ICU_Boom_Attachment_Number_8.pdf

Attachment ICU Nursing and Respiratory Boom Hospital

8: Epidemiology Service Health and Immunization

Requirements

Hospital Epidemiology Service

• Health and Immunization Requirements

Contractors working in the NIH Clinical Center must ensure that they comply with all applicable federal and state government regulations regarding control of infectious diseases in health care facilities. Contractors should consult the specific regulations for further details, exemptions, documentation, and record-keeping requirements. Contractor requirements include, but are not limited to:

• Measles, Mumps Rubella — Personnel who have patient contact must demonstrate proof of immunity to measles, mumps and rubella at preplacement or be immunized with at least two doses of measles, mumps, rubella (MMR) vaccine. The contractor shall keep immunization records or the serologic status of each worker on file (Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013: Summary Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 62(RR04); 1-34.)

• Hepatitis B Vaccine — Personnel at risk for occupational exposure to blood (human blood, human blood components, and products made from human blood) or other potentially infectious materials shall be offered the hepatitis B vaccine within 10 working days of the initial assignment unless the worker has previously received the complete hepatitis B immunization series, antibody testing has revealed that the worker is immune, or the vaccine is contraindicated for medical reasons. The primary series of three appropriately timed immunizations should be completed as indicated. Personnel who decline the hepatitis B immunization must sign the mandatory declination, as specified in the Occupational Safety and Health Administration (OSHA) Bloodbome Pathogen standard. The contractor shall maintain worker records for at least the duration of employment plus 30 years, in accordance with the standard. (29 CFR Part 1910.1030, OSHA Occupational Exposure to Bloodborne Pathogens)

• Universal Precautions Training — Personnel at risk for occupational exposure to blood or other potentially infectious materials must receive annual training in universal precautions.

For workers in the Clinical Center and/or credentialed to provide patient care, this training is routinely offered by the Hospital Epidemiology Service. Contractors must either provide annual training to their employees who are at risk for occupational exposure or ensure that they receive training through the Hospital Epidemiology Service. Contractors must maintain training records for three years, according to the standard. (29 CFR Part 1910.1030, OSHA Occupational Exposure to Bloodbome Pathogens)

• Occupational Exposures to Blood or other Potentially Infectious Materials — Personnel who experience occupational exposure to blood or other potentially infectious materials shall be offered medical evaluation and post-exposure evaluation and follow-up. The contractor shall maintain these records for at least the duration of employment plus 30 years, in accordance with the standard. (29 CFR Part 1910.1030, OSHA Occupational Exposure to Bloodbome Pathogens). The Occupational Medical Service (OMS) provides emergency clinical evaluation and post-exposure treatment to NIH employees, contract personnel, and visitors on campus who report an exposure to potentially infectious materials. Incidents

9-5-08 revised 1-9-14 Page 1 of 2 involving exposure to human blood and body fluids must be reported immediately to OMS and their immediate the supervisor. If the exposure involves a primate retrovirus, OMS also offers chemoprophylaxis and serologic monitoring. Contractors are responsible for follow-up of exposures other than those involving primate retroviruses.

• Tuberculosis (TB) — Personnel who are at risk for occupational exposure to Mycobacterium tuberculosis (Mtb), the causative agent of TB, shall receive counseling, screening, and evaluation. These workers include: persons who routinely have patient contact or who enter patient rooms, examination or treatment rooms whether occupied or not; persons who are exposed to Mtb in a laboratory or morgue; and persons who work in a nonhuman primate animal care setting. Workers who have positive tuberculin skin test (TST) results or a positive interferon gamma release assay (IGRA), TST or IGRA conversions, or symptoms suggestive of TB should be identified, evaluated for tuberculosis infection, and started on antibiotics if indicated. The results of preplacement and, if indicated, periodic TB screening must be kept by the Contractor in a retrievable aggregate database. Contractor data must be reported to the Hospital Epidemiology Service upon request. (Centers for Disease Control and Prevention. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care facilities, 2005. MMWR 54 RR 17)

Every contract employee physically working in the Clinical Center, irrespective of individual risk for occupational exposure to Mtb, must undergo a preplacement TST or IGRA; those with positive tests must be evaluated as described above.

• Varicella - Personnel who have patient contact must have varicella immune status on file.

Those who do not have a clear history of varicella infection (chickenpox) should be tested for varicella immunity. Varicella vaccine should be offered to those who are nonimmune. The contractor shall keep records of each worker's varicella immune status.

• Influenza — Personnel who have patient contact must be immunized annually with the influenza vaccine. Those with medical contraindications (severe allergic reaction to the vaccine, severe egg allergy, or a history of Guillain-Barre syndrome) must submit physician documentation to be exempted from immunization. Personnel with religious objections to immunization must file a statement to that effect each year in order to decline the vaccine.

Records of immunization, declination, or exemption must be kept by the contractor for a period of one year. (Influenza Vaccination of Health-Care Personnel: Recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Advisory Committee on Immunization Practices (ACIP). 2006; 55(RR02);1-16)

• Tetanus, Diphtheria, Pertussis — A one-time administration of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) is strongly encouraged for all contract staff age 19 and older who have not yet received a dose of Tdap. Tdap should be administered regardless of the interval since the last tetanus, or diphtheria toxoid-containing vaccine. (Updated Recommendations for the Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis (Tdap) Vaccine in Adults 65 Years and Older — Advisory

9-5-08 revised 1-9-14 Page 2 of 2

Committee on Immunization Practices (ACIP). 2012. MMWR June 29, 2012/61(25);468- 470)

9-5-08 revised 1-9-14 Page 3 of 2

Exhibit A

Compliance Reporting Schedule

Control of Infectious Diseases

Item Description Quantity Report type Delivery Schedule

Compliance Report

(Exhibit B)

Itemized compliance information on each current employee working on the contract

1 copy to

• Hospital Epidemiology

Service

• Contracting

Officer

• Project Officer

Initial report Due 30 days after contract is effective

Semi-annual report

Due on or before April 15 (for October 1 to March 31)

October 15 (for April 1 to September 30)

Immediate Report for possible transmission for any contract employee identified with pulmonary or laryngeal tuberculosis

Contact HES immediately by phone

301-496-2209 office

301-496-1211 page Hospital Epidemiology

Service person on call

Submit all reports to:

Office of Purchasing and Contracts (OPC)

6707 Democracy Blvd (Suite 106)

Bethesda, MD 20892

Office of Purchasing and Contracts will forward to:

Hospital Epidemiology Service (HES)

National Institutes of Health

Building 10/Room 2N 224

10 Center Drive

Bethesda, MD 20892

Report date: Compliance Report Exhibit B

Clinical Center

Company: Control of Infectious Diseases

Report type: Initial semi-annual

Baseline acceptible compliance Annual requirements

Name/unique identifier Indicate if new employee

2 step TST or IGRA

MMR Hepatitis B

Vaccine

Varicella immunity

Tdap ** Influenza vaccine

Occupational exposure to blood/body fluids Y N

Universal

Precautions training

Exhibit C Job Titles of Clinical Center Employees

Who May Have Occupational Exposure to Blood, Body Fluids or Other Potentially Infectious Material

Recreation Specialist Recreation Aid and Assistant General Biological Science Microbiology Biological Technician Genetics General Health Science Series Medical Officer Nurse Practical (Vocational) Nurse Nursing Assistant Medical Supply Aide and Technician Occupational Therapist Physical Therapist Rehabilitation Therapy Assistant Recreation/Creative Arts Therapist Health Aid and Technician Nuclear Medicine Technician Medical Technologist Medical Technician Diagnostic Radiologic Technologist Medical Instrument Technician Speech Pathology & Audiology Hospital Housekeeping Management Dental Officer Dental Assistant Dental Hygiene Veterinary Medical Science Biomedical Engineering Technician Electronic Technician (Biomed) Biomedical Engineer Chemistry Laundry & Dry Cleaning Plant Management Vocational Rehabilitation Custodial Working (Housekeeping) Laundry Working Dental Laboratory Technician Medical Clerk