This policy and procedure applies to all employees (clinical and non-clinical) of Royal Victoria Health Centre (RVH) as well as physicians with privileges, volunteers, students and contractors. These individuals shall be referred to collectively as workers herein.
The provision of influenza vaccine for workers is an essential component of the standard of care for influenza prevention. Workers should consider it their responsibility to provide the highest standard of care, which includes undergoing annual influenza vaccination. The goal of implementing this policy is to prevent the acquisition and spread of seasonal influenza within RVH’s properties.
Note: Where Collective Agreements are silent this policy shall prevail.
To establish the parameters and expectations for RVH workers related to the annual influenza immunization as well as practices when workers do not receive the immunization in order to:
- Protect those high-risk clients that receive direct services from workers;
- Protect the worker;
- Protect work colleagues and family (including some of those who, unknown to colleagues, may
be in a high-risk category);
- Protect the ability of RVH to provide critical care and emergency services;
- Provide leadership on this preventive measure to the community and our community partners.
Influenza: an acute viral disease of the respiratory tract characterized by sudden onset of fever,headache, aching body, severe tiredness, dry cough and sore throat.
Influenza Outbreak: defined as two or more nosocmially acquired influenza like illness cases occurring within 48 hours on a specific unit, with at least one case being laboratory confirmed.
Influenza Vaccination: influenza vaccination is a vaccine that is approved through the National Advisory Committee on Immunization (NACI) for the current influenza season.
NACI identifies known medical contraindications to influenza vaccination as: an anaphylactic reaction to a previous dose of the influenza vaccine or to any of the vaccine components, with the exception of egg allergy; or Guillain-Barré Syndrome (GBS) within eight weeks of a previous influenza vaccination. Workers who meet these conditions are considered to have a medical contraindication to influenza vaccination. Those who provide certification from a duly qualified physician or nurse practitioner that they have a medical contraindication to influenza vaccination are not required to get their annual influenza vaccination. The procedures noted below with respect to workers who are not vaccinated will apply to those who are exempted from their annual influenza vaccination due to medical contraindication.Pregnancy is not considered to be a contraindication.
Widespread Influenza Activity is defined as: Sporadically occurring Influenza like Illness (ILI) and lab confirmed influenza* together with outbreaks of ILI in schools and/or work sites, or laboratory-confirmed influenza in residential institutions occurring in > 50% of the SMDHU.
*confirmation of influenza within the surveillance area at any time within the prior week.
Health Protection and Promotion Act (1990) – Part IV which provides that in the event of an outbreak in the health care facility, the Medical officer of Health has the authority to exclude any person who presents a risk to the health of residents/patients.
The Occupational Health and Safety Act (1990) – S.25 (2)h
Health Care and Residential Facilities Regulations(1993) Section9. (1) states the employer shall reduce the measures and procedures for the health and safety of workers which consists of controlling infections as well and ensuring immunization and inoculation against infectious diseases is available.
- Prior to influenza season, Occupational Health and Safety (OH&S) will provide the organization with information.
- OH&S will provide access to seasonal influenza vaccination and alternate locations that vaccine can be provided.
- Workers must provide proof of annual influenza information (including immunization status, declination of immunization or medical exemption) to OH&S by the first Monday in December or earlier if community widespread or unit/facility outbreak declared.
- New hires/placements/privileged members have 7 days to provide required documentation from the time of hire or service, during influenza season (Nov- April).
- For workers that have medical contraindications appropriate documentation from a health care provider must be provided to OH&S to be placed on their medical file.
- Subject to other specific provisions of this policy, RVH considers properly administered antiviral medication as an acceptable alternative for workers not able to have their annual influenza vaccination, if the circulating strains are not antiviral resistant. Those wishing to avail themselves of this exception to the general policy noted above must:
- provide current proof of prescription for the antiviral medication,
- sign a form confirming that they are properly taking their antiviral medication and
- must in fact be properly taking such medication.
RVH will not provide antiviral medication to workers, except during a pandemic when vaccine is not available, at which time RVH’s Pandemic Plan will be in effect and provide direction. Workers will be responsible for making these arrangements on their own. RVH’s benefit plan may cover the cost of prescribed antiviral medication.
- Provision of Education and Vaccine
In order to support and facilitate annual influenza vaccination for workers, OH&S will make sure that these individuals are given every reasonable opportunity to be informed of the risks,benefits, and side effects of the Influenza vaccine (the “vaccine”). This includes, but is not limited to the following:
- An education program at the beginning of the “flu season” promoting awareness of influenza and the importance of vaccination as well as a resource list which highlights the risks and side effects.
- Posting of a notice in accessible locations of the facility, e.g. staff lounge and bulletin boards, at least a month in advance of the vaccination clinic dates. The notice will include the clinic dates, hours and location.
- Obtaining worker individual consent
- Documentation of Vaccination Status
- Workers must provide influenza immunization status by the first Monday of December of each year or earlier in time if widespread influenza activity or unit/facility outbreak to OH&S. This documentation will be maintained by OH&S. Documentation will be shared with the Infection Prevention and Control department, Human Resources and manager/responsible person to enable appropriate management of staff, assignments and patients with identified influenza, during widespread influenza activity in the community or during unit/facility outbreak.
- New workers will be informed about this policy prior to being hired/placed/or given privileges and that it is a condition of service. Those that initiate service between November 1st and April 30th will be required to comply within 7 days of being on site. For students training at RVH, the hospital must inform the supplying school that the school is responsible for the appropriate education, vaccination of their students, and maintenance of immunization records (OHA, 2010).
- Documentation will be by means of one of the following or an acceptable alternative where indicated:
- An appropriately completed annual Influenza Vaccine Consent/Decline form;
- Employees who do not provide documentation of receipt of vaccine should be managed as unimmunized (OHA, 2010);
- Those who are not vaccinated due to documented medical contraindications*(see definitions) will provide documentation of reason for medical exemption signed by an approved health care professional. This medical exemption will be maintained in the health file, in the OH&S department.
- Immunized Workers: Those immunized, with documented vaccination at least 2 weeks prior to the declaration of widespread influenza activity by the Simcoe Muskoka District Health Unit (SMDHU) may continue to work without disruption of their work pattern.
- Non immunized Workers: Those workers that are not immunized must choose from the following options during widespread influenza activity:
The worker can receive vaccination at RVH or provide proof of vaccination. In order to resume work:
- After a waiting period of two weeks after vaccination to allow sufficient time to develop immunity to the influenza virus; or
- If prophylactic antiviral medication is taken in the interim (for 14 days after immunization) or;
- Wear a mask until at least 14 days after receipt of vaccination
If one of these options is chosen then an earlier return to work would be allowed. Documentation of prescribed antiviral medication or wearing a mask is required, as well as signing of a Confirmation of Taking Antiviral form.
- Taking daily prophylactic antiviral medication
- Mask use
- Work exclusion
Non-vaccinated workers may take antiviral medication until such time as the widespread influenza activity is declared over. Documentation of prescribed antiviral medication is required. RVH will not provide antiviral medication to workers; they will be responsible for making these arrangements on their own. The hospital benefit plan may cover the cost of prescribed antiviral medication. It is advisable for workers to discuss this with their healthcare provider, in advance of the influenza season, so that arrangements are in place for prompt administration of the antiviral, if required to be at work or on RVH premises (obtain a prescription in advance, to be used if needed to work). Workers will be required to sign a Confirmation of the taking of Antiviral Medication. Those that are non-vaccinated may take antiviral medication until such time as the widespread influenza activity is declared over by the MOH of the SMDHU, in consultation with Infection Prevention and Control and OH&S.
Non-vaccinated workers may choose to wear a mask until such time as the widespread activity is declared over but this is not an option during a unit/facility outbreak. There is a requirement for worker to sign that they will wear a mask at all times while on RVH premises, except during meals breaks.
Non-vaccinated workers, not on prophylactic antiviral medication or agreeing to wear a mask, will be excluded from the RVH premises for the duration of the widespread community influenza activity.
- Immunized workers – if immunized for 14 days or more they can continue to work on the affected unit
- Workers not immunized taking antivirals may continue to work on the affected unit
- Workers under immunized – those that received the vaccine less than 14 days can take antivirals and continue to work. The can stop antivirals after 14 days of immunization.
For those not taking immunization or antivirals during a unit/facility outbreak the following options are available and work is not available in non-outbreak areas:
- Use of stat holidays, vacation and/or owed overtime
- Unpaid leave of absence
- Paid leave of absence (this option is only available to staff with medical contraindications to the influenza vaccine that has been documented and are on file). This option also requires that the staff member is unable to take antiviral medication and has provided documentation to this affect to the OH& S/ from their medical provider.
- Medical staff restrictions will be in place for physicians, as per the direction of the Chief of Staff.
*****Caveat: If at any point the seasonal Vaccine is found to be not a good match that season or the available antiviral is found to be resistant to the strain, and then the SMDHU MOH and Infection Prevention and Control/OH&S department may be required to alter the policy to provide appropriate guidance.
Confirmation of influenza within the surveillance area at any time within the prior week. When there is reported widespread influenza activity in the SMDHU catchment area as communicated by the MOH, all staff/physicians/volunteers and students working at RVH will be required to receive their influenza vaccine and/or start an antiviral(if not resistant) or wear a mask when on RVH premises.
Simcoe Muskoka District Health Unit Staff Influenza Policy, 2011.
North Bay General Hospital Influenza Policy, 2010.
OHA/OMA (2012). Influenza surveillance protocol for ontario hospitals. Retrieved August 12,2013 from: www.oha.com
National Advisory Committee on Immunization (NACI) (2013). Statement on seasonal influenza
vaccine for 2013 – 2014. Retrieved August 30, 2013 from:www.bccdc.ca