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:
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.
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.
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.
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.
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:
*****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