Pre-commencement Health Assessment Immunity Requirements

Pre-commencement Immunity Requirements and Vaccination Programmes

• Pre-employment health assessment is mandatory for all staff.
• Immunity requirements are determined based on factors such as pathogens staff may be exposed to, local epidemiology of disease, and frequency of patient contact.
• The benefits of a pre-commencement vaccination programme for workers include meeting statutory obligations, protecting against communicable diseases, and ensuring efficient running of services.
• Routine vaccinations include DTP (5 doses), MMR (2 doses), and varicella immunity.
• Measles is caused by the paramyxovirus and infects 90% of non-immune contacts, with symptoms including high fever, rash, pneumonia, and encephalitis.
• Close contacts of TB patients should be clinically assessed for pulmonary TB and offered standard screening for latent TB.
• Tuberculosis is a notifiable disease with symptoms such as cough, weight loss, and night sweats, and it is transmitted through inhaled droplets and close contact with sputum positive cases.
• Healthcare workers are at risk of TB due to aerosol generating procedures and close contact with infected individuals.
• The most common cause of tuberculosis in UK healthcare workers is unprotected occupational exposure during aerosol generating procedures on a patient known to be infected.
• The Employee Safety Representative contacts regarding the benefits of a pre-commencement vaccination programme for workers.
• The employer benefits from meeting statutory obligations and ensuring efficient running of services, while employees are protected against communicable diseases.
• The immunity requirements are based on local epidemiology, frequency of patient contact, and severity of the disease, and the vaccination program benefits both employees and employers.

Biological Hazard Control and Classification

• Key topics include zoonoses, tropical parasites and diseases, travel medicine, tuberculosis, blood borne viruses, food borne diseases, food handlers fitness standards, and COSHH principles in relation to biological hazards.
• Cordell Health's recent papers cover various topics such as body fluid exposure, malaria, hydatidosis, Q fever, rabies, and vaccinations by occupation.
• Biological agents include micro-organisms like bacteria, viruses, fungi, and parasites that live inside their host, and can cause health effects beyond infection.
• According to COSHH 2002, ticks and mosquitos are considered biological agents because they have the capacity to cause disease in humans.
• Ticks and mosquitoes are not biological agents, but their bite may be the route by which a parasite or pathogen can infect a human.
• Viruses are 20-450nm in size and can be transmitted through airborne or blood-borne routes.
• Bacteria come in various forms and fungi may produce mycotoxins, posing occupational health risks.
• The classification of occupational biological hazards is based on the pathogenicity to humans, employee hazard level, spread to the community, and availability of treatments/vaccines.
• Examples of biological agents include Borrelia burgdorferi, measles virus, Legionella sp., Bacillus anthracis, rabies virus, Mycobacterium tuberculosis, SARS-CoV-2, Ebola virus, and others.
• The COSHH Hazard Group system has limitations as it does not consider vulnerable staff, such as those with underlying medical conditions, immunosuppression, breastfeeding, or pregnancy.
• Risk assessment for biological hazards involves considering the work activity, control measures, potential health effects, exposed population, and type/extent of exposure.
• Anyone working with Hazard Group 2, 3, or 4 biological agents must undergo a risk assessment, and COSHH specifies containment levels for activities involving these agents.

Occupational Medicine Key Points

• "Healthy worker effect" refers to the selection bias in comparing worker health to general population in studies
• Karoshi is sudden death due to overwork, recognized in Japan and neighboring countries
• Workplace interventions are most effective for reducing disability in those out of work due to musculoskeletal disorders
• Young individuals are more susceptible to "manganese madness" after 6 months exposure, potentially associated with Parkinsonism
• Job strain, defined by high psychological demands and low decision latitude, increases risk of depressive symptoms
• Humans are trichromatic, with infants having good color vision by two months of age
• No good evidence supports workplace interventions reducing low back pain risk
• Frozen shoulder (adhesive capsulitis) tends to last 12-18 months and is resistant to treatment, more common in those with diabetes
• Limited evidence for association between computer use and wrist tendinitis, tension neck pain
• Studies suggest up to 90% return to work post-operatively, earlier for lighter work after hip arthroplasty
• Noise-induced hearing loss may cause tinnitus, vertigo, and social isolation, typically bilateral
• Methaemoglobinaemia may occur due to occupational exposure to benzene, chlorates, or chromates, with treatment using methylene blue

Learn about the factors that should be considered when determining the immunity requirements at the precommencement health assessment for staff. Understand the impact of pathogens, local epidemiology of diseases, frequency of contact with infected material, and nature of patient interaction on immunity requirements.