Rank: Forum user 
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Hi All
I have recently taken over a position in a Local Authority.
On my to do list is to roll out Hep B Vaccinations.
I have been researching around this topic and seem to come across mixed views as to whether vaccinations are provided as a matter of course for those deemed at risk or given as a reactive measure should individuals be exposed to a source e.g. Needlestick / Sharp injury.
I was just wondering if anyone has any experience / opinions on this they would be willing to share please?
Kind Regards
Claire
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Rank: Super forum user 
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In Healthcare we provide them as a vaccination. Those deemed at risk or who may be exposed to infectious matter or needlestick injury are pre- exposure vaccinated. It is the norm. Prevention being better than cure and all that!
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Rank: Forum user
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Hi Claire
It depends on the risk of exposure, so the decision on whether or not to proactively vaccinate should be based on the outcome from your risk assessment.
If your workforce are working in circumstances where they will be exposed to known Hep B risks then I would suggest vaccinate (eg the examples kevkel has stated.) But obviously this only protects against Hep B, and depending on route of exposure there may be any number of other 'nasties' that the staff are not being protected against.
In my organisation (not a clinical environment) we took the decision not to vaccinate and that the application of universal infection control standards would be sufficient to mitigate the risk of exposure to Hep B - as well as other bloodborne viruses).
Sam
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Rank: Super forum user 
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Claire
It would be good to offer vaccination - with prior antibody testing to check for pre-existing immunity and follow-up testing to ensure a 'take' - to staff collecting drug litter, or otherwise handling clinical wastes, to those working regularly with high risk client groups (DATs, some secure housing/hostels etc).
Since public health services were transferred last year to the LAs, why not ask them to work with you to consider each group of staff - they may not know of many of them so you help identify those who need to be considered.
Think also about any volunteers, and any contractors you might use. Can you offer them protection, or make it a requirement of contract that it should be offered (you cannot demand) to relevant contractor staff such as clinical waste handlers/litter pickers, deep clean waste removal teams, some security staff etc. If you think it appropriate to offer vaccination to your own staff, you should offer it also to at risk volunteers and expect a similar standard from your contractors.
Would be great also to take the opportunity to engage with all of those higher risk staff, to get someone in to talk to them about hygiene and biosafety. That delivers the full package.
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Rank: Super forum user 
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I'd stick with precautionary vaccination of the risk groups identified in HSE Guidance: http://www.hse.gov.uk/bi...atitis-b-vaccination.htmVaccinations can give a false sense of security. There is a slight risk of adverse reaction to vaccination. The programme of vaccinations and boosters does have to be effectively managed.
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Rank: Forum user
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Where would people stand who were needle phobic if they were already employed?
Only curious as a friend is needle phobic, gave up his old job and wasnt told about injections until the day he started
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Rank: Super forum user
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ron hunter wrote:I'd stick with precautionary vaccination of the risk groups identified in HSE Guidance: http://www.hse.gov.uk/bi...atitis-b-vaccination.htmVaccinations can give a false sense of security. There is a slight risk of adverse reaction to vaccination. The programme of vaccinations and boosters does have to be effectively managed. You'll also have to figure-out what to do about those who do not develop immunity (about 10%). And, of course, the vaccination is a 3-course event. Those "doing the injecting" will recommend "boosters", even if not needed. In spite of being "done" twice, I still do not "show" any immunity to Hep B.
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Rank: Forum user
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Thanks Guys
All valid points!
I hadn't thought of Public Health so thank you !
Our Occ Health providers have advised that if they have an immunity they would at the end of the course(s) do a one to one hyigene talk and discussion around PPE etc
Kind Regards
Claire
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Rank: Super forum user
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Claire
You now need to consider another question..... If they don't have proven immunity, of simply don't want to engage with the process and have any serological tests or vaccination, then what do you do?
You have already identified them as high risk. I suggest a careful look at training, protocols, PPE use and supervision etc, and a far more detailed training session to make sure they are fully aware.
Some may then change their mind. Others might carry on regardless, and you must consider if the risks are so great - probably not, but do consider this - as to change their duties. Record everything, as in the most extreme circumstance that documentation could then be your saviour
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Rank: Forum user
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ian.blenkharn wrote:Claire
You now need to consider another question..... If they don't have proven immunity, of simply don't want to engage with the process and have any serological tests or vaccination, then what do you do?
You have already identified them as high risk. I suggest a careful look at training, protocols, PPE use and supervision etc, and a far more detailed training session to make sure they are fully aware.
Some may then change their mind. Others might carry on regardless, and you must consider if the risks are so great - probably not, but do consider this - as to change their duties. Record everything, as in the most extreme circumstance that documentation could then be your saviour
Thanks Ian - I appreciate the advice!!
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Rank: Forum user
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Hi, I have been a CMO to several councils where we immunised high risk groups (e.g. special needs schools) and health care workers (e.g. in nursing homes). The guidance that medics use is the green book, which expands on the HSE link above and has information about what to do in event of a needlestick. Even if you choose not to vaccinate staff, you should still have a policy (e.g. what to do if an employee gets a needlestick). You should also do a risk assessment (under COSHH). https://www.gov.uk/gover...reen-Book-Chapter-18.pdfMark Consultant Occupational Physician
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Rank: Forum user
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mejacklin wrote:Hi, I have been a CMO to several councils where we immunised high risk groups (e.g. special needs schools) and health care workers (e.g. in nursing homes). The guidance that medics use is the green book, which expands on the HSE link above and has information about what to do in event of a needlestick. Even if you choose not to vaccinate staff, you should still have a policy (e.g. what to do if an employee gets a needlestick). You should also do a risk assessment (under COSHH). https://www.gov.uk/gover...reen-Book-Chapter-18.pdfMark thank you mark i will take a look Claire Consultant Occupational Physician
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