Print

Print

 

Please could I have your opinion and advice on administering a vaccinane
for HCW in children and women,s health areas as a part of OH routine
vaccination.

My colleague returned from vaccination training and was advised that OH
does not vaccinate however the HPE advises to do so in 2012 document if
there is an exposure to the disease.

Who should be prescribing chemoprofilaxis if your Occupational Health
Physician is not in and HCW were exposed to confirmed case of whooping
cough.

Would you administer the vaccine which was precribed by a doctor (not an
Occupational Physician) for HCW exposed to the illness without a PGD.
If I am reading the question correctly, the OH department is providing a service to Health Care Workers working in the the area of Women and child health of a health care facility.

If in doubt always refer to the Green Book Chapter ONLINE - please throw away any hard copies of the 2006 guidelines as they are way out of date.

There is no reason the OH department should not give the pertussis vaccine provided that the appropriate prescription/PGD / written direction is in place.

However it does not appear to be given as a  routine vaccination, but in specific instances.

I think the important issue is "significant" exposure as described below... as opposed to everyone who works with children  etc.

Some theory here,  I hope one of the experienced NHS Advisors, like Sue Gorton of Great Ormond Street, will be able to comment on the practical application of the guidance.

https://www.gov.uk/government/publications/pertussis-the-green-book-chapter-24





http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1317136713302   This may be the 2012 document you refer to

Group 2. Individuals at risk of transmitting to ‘vulnerable’ individuals in group 1 who 
have not received a pertussis containing vaccine more than 1 week and less than 5 
years ago 
 
• Pregnant women (> 32 weeks gestation) 
• Health care staff working with infants or pregnant women 

Chemoprophylaxis/vaccination should therefore be considered for contacts in priority 
groups with significant exposure if BOTH these conditions are met: 
• Exposure occurred during infectious period 
• Prophylaxis can be offered within 21 days of last exposure (incubation period) 


3.5. Significant exposure in a healthcare setting 
 
Unprotected4 direct face-to-face contact (< 2metre distance) for greater than a 
cumulative period of 1 hour with an infectious case 
OR 
Direct contact with respiratory secretions from an infectious case e.g. performing 
aerosol-generating procedures or examination of the nose and throat without 
appropriate personal protective equipment (PPE). 
The 2 metres (6.5 feet) distance is based on the evidence that coughing can result in 
dispersal of droplets up to a distance of 2 metres (Section 2.2). The 1 hour cut-off is 
arbitrary, based on the lower risk to transient contacts, and is consistent with other 
international guidelines [19]. However the time/distance criteria should be used as a 
guide and a lower threshold may be considered in some circumstances. For 
example where an infected HCW has provided direct clinical care to hospitalised 
infants (unimmunised/partially immunised), prophylaxis may be offered to these 
infants even when the duration of contact is less than 1 hour. Such circumstances 
should be discussed with the local HPU and after April 2013, the Public Health 
England (PHE) Centre. 


Here is some info re HSW and pertussis,
http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/WhoopingCough/Guidelines/whoo001QuestionsandanswersPertussisGuidelines/



  1. Should an unvaccinated healthcare worker be provided with an additional course of chemoprophylaxis if they are re-exposed to a further case of pertussis? 

    Yes, a healthcare worker (HCW) who is re-exposed to a further case of pertussis and who has not received a pertussis containing vaccine in the previous 5 years should receive an additional course of antibiotics if within the time frame for public health action. There are currently no data on the duration of protection from a course of antibiotics for prophylaxis. Chemoprophylaxis should also be offered to HCW’s who have recently received a pertussis containing vaccine where exposure to an infectious case occurred less than 2 weeks after administration of the vaccine.


    So if this is the system in your organisation, you might consider  getting a PGD for the antibiotics so that they can be given. 


    Alternatively their GP may prescribe (but also may decline)
   I think I can clear up the question regarding "no PGD". If it is prescribed by a physician (any ) for a named patient it is termed a Patient Specific Direction. Which is essentially a prescription. If the nurse feels competent to deliver that drug... and in the case of vaccines is comfortable discussing the disease, the vaccine,  side effects  number of dose etc, then there is no reason the nurse should not give the medication as prescribed (think about the drug charts in hospitals, essentially the same situation). The Health Protection Agency does suggest that those administering vaccines should go on an initial 2 day training and then an annual update.

Bear in mind PGD only have legal standing within the NHS although they are widely used as best practice.


Outside the NHS  in Occupational Health,the medications are delivered by an exemption for OH in the Medicines Act

" Where the medicine is classed as prescription only and is supplied or administered by a registered nurse, there is a requirement for written directions of a doctor setting out the circumstances in which it is to be used in the course of the scheme. The law does not specify any requirements for the content of directions."



So this "written direction"  can be in the form of a "PGD" but there is no requirement for a pharmacist to be involved.

Cheers
Diane


Diane Romano-Woodward
RN  RSCPHN-OH  BSc   M Med Sc.(Occ Health)
Sunny Blue Sky Limited
Company Number  06865212








******************************** Please remove this footer before replying.

OCC-HEALTH ARCHIVES: http://www.jiscmail.ac.uk/lists/occ-health.html

CONFERENCES AND STUDY DAYS: http://www.jiscmail.ac.uk/cgi-bin/filearea.cgi?LMGT1=OCC-HEALTH