Healthcare personnel (HCP) are defined as all paid and unpaid persons working in healthcare settings who have the potential for exposure to patients and/or to infectious materials, including body substances, contaminated medical supplies and equipment, contaminated environmental surfaces, or contaminated air.
HCP might include (but are not limited to) physicians, nurses, nursing assistants, therapists, technicians, emergency medical service personnel, dental personnel, pharmacists, laboratory personnel, autopsy personnel, students and trainees, contractual staff not employed by the healthcare facility, and persons (e.g., clerical, dietary, housekeeping, laundry, security, maintenance, administrative, billing, and volunteers) not directly involved in patient care but potentially exposed to infectious agents that can be transmitted to and from HCP and patients.
Maintenance of immunity is therefore an essential part of prevention and infection control programs for HCP.
On the basis of documented nosocomial transmission, HCP are considered to be at substantial risk for acquiring or transmitting immunization-preventable diseases, including hepatitis B, influenza, measles, mumps, rubella, pertussis, and varicella.
See Table 60-1 for current recommendations for vaccination for HCP.
HCP who perform tasks that may involve exposure to blood or body fluids should receive a three-dose series of hepatitis B vaccine at 0-, 1-, and 6-month intervals.
Test for hepatitis B surface antibody (anti-HBs) to document immunity 1 to 2 months after dose #3.
If anti-HBs is at least 10mIU/mL (positive), the patient is immune. No further serologic testing or vaccination is recommended.
If anti-HBs is <10 mIU/mL (negative), the patient is unprotected from hepatitis B virus (HBV) infection; revaccinate with a three-dose series. Retest anti-HBs 1 to 2 months after dose #3.
If anti-HBs is positive, the patient is immune. No further testing or vaccination is recommended.
If anti-HBs is negative after six doses of vaccine, the HCP is a nonresponder.
HCP who are nonresponders should be considered susceptible to HBV and should be counseled regarding precautions to prevent HBV infection and the need to obtain HBIG prophylaxis for any known or probable parenteral exposure to hepatitis B surface antigen (HBsAg)-positive blood.
See Table 60-2 for postexposure prophylaxis for HBV.
Table 60-1 Recommendations for Vaccination of HCP
Vaccine
Available Form(s) of Vaccine
Dose
Recommendation/Comments
Hepatitis B
Single-antigen vaccine available as Recombivax HB or Engerix-B
Three-dose series at 0, 1, and 6 months
All healthcare workers should receive a three-dose series and obtain anti-HBs titer 1-2 months after third dose.
Influenza
Inactivated trivalent injectable vaccine; live attenuated
One dose annually
All healthcare workers should receive influenza vaccine annually.
MMR
Monovalent vaccine of measles, rubella, and mumps as well as combinations of measles-mumps-rubella (MMR), measles-rubella (MR), and rubella-mumps are available.
Two doses given 4 weeks apart, SC
Two doses of MMR vaccine to unvaccinated healthcare workers born before 1957 who do not have serologic evidence of immunity as well as all adults born after 1956 with no evidence of immunity
Varicella
Available as a single-antigen varicella vaccine and a combination MMR and varicella vaccine
Two doses given 4 weeks apart, SC
Healthcare professionals, teachers, child-care workers, residents and staff in long-term care facilities, nonpregnant women of childbearing age, college students
Td/Tdap
Tdap is available as Boostrix, Adacel
Td every 10 years intramuscularly (IM)
All adults should receive a one-time dose of Tdap and a Td booster every 10 years.
Meningococcal vaccine
MCV4
One dose IM or SC
Microbiologists who are routinely exposed to isolates of N. meningitidis
Table 60-2 Postexposure Prophylaxis for HBV
Status of Source
Status of Source Unknown
Status of Exposed Person
HbsAg Positive
HbsAg Negative
High Risk
No vaccine
HBIG + vaccine
Initiate vaccine series
Initiate vaccine series
Vaccine responder
No treatment
No treatment
No treatment
Vaccine nonresponder
HBIG + vaccine
Vaccine
HBIG + vaccine, no need for revaccination for low-risk exposure
Nonresponder status post revaccination
HBIG × 2
No treatment
HBIG × 2 for high-risk exposure, no treatment for low-risk exposure
Response unknown
If anti-HbsAb negative, give HBIG + vaccine
No treatment
If anti-HBsAb negative, initiate vaccine series and follow up anti-HbsAb
HBIG, hepatitis B immunoglobulin; HbsAg, hepatitis B surface antigen; HbsAb, hepatitis B surface antibody.
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