[MCOH-EH] Onboarding: tracking immunizations and titers

[Dr Joe Fanucchi]

Colleagues,

Many of our client hospitals utilize an EMR database to track required 
steps in the onboarding process. For those without compatible software, 
these events can also be tracked in an Excel spreadsheet with the use of 
macros. We have an Excel template which we would be happy to share with 
any facilities which are still using paper charts or are using software 
which cannot provide this type of tracking. Please write to 
support at meditrax.com <mailto: support at meditrax.com> (not to the entire 
maillist) if you wish to to request a copy of the spreadsheet.

In this example, requirements which have been fulfilled are shown in 
green; those still incomplete are shown in red. If a particular option 
is not necessary (such as the TSTs in this example, which are not 
required because the applicant has had an IGRA test) it is shown in a 
"strikeout" font. The dark blue square icons are point-and-click links 
which enable the Employee Health staff to enter or update the date and 
details of any individual event. The entire sequence of steps can be 
documented whether or not a record has been created for the applicant in 
the hospital's payroll or EMR databases.

The algorithm at this particular hospital is:

  * Drug testing for all applicants is required within the two weeks
    prior to hire.
  * Flu immunization or declination is required for hires between August
    1 and March 31.
  * Clinical and medical staff are required to have respirator
    clearance, and fit testing /_or_/ PAPR clearance, within the
    previous 12 months.
  * Two-step TST testing /_or_/ an IGRA _/or/_ a TB Questionnaire /_or_/
    clinical followup of a previous positive test must be documented
    within the previous 12 months.
  * MMR titers must be documented; if any of the three titers is
    negative or absent, MMR immunization_/or/_ a written declination
    must be documented. The applicant's age and clinical history of
    disease(s) are not considered relevant.
  * Varicella titer _/or/_ immunization _/or/_ written declination must
    be documented; if the titer is negative or absent, immunization
    /_or_/ a written declination must be documented. Again, age and
    clinical history are not considered relevant.
  * TDaP within the past 5 years, _/or/_ written declination of the TDaP
    vaccine, is required.
  * HBsAb /_or_/ completion of the Hep B vaccine series /_or_/
    initiation of the vaccine series within the previous 5 weeks /_or_/
    a written declination is required. If the titer is negative,
    immunization _/or/_ a written declination must be documented.

Hope this helps,

Joe Fanucchi

-- 
*Joe Fanucchi MD FACOEM*
President and Medical Director
MediTrax / OHS, Inc. <http://www.meditrax.com/>
o:925-820-7758
c:925-368-3367
drjoe at meditrax.com <mailto: drjoe at meditrax.com>
<http://www.meditrax.com/>
/MediTrax software: Everything you need, at a fraction of the cost!/

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On 1/26/2019 9:31 AM, Mike Heck wrote:
> To start with, we never use history or age as an acceptable method to 
> determine immunity.
> We titer for MMR, Varicella, and HepB. We give Tdap if the last one 
> wasn't within 5 years. We allow declination for HepB without issue, 
> for flu also, but a mask must be worn all flu season for areas where 
> patient care is given or visitors may frequent.
> If a pre-employee declines MMR, Varicella, or Tdap, they are not 
> cleared to work in a high risk patient area such as our Cancer 
> Institutes, ICU/CVU/TICU, PEDs, NICU, ER, EMS.
>
> Mike Heck, MLT, BS, BSN, RN, CIC
> Occupational Health & Ambulatory
> Infection Preventionist
> Department of Infection Prevention
> AtlantiCare Regional Medical Center
> Atlantic City NJ 08401
> P: 609-572-8520
> mheck at atlanticare.org
> ------------------------------------------------------------------------
>
> On Fri, Jan 25, 2019 at 3:34 PM AOHP Listserv 
> <aohpdiscussiongroup at aohp.topicbox.com 
> <mailto:aohpdiscussiongroup at aohp.topicbox.com>> wrote:
>
> We require the MMR, Varicella (unless they have medical 
> exemptions) and accept declinations for Hepatitis B, Tdap and Flu.  We 
> no longer titer for MMR and only accept 2 MMR Vaccines as evidence of 
> immunity.
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