, either:

  1. Have titers drawn to establish immunity to Measles, Mumps, Rubella, & Varicella
  2. Or receive Measles/Mumps/Rubella, Varicella, &/or Pertussis immunizations as indicated or sign a waiver declining immunization

If, at a future date, US government regulatory agencies (i.e. CDC, OSHA, CDPH, etc. ) recommends a routine booster dose of any of the above mentioned vaccines or new vaccination for health care workers at occupational risk, such a vaccine will be available to eligible employees at no cost.

Tuberculosis Screening  All new employees are screened for TB as soon as possible upon hire. 

  1.  If the employee has been continuoulsy working in a position where annual TB screeing has been performed, a negative TB test within the previous year prior to hire will be accepted.   
  2. If the employee has not been continuously working in a position where annula TB screening has been performed, a 2 step TST testing will be performed. For operational ease, non-career staff that may be working irregular schedules and not able to complete 2 step testing in the required time frame can  be screened via an IGRA serological test.
  3. Employees with a history of a positive TB test must provide the following documentation:
  • If the date and result of the previous test are documented, these employees do not need a repeat TST or TB blood test. They should be assessed for current symptoms & receive a chest radiograph; if negative no further evaluation needed.  If positive they are referred to their own PCP for further evaluation and should not engage in patient care until cleared. 
  • If they have written documentation of the results of a chest radiograph indicating no active TB disease that is dated after the date of the positive TST or TB blood test result they do not need another chest radiograph at the time of hire. They should be assessed for current symptoms.
  • If they do not have written documentation, they must receive a chest radiograph to exclude a diagnosis of infectious TB disease before having direct patient contact. These employees should be assessed for current TB symptoms on an annual basis, and instructed to seek medical evaluation with their Primary Care Provider (PCP) if TB symptoms develop at any time.
  • After this baseline chest radiograph is performed and the result is documented, repeat radiographs are not needed unless symptoms or signs of TB disease develop or a clinician recommends a repeat chest radiograph.

Annual Employee Aerosol Transmissible Disease screening and immunization

TB screening:
  1. All employees at risk of occupational exposure to aerosol transmissible disease receive annual TB screening
  2. Employees with negative TB/negative TST history receive one-step TST testing.
  3. Employees with a negative IGRA history receive either IGRA or one-step TST testing in consult with the Employee Health Nurse. 
  4. Employees with positive TB history complete a symptom review. Those with a positive symptom review are referred to their own PCP for further evaluation and should not engage in patient care until cleared.   Those with a negative symptom review need no further evaluation. 
  5. A conversion is when a person's TST or TB blood test result changes from negative initially to positive with subsequent testing. For surveillance purposes, an increase of >10 mm is defined as a TST conversion. These employees are referred to their own PCP for further evaluation and should not engage in patient care until cleared.   Return to work requires a copy of a negative chest X-ray report performed after date of conversion and a letter of medical clearance.

Influenza immunization

  1. All employees at risk of occupational exposure to aerosol transmissible disease receive an annual influenza immunization
  2. Employees who decline immunization against this pathogen must sign a specific declination form, be required to follow any mandates from the County Health Officer or other regulatory agency, and must understand that in the event of an outbreak they may be excluded from work.
Key Points: 
  • Proof of Hepatitis B immunity is required for all new direct patient care employees
  • Proof of Measles, Mumps, Rubella, Varicella, Pertussis immunity is required for all new employees at risk of occupational exposure to aerosol transmissible disease
  • New hire and annual TB screening is required for all employees at risk of occupational exposure to aerosol transmissible disease
  • Immunizations are provided by the Student Health Center at no charge to the employee
  • All employee health records are maintained in accordance with the HIPAA confidentiality policy and are maintained for the duration of employment and thirty years thereafter
  • Employees hired prior to the date of this revision will be required to meet the standards of this policy within 90 days of implementation. Current employees who decline immunization against Measles, Mumps, Rubella, Varicella, &/or Pertussis must sign a specific declination form and must understand that in the event of an outbreak they may be excluded from work.  This statement will be kept in the employee’s confidential medical record.