Health Care Workers (HCWs) have an increased risk of most vaccine preventable diseases and may transmit infections to susceptible patients or people in their care. HCWs are defined as all those who have contact with patients or contact with blood or other body substances from patients in a health care or laboratory setting. This includes: medical, dental, nursing, allied health, emergency health care workers (ambulance and volunteer first aid workers), laboratory staff and mortuary workers, including all trainees and student health care workers in these groups.

Health care workers may be exposed to, and transmit, vaccine-preventable diseases such as influenza, measles, rubella and pertussis. Maintaining immunity in the health care worker population helps prevent transmission of vaccine-preventable diseases to and from health care workers and patients. The likelihood of contact with patients and/or blood or body substances determines vaccination recommendations. Health care workers should receive the vaccines they require before or within the first few weeks of employment, with the exception of influenza vaccine, which should be administered annually between March and May. You need to consult your GP to discuss your current immunisation status and requirements depending on your individual circumstance. You can also refer to department of health website for further information.
Most health care workers will have received a primary course of diphtheria/tetanus vaccine however, if in doubt, offer three doses (ADT) at one-monthly intervals. Recommend a further dose on the 50th birthday. A pertussis-containing vaccine (dTpa) may be used instead of ADT at 50 years of age.
A single booster dose (given as dTpa vaccine) is recommended for health care workers in paediatric settings, particularly maternity and neonatal settings.
Varicella (chickenpox)
A history of chickenpox is strongly predictive of prior infection (>90 per cent). Consider serological screening of people with no definite prior history of chickenpox (approximately 50 per cent of this group will be susceptible). Document results of testing.

All non-immune direct care staff (see above for definition) should be vaccinated with varicella vaccine. Two doses of vaccine at least one month apart are required for adults.
Hepatitis B
A course of three doses of vaccine to all health care workers. Perform post-vaccination serological testing one month after the third dose of vaccine. If adequate anti-HBs antibodies are not reached following the third dose, the possibility of HBsAg carriage should be investigated. Those who are HBsAg negative and do not respond should be offered either a further double dose or a further three doses at monthly intervals of hepatitis B vaccine. Further testing should be performed four weeks later. Persistent non-responders should be informed about the need for HBIg within 72 hours of parenteral exposure to hepatitis B.

Booster doses of hepatitis B vaccine are no longer recommended for people who have an adequate antibody response to the primary course, as there is good evidence that a primary course provides long lasting protection.
Hepatitis A
Staff at higher risk of occupational exposure to hepatitis A includes nursing staff and other health care workers in contact with patients from Indigenous communities, in paediatric wards, infectious disease wards, emergency rooms and intensive care units or who frequently attend patients in rural and remote Indigenous communities.
Measles, mumps, rubella
Document at least two doses of a measles-containing vaccine for all staff born since 1966. Those born prior to 1966 are considered immune.If in doubt, offer two doses of MMR vaccine a minimum of one month apart.
  1. High risk workers include all staff working in respiratory clinics and laboratories and specific tuberculosis treatment areas; staff working in intensive care, emergency departments, and bronchoscopy theatres; all those who regularly work with TB or HIV positive patients; laboratory staff exposed to potential tuberculous material; mortuary staff and all immunocompromised health care workers.

  2. Medium risk workers include other medical and nursing staff, physiotherapists, radiographers, paramedical and ambulance staff and students involved in direct patient care, non-clinical staff in regular close contact with patients and community nurses working with at-risk groups.

  3. Low risk staff are those not routinely exposed to patients or their clinical specimens, for example, kitchen staff, administration and clerical staff.

All medical, nursing, general ward, pathology, radiology, dental, mortuary and paramedical hospital staff should have their TB status determined pre-placement, unless they have documentation of a positive test, adequate treatment for disease or infection or a negative test within the previous three months.

The frequency of periodic TB screening depends on the risk categories of the facility and the worker. Screen negative health care workers in high risk settings annually. Negative workers in medium risk settings require screening every two years unless the risk of infection is shown to be less than 1 per cent per annum. Health care workers in low risk settings need not be routinely screened during employment.

All health care workers should have an exit test of TB status on completion of employment at each health care institution.

BCG vaccination is no longer routinely recommended for Victorian health care workers, however health care facilities should consider offering BCG to health care workers and voluntary workers who are TB negative, where the risk of repeated exposure to infectious TB is high and not controlled despite appropriate infection control procedures. Use of BCG vaccination does not preclude periodic TB surveillance. Do not give BCG to those who are HIV infected or immune-suppressed, or who are pregnant or likely to be pregnant.

TB status in health care workers has traditionally been determined by administration of a Tuberculin (Mantoux) Skin Test (TST). The TST is known to have a number of limitations, including lack of sensitivity in people who have previously been vaccinated with BCG.