Date: Thu, 28 Mar 2024 15:20:27 -0400 (EDT)
Message-ID: <493990840.13020.1711653627143@confluence05.rowan.edu>
Subject: Exported From Confluence
MIME-Version: 1.0
Content-Type: multipart/related;
boundary="----=_Part_13019_801842730.1711653627139"
------=_Part_13019_801842730.1711653627139
Content-Type: text/html; charset=UTF-8
Content-Transfer-Encoding: quoted-printable
Content-Location: file:///C:/exported.html
ROWAN UNIVERSITY POLICY
Title: House=
staff Immunizations and Health Requirements
Subject: Health Services
Policy No=
: SOM: 2013:03
Applies: School of Osteopa=
thic Medicine
Issuing Authority:=
Dean, School of Osteopathic Medicine
Responsible Officer: Dean, School of Osteopathic Medicine =
;
Adopted: 07/12/2012
Last Rev=
ision: 01/12/2018
Last Reviewed: 01/12/=
2018
I. PURPOS=
E
To prevent or reduce the risk of transmis=
sion of vaccine-preventable and other communicable diseases between RowanSO=
M medical interns and residents (housestaff) and their patients and other p=
ersons at RowanSOM and RowanSOM-affiliated health care units.
I=
I. ACCOUNTABILITY
The Dean shall ensure compliance with thi=
s policy. The Associate Deans or other administrators responsible for gradu=
ate medical education, and the individual Program Directors shall implement=
this policy in conjunction with the campus Occupational Medicine Service.<=
/p>
I=
II. APPLICABILITY
This policy shall apply to all interns an=
d residents (including clinical fellows), hereinafter called "house officer=
s" or "housestaff," enrolled in any RowanSOM-sponsored graduate medical edu=
cation program conducted in any health-care facility participating in the p=
rogram, and all visiting, exchange or special-program housestaff from other=
institutions. New housestaff will preferably be in full compliance with th=
is policy prior to beginning their programs, but must be in full compliance=
within six months of beginning their duties.
IV. =
DEFINITIONS
RowanSOM - sponsored graduate educati=
on program is one for which RowanSOM maintains academic responsibility=
.
V. REF=
ERENCES
- Rowan University School of Osteopathic Medicine Policy: Tuberculosis Su=
rveillance
- Rowan University School of Osteopa=
thic Medicine Policy: HIV, HBV and HCV
- Centers for Disease Control and Pr=
evention, Guidelines for Preventing the Transmission of Mycobacterium tuber=
culosis in Health-care Settings, 2005, MMWR 2005; 54 (RR-17), i-141.=
- National Research Council, Occupat=
ional Health and Safety in the Care and Use of Research Animals, National A=
cademy Press, Washington, D.C., 1997.
- Immunization of Health-Care Person=
nel: Recommendations of the Advisory Committee on Immunization Practices (A=
CIP), MMWR 2011;60(No. RR-7).
- Centers for Disease Control and Pr=
evention, Guidelines for Infection Control in Dental Health- Care Settings =
=E2=80=93 2003. MMWR 2003;52(No. RR-17).
- Occupational Safety and Health Adm=
inistration, "Occupational Exposure to Bloodborne Pathogens," 2=
9 CFR Part 1910.1030.
VI. POLIC=
Y
A. Immunization and Health Requirements=
p>
- His=
tory and physical exam:
Each=
house officer shall undergo a complete medical history review within thirt=
y (30) days of beginning the program and, if needed, an appropriate ph=
ysical examination based upon the history.
- Hep=
atitis B:
New housestaff sha=
ll undergo testing for HBV infection and immunity pre-placement (post-offer=
of employment), and prior to patient contact. These tests should ordinaril=
y consist of hepatitis B surface antigen (HBsAg), antibody to HBsAg (HBsAb)=
and antibody to hepatitis B core antigen (HBcAb), followed by additional t=
ests as deemed appropriate by the campus Occupational Medicine Service.
- If =
house officers test negative for =
HBV infection and immunity, and t=
hey have not been previously immunized, they shall begin immunization again=
st HBV or sign a RowanSOM-approved waiver declining immunization prior to p=
atient contact or contact with blood or other potentially infectious body f=
luids or laboratory material. If house officers test negative for HBV infec=
tion and have been previously immunized but have inadequate levels of antib=
odies despite such previous immunization, they shall receive a booster dose=
of the vaccine or sign a RowanSOM-approved waiver declining immunization p=
rior to patient contact or contact with other potentially infectious body f=
luids or laboratory material. Testing for antibody titers (HBsAb) 1-2 month=
s post-immunization should be performed; non-responders to a primary series=
of immunizations or booster dose should complete a second three-dose immun=
ization series and be tested again for serologic response. Individuals who =
still do not respond with antibody production following a second series of =
immunizations are considered susceptible to HBV infection, and shall be cou=
nseled regarding precautions to prevent HBV infection and the need to obtai=
n hepatitis B immune globulin (HBIG) prophylaxis for any known or probable =
significant exposure to HbsAg-positive blood.
- In =
all instances, current CDC recommendations should be followed regarding ini=
tial HBV immunization, post-immunization antibody titers, re-immunization o=
r booster doses for inadequate antibody titers, and post-exposure immunoglo=
bulin prophylaxis for non-responders. If the initial HBV tests are positive=
and indicate a significant potential for transmission of the virus, an eva=
luation shall be made prior to patient contact of the need for monitoring o=
f clinical performance and/or of the scope of assigned or permitted clinica=
l activities consistent with patient protection, especially the performance=
of exposure-prone procedures. This evaluation shall be made by designated =
personnel as per the University policy on HIV, HBV and HCV, 00-01-45-52:00.=
If hired under these circumstances, house officers may be restricted in th=
eir clinical activities.
- Cur=
rently employed housestaff shall comply with all HBV requirements of the Un=
iversity policy on HIV, HBV and HCV, 00-01-45-52:00.
- Tub=
erculosis:
- All=
housestaff must meet the requirements of the Rowan University School of Os=
teopathic Medicine policy on Tuberculosis Surveillance.
- Eac=
h house officer shall undergo TB skin testing (TST) using the Mantoux metho=
d (5 tuberculin units of intradermal TST), or an FDA-approved blood assay f=
or TB, prior to employment. All TST must be administered, read and interpre=
ted in accordance with Centers for Disease Control and Prevention (CDC) gui=
delines (see Reference 3). All FDA-approved blood assays for TB must be adm=
inistered, read and interpreted according to guidelines issued by the CDC, =
FDA and the manufacturer. Positive reactions shall be appropriately followe=
d up. The two-step method shall be used if the pre-employment TST is negati=
ve and there is not another documented negative TST within the preceding 12=
months.
- The=
reafter, annually or more frequently if indicated, house officers with nega=
tive reactions shall be re-tested. Housestaff with non-human primate contac=
t shall receive periodic testing every six months in accordance with the Na=
tional Research Council's Occupational Health and Safety in the Care and Us=
e of Research Animals. Those with positive reactions shall be followed and =
treated as appropriate.
- Hou=
se officers with a history of BCG (bacille Calmette-Guerin) vaccination are=
not exempt from the TB testing requirement because there are no data to in=
dicate that these individuals experience an excessively severe reaction to =
TST, and because anyone with a history of BCG with a positive TST result is=
considered infected with TB and is treated accordingly.
- Hou=
se officers who have initial positive TB test results, subsequent TB test c=
onversions, or symptoms suggestive of TB must be evaluated promptly for act=
ive TB. This evaluation must include a history, clinical examination and a =
chest X-ray. If the history, clinical examination or chest X-ray is compati=
ble with active TB, additional tests, such as sputum microscopy and culture=
, must be performed. If symptoms compatible with active TB are present, the=
house officer should be excluded from clinical activities until either (a)=
a diagnosis of active TB is ruled out or (b) a diagnosis of active TB is e=
stablished, treatment is begun and a determination is made by the director =
of a RowanSOM Occupational Medicine/Employee Health Service that the house =
officer is noninfectious. Those house officers who do not have active TB sh=
ould be evaluated for preventive therapy according to published CDC guideli=
nes. However preventive therapy for latent infection in the absence of acti=
ve disease is not required. If the evaluation for active TB, treatment for =
active TB and/or preventive therapy for latent infection is carried out at =
a facility other than a RowanSOM site or RowanSOM-approved site, all test r=
esults and documentation of care provided must be shared with the director =
of the appropriate RowanSOM Occupational Medicine Service. House officers r=
eceiving preventive treatment for latent TB infection need not be restricte=
d from usual clinical activities.
- Mea=
sles-mumps-rubella:
- Eac=
h house officer must submit documented proof of immunity to measles, mumps =
and rubella prior to or within thirty (30) days of beginning the program. (=
People born before 1957 may be immune from childhood exposure to the natura=
lly occurring diseases, but this evidence has proved unreliable.) Immunity =
can be proved by serologic (laboratory) evidence of immunity to each diseas=
e.
- Hou=
sestaff lacking serologic immunity must receive at least one dose of MMR va=
ccination prior to or within thirty (30) days of beginning the program.
- Inf=
luenza:
Housestaff should be=
immunized each year of their employment with RowanSOM during the fall seas=
on with seasonal and any other current influenza vaccines available.=
- Var=
icella:
Housestaff must rece=
ive two doses of varicella vaccine 4 to 8 weeks apart or prove immunity to =
varicella-zoster virus via serology prior to beginning the program or prior=
to patient contact. If the titer is negative, the housestaff member will b=
e offered varicella vaccine to complete a vaccination series. If the houses=
taff member has a negative varicella titer and has not previously had varic=
ella vaccine, the housestaff member will be required to complete a series o=
f varicella vaccination within the first three months of patient contact. B=
ecause of potential transmission of the vaccine virus to susceptible high-r=
isk patients, such as immunocompromised patients, newborns and pregnant wom=
en, contact with high-risk susceptible patients should be avoided if a vacc=
ine-related rash develops within three weeks of receipt of either the first=
or second dose of the vaccine.
- Tet=
anus-diphtheria-pertussis:
E=
ach house officer prior to beginning the program should have completed a pr=
imary series of tetanus, diphtheria and pertussis immunizations (DPT), and =
received a booster dose of Td (tetanus-diphtheria) every ten years since. E=
ffective for house officers hired in 2007 or later, with the availability o=
f Tdap (tetanus-diphtheria-acellular pertussis) immunization, house officer=
s must, prior to employment, receive one dose of Tdap.
B. Exemptions/Exceptions
- A h=
ouse officer may be exempted from any required immunization if he/she has a=
medical contraindication for that immunization and if failure to receive t=
his immunization does not prevent fulfillment of the requirements of the tr=
aining program. Conditions comprising valid medical contraindications to va=
ccine administration are those set forth by the Centers for Disease Control=
and Prevention. Such housestaff must present a written statement from a ph=
ysician licensed to practice medicine in the United States or a foreign cou=
ntry stating that a specific immunization is medically contraindicated, and=
giving the reasons for and duration of this contraindication. These writte=
n physician's statements shall become part of the individual's immunization=
record and shall be reviewed annually by the Program Director in conjuncti=
on with the Director of Graduate Medical Education or infectious disease ex=
pert from the health-care unit where the house officer works to determine w=
hether this exemption shall remain in effect for the next year. When a medi=
cal contraindication no longer exists, the house officer must then comply w=
ith the immunization requirements. The University shall provide reasonable =
accommodations to those housestaff whose medical conditions contraindicate =
immunizations so long as the failure to be vaccinated will not prevent the =
individuals from fulfilling the requirements of the training program. House=
staff should be informed of the immunization and testing requirements prior=
to employment.
- A h=
ouse officer may be exempted from any required immunization if he/she submi=
ts a bona fide written signed statement explaining how immunization conflic=
ts with his or her religious beliefs and if failure to receive this immuniz=
ation does not prevent fulfillment of the requirements of the training prog=
ram. The individual may be required to acknowledge in writing that he or sh=
e was informed of the value of immunizations and has knowingly declined to =
have such immunizations for religious reasons. RowanSOM shall provide reaso=
nable accommodations to those housestaff whose religious beliefs bar immuni=
zations so long as the failure to be immunized will not prevent the individ=
uals from fulfilling the requirements of the training program. Housestaff s=
hould be informed of the immunization and testing requirements prior to emp=
loyment.
- Hou=
sestaff who are not able to complete immunizations and tests by the start o=
f the program may be employed on a provisional basis if temporary exemption=
is granted by the Program Director. However, depending upon which document=
ation, immunization or test is lacking, these housestaff may be excluded fr=
om certain activities such as patient contact or laboratory work. For examp=
le, housestaff may be restricted from contact with patients or with blood o=
r other potentially infectious body or laboratory fluids if they have not r=
eceived at least one dose of hepatitis B vaccine or cannot provide serologi=
c evidence of current immunity to hepatitis B or have not signed a waiver. =
Housestaff shall not be permitted to have contact with patients unless they=
have received tuberculin testing and any required follow up. Provisional e=
mployment on this basis may be limited by the Program Director, at his or h=
er discretion. If a house officer is restricted from patient contact or lab=
oratory work and is unable to fulfill the academic requirements of the prog=
ram, the house officer may be subject to dismissal.
C. Record-Keeping Requirements
- The=
re must be acceptable evidence of required immunizations, immune status or =
health status listed in Section VI.A for each house officer prior to beginn=
ing the training program.
- Acceptable documents serving as evidence=
of previous immunization and/or immunity may include:
- an official school immunization record o=
r copy thereof from any primary, secondary, undergraduate, graduate, health=
professions or other school;
- a record from any public health departme=
nt;
- a medical record or form summarizing a m=
edical record and prior immunizations signed by a physician licensed to pra=
ctice medicine in any jurisdiction of the United States or foreign country =
or other licensed health professional approved by the New Jersey Department=
of Health and Senior Services;
- a report of serology from a licensed lab=
oratory.
- Records shall be maintained of the docum=
ented histories, physical exams, immunizations, immune status and any exemp=
tions of all housestaff. These records shall be updated upon additional imm=
unization, immunity testing or occurrence of a relevant infectious disease.=
Immunization records shall be kept for thirty (30) years following complet=
ion of the program, termination, transfer or other departure of a house off=
icer from RowanSOM.
- Summaries of measles-mumps-rubella house=
staff immunization/immune status shall be available for inspection by autho=
rized representatives of the New Jersey Department of Health and Senior Ser=
vices, and as part of the Annual Hospital Rubella and Measles Immunity Repo=
rt required under hospital licensing standards.
------=_Part_13019_801842730.1711653627139--