[Previous article][Contents] [Next article]
RN, ICC, BN, Clinical Nurse Consultant, Infection Control, St Vincent's Hospital & Sacred Heart Hospice
[Abstract] [Introduction] [Method] [Results] [Hepatitis B] [Mantoux] [BCG] [Measles] [Rubella] [Tetanus] [Poliomyelitis] [Varicella-zoster] [Conclusion] [References]
All healthcare facilities are under an obligation to provide a safe working environment for all employees, including prevention of occupational exposure to infectious diseases. To achieve this, immunisation against vaccine preventable diseases and knowledge of disease status of health care workers is advocated in all types of healthcare facilities including palliative care facilities.
A survey was conducted at the Sacred Heart Hospice in Darlinghurst, New South Wales (NSW), to determine the number of healthcare workers and volunteers who were immunised against certain diseases, had disease screening or who knew their disease status.
A confidential structured questionnaire was distributed to all healthcare workers and volunteers at the Hospice. The questionnaire requested information on diseases such as hepatitis B, tuberculosis, measles, rubella, tetanus, poliomyelitis and varicella-zoster.
Of the 200 questionnaires that were distributed, 159 (79.5%) questionnaires were returned from healthcare workers and volunteers. While the results for immunisation of the healthcare workers and volunteers for most disease categories were encouraging, there remains a number of healthcare workers who fail to access the available immunisation programme. Managers must remain vigilant in highlighting to their staff the importance of immunisation and disease screening in disease prevention.
Healthcare workers and especially volunteers who may come into contact with patients blood/body substances or airborne diseases are required to know their disease status, particularly against diseases such as hepatitis B, tuberculosis and varicella zoster therefore reducing the risk of occupational exposure.
The findings of the healthcare worker and volunteers immunisation status for the Sacred Heart Hospice are reported here.
[top]
Immunisation has been shown to be an effective method of eradication for many diseases that have caused untold human suffering over many years. Diseases such as smallpox have now been eliminated worldwide and poliomyelitis is becoming a rarity in developing countries. More recently we have seen a huge decline in bacterial meningitis caused by Haemophilus influenzae type B through ongoing vigilant immunisation programmes (Watson, 1997:12).
Healthcare facilities, including palliative care settings have an obligation under the Occupational Health and Safety Act 1983 to ensure the health and safety of all employees. This means that the healthcare facility must provide an effective immunisation programme that regularly updates the healthcare workers immunisation status, ensures confidentiality, can be easily accessed and provides the healthcare worker with documentation of their records should they transfer to another facility (National Health & Medical Research Council (NHMRC), 1996:48). Effective immunisation in combination with infection control precautions can reduce the risk of occupational transmission of infectious diseases.
While some employees in healthcare facilities have a low risk of acquiring diseases from the healthcare facility, especially those who are not exposed to the patients blood/body substance or droplets from a patient, they should remain up-to-date with immunisation to reduce the risk of disease transmission from the community.
Here we investigated the immunisation status of staff and volunteers working in a palliative care setting to determine those categories of staff that require further education and encouragement to utilise the free immunisation programme that is available to them.
[top]
A confidential structured questionnaire, was distributed to all staff at the Sacred Heart Hospice to determine the number of staff who were immunised against certain diseases, had participated in disease screening or who knew their disease status. This questionnaire was extended to the volunteers as in this facility many volunteers have patient contact which may put them at risk of exposure to an infectious disease. The questionnaire requested information from the staff on disease status that included diseases such as hepatitis B, tuberculosis measles, rubella, tetanus, poliomyelitis and varicella zoster.
[top]
Of the 200 questionnaires that were distributed throughout the Hospice, 159 (79.5%) questionnaires were returned from staff and volunteers. Below, the result are presented by disease immunisation or screening.
Hepatitis B infection is caused by the hepatitis B virus and in infected people can be present in redundant blood, tissues and body secretions. All healthcare workers, especially those who are at risk of exposure to blood and body substances, should be vaccinated against this disease (NHMRC, 1996:61). Table 1 shows the number and percentage of respondents who have been immunised or who had acquired immunity through disease exposure.
| TABLE 1 - Number/percentages of respondents immunised against hepatitis B or who had acquired immunity through disease exposure | |||
| Staff category |
|
|
|
| Registered Nurses |
|
|
|
| Volunteers |
|
|
|
| Enrolled Nurses |
|
|
|
|
Hotel Services |
|
|
|
| Other staff categories * |
|
|
|
As shown in Table 1 there are a number of respondents who remain unimmunised and who may be at risk of exposure to the hepatitis B virus, therefore staff may require further education on the benefits of immunisation and be should encouraged to take up the offer of the free immunisation programme available to them.
[top]
Mantoux screening is conducted to detect latent infection with Mycobacterium tuberculosis. The NSW Health Department (1994) recommends that all healthcare workers and volunteers should have an annual Mantoux follow-up. Table 2 shows the number of respondents who have had a Mantoux screening.
| TABLE 2 Numbers/percentages of respondents who had a mantoux screening | |||
| Staff category |
|
|
|
| Registered Nurses |
|
|
|
| Volunteers |
|
|
|
| Enrolled Nurses |
|
|
|
|
Hotel Services |
|
|
|
| Other staff categories * |
|
|
|
[top]
A live attenuated strain of Mycobacterium bovis that has lost its virulence but retains it antigenic properties make up the vaccine of the Bacille-Calmette-Guerin (BCG) (NSW Health. Department, 1994). It is recommended by the NSW Health Department that health care workers and volunteers be offered BCG vaccination. However, there are certain people such as HIV positive or immune suppressed people who should not be given a BCG, therefore BCG should be given by a health care workers who are specially trained ' in BCG vaccination (NHMRC, 1996). Table 3 shows the number of responde . nts who had been vaccinated with BCG. There are many healthcare workers who are not vaccinated with BCG, this may be due to the medical controversy about the efficacy of BCG.
| TABLE 3 Number/percentage respondents who are immunised with BCG | |||
| Staff category |
|
|
|
| Registered Nurses |
|
|
|
| Volunteers |
|
|
|
| Enrolled Nurses |
|
|
|
|
Hotel Services |
|
|
|
| Other staff categories * |
|
|
|
[top]
Measles is a virus that can cause severe illness and even death especially in children under five years of age (Benenson, 1995:293). The combined immunisation for measles, mumps and rubella (MMR) is recommended by the National Health and Medical Research Council (NHMRC) for non immune healthcare workers (NHMRC, 1996:67). Table 4 shows that most respondents had either been vaccinated against measles or who have immunity through acquiring the disease.
| TABLE 4 Numbers/percentages of respondents immunised against measles or who had acquired immunity through disease exposure. | |||
| Staff category |
|
|
|
| Registered Nurses |
|
|
|
| Volunteers |
|
|
|
| Enrolled Nurses |
|
|
|
|
Hotel Services |
|
|
|
| Other staff categories * |
|
|
|
[top]
Rubella usually a mild febrile disease can cause devastating effects to the developing foetus in women who are non-immune and acquire the disease (Benenson, 1995:406). Healthcare workers, especially those who work in obstetric units, should know their rubella status (NHRMC, 1996:70). Immunisation is usually given as an MMR as discussed above. Table 5 shows many respondents were unaware of their rubella status.
| TABLE 5 Numbers/percentages of respondents immunised against rubella or who had acquired immunity through disease exposure. | |||
| Staff category |
|
|
|
| Registered Nurses |
|
|
|
| Volunteers |
|
|
|
| Enrolled Nurses |
|
|
|
|
Hotel Services |
|
|
|
| Other staff categories * |
|
|
|
[top]
Clostridium tetani produces a toxin that causes the disease tetanus. Tetanus can be an acute often fatal disease. In Australia, older adults more commonly acquire tetanus through neglecting to maintain their immunity through immunisation (NHMRC, 1997:66). Table 6 shows the number of respondents who knew their tetanus immune status. Again there are a number of staff who require immunisation against tetanus.
| TABLE 6 Numbers/percentages of respondents immunised against tetanus. | |||
| Staff category |
|
|
|
| Registered Nurses |
|
|
|
| Volunteers |
|
|
|
| Enrolled Nurses |
|
|
|
|
Hotel Services |
|
|
|
| Other staff categories * |
|
|
|
[top]
The last documented case of poliomyelitis in Australia was in 1986. This is a dramatic decrease since the reports of 1938 when the incidence of poliomyelitis was as high as 39.1 per 100,000 (NHMRC, 1997:97). This shows the success of immunisation in disease eradication. Table 7 shows respondents who are immunised against poliomyelitis.
| TABLE 7 Numbers/percentages of respondents immunised against poliomyelitis. | |||
| Staff category |
|
|
|
| Registered Nurses |
|
|
|
| Volunteers |
|
|
|
| Enrolled Nurses |
|
|
|
|
Hotel Services |
|
|
|
| Other staff categories * |
|
|
|
[top]
Varicella-zoster virus causes varicella which is commonly known as chickenpox. This virus can cause severe disease in adults and may be fatal in the immunosuppressed person. Therefore, all healthcare worker should know their varicella status and those staff who are not immune should not be in contact with people who have varicella zoster, commonly known as shingles (NHMRC, 1997:151). Table 8 shows the number of respondents who knew their varicella status. It is suggested that all staff should be encouraged to find out their immune status for varicella.
| TABLE 8 Number/percentages of respondents who knew their disease status for varicella zoster. | |||
| Staff category |
|
|
|
| Registered Nurses |
|
|
|
| Volunteers |
|
|
|
| Enrolled Nurses |
|
|
|
|
Hotel Services |
|
|
|
| Other staff categories * |
|
|
|
[top]
Despite the success of immunisation in controlling diseases and substantially reducing other vaccinepreventable diseases such as hepatitis B, healthcare workers in some categories remain unimmmunised. Managers need to highlight the importance of immunisation and disease screening especially to those staff or volunteers who may come into contact with patient's blood or body substances. Up to date immunisation is required against diseases such as hepatitis B and tuberculosis, therefore reducing the risk of occupational disease transmission.
Healthcare worker must understand that even though they may or may not have immunity against some diseases through immunisation, there remains a risk of acquiring other disease that are non vaccine preventable, therefore compliance with infection control precautions must be maintained at all times (NHMRC, 1996:48).
Leading into the 21st century one of the main defences against the increasing incidence of multiple resistant bacteria will be active immunisation (Watson, 1997:14). Infection control practitioners must remain vigilant in the education and promotion of immunisation against vaccine preventable diseases, continually explore future new vaccines, and introduction of those vaccines to healthcare workers to provide a safer environment for both patients and all healthcare workers.
[top]
* Denotes: Secretary/receptionist medical, managers, maintenance, physiotherapist wardsmen, pastoral care, social worker, occupational therapist.
Benenson, A. S. (1995) Control of Communicable Diseases Manual (16th Edition), American Public Health Association: Washington.
National Health and Medical Research Council (1997) The Australian Immunisation Handbook (6th Edition), Australian Government Publishing Service: Canberra.
National Health and Medical Research Council (1996) Infection Control in the Health Care Setting, Australian Government Publishing Service: Canberra
New South Wales Health Department (1994) Controlling Tuberculosis in New South Wales, State Health Publication No 94:1-76: Sydney.
Watson, M. (1997) Immunisation in the 21 st century, Australian Infection Control, 3(4):12-14.
[top]