Immunisations for staff – obligations and considerations

Jan 8, 2018

You recently hired a receptionist to work at your practice on a permanent employment contract. After she starts work, the receptionist tells you that she was not vaccinated as a child. She holds strong views about vaccinations and immunisation, and says that she will not agree to be immunised. The issue of staff immunisation is not addressed in her employment contract and was not discussed during the interview stage.

You are concerned about her working on reception in case she contracts illnesses, and also spreads these to patients visiting the clinic and to other staff.

Things to consider

There are a number of factors for you to consider in this scenario including:

  • the health of the employee and your health and safety workplace obligations to her;
  • the health and wellbeing of patients attending the practice;
  • your obligations to run a safe workplace, including the health and wellbeing of other staff at the practice;
  • your employment relationship with the receptionist, and what you can reasonably request of her; and
  • relevant industry guidelines.

These are considered in more detail below:

RACGP guidelines

The RACGP’s newly released, Standards for general practices (5th Edition) provide guidance on staff vaccination, in the context of protecting staff members from being infected with vaccine-preventable infectious diseases and from transmitting these infections to patients. These note that practices should encourage members of the practice team to obtain immunisations recommended by the Australian Immunisation Handbook (10th Edition) based on their duties and immunisation status. The guidelines say, ‘The exact immunisation requirements will depend on the risk of infection based on the practice’s location, patient population and each practice team member’s duties.’

Under the guidelines, any natural immunity to vaccine-preventable diseases or immunisation status of practice team members should be recorded, with their consent. It cannot be assumed that staff will seroconvert post-immunisation (for example, hepatitis B). Therefore, it is recommended that post-immunisation status is serologically confirmed wherever possible and that further vaccinations are provided as required. Post-immunisation immunity, if known, should be documented.

Refer to section 3.3.7 of the Australian Immunisation Handbook for role-specific recommendations for groups with occupational risk.

The standards set out the following immunisations that can be considered for office-based health professionals – hepatitis B, influenza, pertussis, MMR (if non-immune), varicella (if seronegative).

Medical Board of Australia: Good medical Practice: a code of conduct

Section 9.2 of the Medical Board of Australia’s Good medical practice: a code of conduct for doctors in Australia states, ‘Good medical practice involves making sure that you are immunised against relevant communicable diseases.’

This requirement minimises the risk of a healthcare worker contracting or disseminating infection in the course of their work.

It is entirely reasonable that a practice should have the same aspiration.

The employment relationship

Ideally, you should discuss the practice’s requirement for immunisation during the interview process and resolve any issues then. You should not base any recruitment decision on a person’s refusal to be vaccinated as this could potentially lead to a discrimination claim.

Your employment offer letter and/or contract should require the employee to have immunisation against relevant illnesses appropriate to their role as a condition of employment. Evidence of immunisation should be provided before commencing work, if this is a requirement for the role.

If an employee objects to immunisation, you should meet with the employee and encourage immunisation against certain illnesses. You should explain the reasons for encouraging immunisation (for example, level of patient interaction, risk of becoming sick and/or spreading illness and that it is in the best interests of employees to be immunised to ensure their own workplace health and safety and the workplace health and safety of others at the practice.

You should remember that you are not in a treating relationship with the employee in the course of these discussions. You may wish to recommend that the employee seeks appropriate medical advice.

You should fully document your discussion with the employee and any response that you receive.

Your options if the employee still refuses vaccination

If an employee continues to refuse to be vaccinated, you should consider your options in light of the risks that arise from the employee not being vaccinated. These risks will be different depending on the employee’s position at your practice (for example, whether they are a receptionist or a nurse). There are a number of legal risks if you terminate an employee’s employment because they will not be vaccinated, and these risks must be weighed up against the risks to your practice under workplace health and safety legislation if you are unable ensure the health and safety of your employees because an employee is not vaccinated. You should seek legal advice in relation to the risks of termination if this is something you decide you want to pursue.

Practice systems

In light of the practice standards set out by the RACGP, practices need to have a system in place to consider the vaccination status of their staff, to comply with GP accreditation requirements. However, you should bear in mind that the RACGP guidelines specify that ‘informed consent’ is needed from staff members, meaning that they may refuse to disclose their immunisation status.

Immediate steps forward

  • Review your application forms/interview protocols so that you speak with prospective employees about this issue during the recruitment stage.
  • Review your employment offer letters and contracts, induction checklists, policies and procedures.
  • Insert wording where required into your template contracts/offer letters for future employees, requiring them to be vaccinated against certain illnesses in roles that you deem to be higher risk and ensure your policies reflect the expectation and obligation on staff members regarding immunisation.
  • Revisit the systems that you have in place for considering the vaccination status of staff members and the recording of any refusal to vaccination or natural immunity, bearing in mind the RACGP guidelines set out above.
  • Ensure you have a system in place to offer immunisation to staff members based on job risk.

More information

If you would like further information regarding employment issues, visit our website or for immediate advice, call our Medico-legal Advisory Service on 1800 128 268, 24-7 in emergencies.

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