Immunizations Essential Part of Infection Prevention and Control Program
Immunizations substantially reduce the number of oral health care workers (OHCWs) susceptible to infectious diseases, as well as the potential for disease transmission to other staff and patients. That is why immunizations are an essential part of infection prevention and control (IPAC) programs.
All OHCWs should be adequately immunized against the following diseases:
- hepatitis B
- measles
- mumps
- rubella
- varicella
- influenza
- diphtheria
- pertussis
- tetanus
- polio
It is important that all OHCWs know their personal immunization status and ensure that it is up to date. In this regard, OHCWs should consult with their physician or other primary family health care provider about the status of their immunizations. Baseline and annual tuberculosis skin testing may also be considered. In addition, the Canadian Immunization Guide sets out recommendations and schedules for adults, including those engaged in the provision of health care.
Hepatitis B is the most important vaccine-preventable infectious disease for all workers engaged in health care. The risk of being infected is a consequence of the prevalence of virus carriers in the population receiving care, the frequency of exposure to blood and other body fluids, and the contagiousness of hepatitis B virus (HBV). Therefore, immunization against HBV is strongly recommended for all OHCWs who may be exposed to blood, body fluids or injury involving sharps. As part of the immunization policy for the dental office, include a record of hepatitis B vaccination and documented immunity to hepatitis B by serology for all OHCWs.
Serological testing for anti-HBs should be conducted 1 to 2 months after completion of the 3-dose vaccination series to establish antibody response. OHCWs who fail to develop an adequate antibody response should complete a second vaccination series, followed by retesting for anti-HBs. OHCWs who fail to respond to the second vaccination series should be tested for HBsAg.
Nonresponders to vaccination who are HBsAg-negative should be counselled regarding precautions to prevent HBV infection and the need to obtain immunoglobulin prophylaxis for any known or probable parenteral exposure to HBsAg-positive blood.
OHCWs who are HBsAg-positive should seek guidance regarding necessary and reasonable steps to prevent HBV transmission to others and the need for medical evaluation. In particular, OHCWs who might perform exposure-prone procedures should be assessed on a case-by-case basis regarding the need for possible work restrictions.
OHCWs who might perform exposure-prone procedures have an ethical obligation to know their serologic status. If infected, dentists should seek guidance from the RCDSO with respect to the potential for transmission of their infection to their patients.