Medical evaluations before placement can ensure that personnel are not placed in jobs that would pose undue risk of infection to them, other personnel, patients or visitors. An important component of the placement evaluation is a health inventory. This usually includes determining immunization status and obtaining histories of any conditions that might predispose personnel to acquiring or transmitting communicable diseases. This information will assist in decisions about immunizations or post-exposure management.
Dental health care providers (DHCP) are at great risk of exposure to infection in the delivery of dental service. They are at considerable risk of acquiring or transmitting hepatitis B, influenza, measles, mumps, rubella and varicella. Even with the greatest care, accidents do inadvertently occur. One strategy to prevent the DHCP from acquiring or transmitting some of these infectious diseases is vaccination. Vaccination is considered an effective means to prevent acquisition and transmission of disease. The Department of Health of the Republic of the Philippines developed a routine immunization schedule for infants. There is, however, a lack of guidelines for adult healthcare providers’ immunization recommendations. Routine immunization against tuberculosis is not generally recommended. DHCP who are pregnant or who have diabetes or HIV require special recommendations prior to vaccination.
Decision on which vaccine to include in the immunization program depends on:
• Likelihood of personnel exposure to vaccine-preventable diseases and the potential consequences of not vaccinating personnel
• Nature of employment (type of contact with patients and their environment)
• The characteristics of the patient population within the healthcare organization
Immunization of the DHCP must ideally be accomplished before they are placed at risk of exposure to these infectious processes. In the Philippines, this risk of exposure begins in dental universities where the dental clinicians are allowed to work on live patients, performing invasive procedures such as exodontias and minor surgeries. The danger of disease transmission is not only limited to these procedures but to less invasive procedures such as scaling operative dentistry procedures.
As such, dental schools have the responsibility of ensuring the safety of their students and faculty against vaccine-preventable diseases. Faculty members must be encouraged to have completed all these immunization programs within the first year of their employment. Students must be encouraged to have completed all immunizations prior to being exposed to patients in the dental infirmary. Faculty and students who decline to undergo the immunization programs must sign an appropriate waiver indicating that they refuse the vaccination.
Dentists and their staff should also undergo such immunization programs if they have not received prior immunization. It should be the responsibility of the dentist employing personnel to ensure that his staff is adequately protected. This is especially important for the personnel who will be handling or be in close contact with blood. As with dental schools, the appropriate waiver should be signed if the DHCP refuses the vaccination.
Those DHCP working in hospitals or health centers are encouraged to follow the same recommendations as stated above.
RECOMMENDATIONS:
1. Develop a written comprehensive policy regarding immunizing DHCP, including a list of all required and recommended immunizations.
2. Refer DHCP to a pre-arranged qualified healthcare professional or to their own healthcare professional to receive all appropriate immunizations based on the latest recommendations as well as their medical history and risk for occupational exposure.