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@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

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Joe Fanucchi MD FACOEM
President and Medical Director
MediTrax / OHS, Inc.
o:925-820-7758
c:925-368-3367
drjoe@meditrax.com

MediTrax software: Everything you need, at a fraction of the cost!

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@atlanticare.org

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On Fri, Jan 25, 2019 at 3:34 PM AOHP Listserv <aohpdiscussiongroup@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.