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CQC Essentials: Immunisation of healthcare staff

The CQC expects practice to ensure that staff receive the appropriate immunisations according to the roles that they undertake.

This article relates to the CQC key questions: Is your practice safe? and Is your practice well-led?

We have had questions on our inspections of GP practices about the requirements for staff to have immunisations.

Practices are required to ensure that staff receive the appropriate immunisations according to the roles that they undertake. All employees should have access to an occupational health assessment that includes consideration of any necessary immunisations. This should be a standard part of the practice protocol for appointment of new staff.

Immunisation of healthcare staff is to:

  • provide protection for the individual and their family
  • protect patients and service users, including vulnerable patients who may not respond well to their own immunisation
  • protect other healthcare staff
  • allow for the efficient running of services without disruption.

GP practices should be able to demonstrate that an effective employee immunisation programme is in place and they have an obligation to arrange and pay for this service. The GP practice does not have to provide this service for its employees, but should ensure an occupational health service does. This will often be at the local hospital.

The 'Green Book' Immunisation against infectious diseases gives information on immunisation for employees in general practice (chapter 12):

The Green Book states that all new employees should undergo a pre-employment health assessment, which should include a review of their immunisation needs. Staff not considered to be at risk need not routinely be offered immunisation, although post-exposure prophylaxis may occasionally be indicated.

The Green Book provides guidance on the types of immunisation that may be appropriate for different groups of staff; the types of immunisations required may vary from workplace to workplace.

Vaccinations for clinical staff involved in direct patient care (doctors, nurses, healthcare assistants)

All staff should be up to date with their routine immunisations:

  • tetanus, polio, diphtheria, measles, mumps and rubella (particularly important to avoid transmitting measles or rubella to vulnerable groups. Satisfactory evidence is positive antibody test or having received two doses).

Some staff may need to have other selected vaccines, as recommended below:

  • BCG – healthcare workers who may have close contact with infectious patients
  • Hepatitis B – healthcare professionals who may have direct contract with patients’ blood or blood-stained body fluids eg from sharps
  • Influenza – healthcare workers directly involved in patient care, who should be offered influenza immunisation on an annual basis to protect staff and reduce transmission to patients
  • Varicella (Chickenpox) – susceptible healthcare workers who have direct patient contact. Those who have not had a definite history of chickenpox or shingles should have a blood test and given vaccination unless immune.

Non clinical staff in healthcare settings

This includes non-clinical ancillary staff who may have social contact with patients but are not directly involved in patient care, such as receptionists. All staff should be up to date with routine immunisations e.g tetanus diphtheria, polio and MMR.

However, hepatitis B vaccination would only be necessary if a risk assessment of the employee’s role concludes that they are at risk of injury from blood-contaminated sharp instruments, or of being deliberately injured or bitten by patients.  Annual influenza vaccine is not routinely recommended for this group.

The requirements for this are set out in the Health and Safety at Work Act (HSWA) 1974, the Control of Substances Hazardous to Health (COSHH) Regulations 1992, and the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which set out the fundamental standards.

  • Professor Nigel Sparrow is senior national GP advisor and responsible officer at the CQC

More CQC resources

Picture: iStock

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