I’m Linda Fabre and I would like to welcome you to the practice. There are many healthcare options from which parents can choose. Our heart is for children here at Ron Smith MD Pediatrics. It is our privilege and pleasure to help you raise and grow healthy children. Continue reading
As some have seen in the news, there is an alarming trend in Pediatric offices toward strong-arming parents into vaccinating their children and giving them their marching orders to find a new Pediatrician. Those who know me will tell you that I’m a strong proponent of vaccinations. I believe that vaccines are safe and effective. As a world medical traveler, I’ve had all mine and then some, including the smallpox vaccine as a child.
However, I refuse to try and dictate to parents what they will or won’t do with vaccines. A pinch of caring and compasion I think will go further than a pound of forceful ‘persuasion.’ I will try to persuade parents through a good patient-physician relationship where they can trust that the vaccine information I present to them is sound and reasonable. I must and will, however, put this decision in their hands as the parents of children that they love deeply.
There are three groups of children that I think we need to consider here. The children in the first group are those who are ill and cannot receive vaccinations as a result. Their parents want them to be able to attend school and try to live as normal a life as possible free from the risk of infection with viruses like measles and such wherever they go. The children in the second group are those whose parents are wary, even fearful, of the vaccines harming their children, and elect to refuse some or all of the vaccines, or opt for a different vaccine schedule than the current recommendations. The children in the third group are those whose parents are already planning to vaccinate per published recommendations.
Children in the first group who can’t receive vaccinations are at risk everywhere in society unfortunately. Much as I would like, I cannot protect them wherever they are. I sometimes wonder if the same parents who demand that all other children be vaccinated to protect their children, are also careful about taking them out to large venues. For example, I suspect that some 50,000 people a day may pass through WalMart’s 24-hour facilities. I am suspicious that everything that a child could touches in these places puts them at risk of infection. I have no studies to back this up, but that is my suspicion, nonetheless. I care for children with significant immune deficiencies myself, and their parents and I always have the discussion about these risk factors, and I am very aware of the needs of these children.
Children in the second group who may receive only few or no vaccines are at risk of getting the infections when they are exposed to others who bring in the infections across our borders. Unlike Yellow Fever, where visitors to endemic countries must be vaccinated prior to travel, and who must also present a Yellow Fever certificate before regaining entry back into the United States, we have no such screening for any other contagious infections. Even Ebola screenings where death rates are upwards of 70% or more, is not properly done before a person reenters from an endemic Ebola area by simply measuring a temple temperature.
Children in the third group are those who are being vaccinated according to schedule. With respect to the MMR vaccination and measles, these children however are at risk for a period of up to the first year where they have limited or no immunity. The MMR is not routinely given until on or after the first birthday. This is because the seroconversion rate, which is the measure of vaccine effectiveness, after the one year measles vaccination is around 95%.
While the solution for the first group lies in exposure prevention on a day to day basis, and for the second group in convincing parents to vaccinate, there is something more I can do to help the third group, and perhaps very significantly. It may also help to limit the exposure of immuncompromised children more effectively than trying mandate that all children receive the present schedule of vaccines.
Children can get the MMR vaccine before their first birthday. However they will still be required to get vaccinated according to the regular two-dose schedule at and beyond age one year. It has been demonstrated that 74% of children who get MMR at 6 months do seroconvert and become immune to measles. Over 89% of those vaccinated at 8 months have been shown to acquire measles immunity.
It is already recommended that unvaccinated children as young as 6 months get the MMR prior to travel to endemic areas of the world or during local outbreaks of measles. I am now officially recommending that parents of my patients consider giving their children their first MMR at age 6 months. Currently here in Georgia they will still have to have two more MMRs at or beyond their first birthday for entities that require the official form 3231 for attendance. This will, I think, significantly reduce the susceptible population of young children, and indirectly reduce some of the risks to the first group of children, whose parents are particular concerned about exposure.
What about immnity to measles in the first 6 months of life then? Because the largest antibody transfer from mother to child occurs at some point prior to delivery, I’m recommending that all women who have low measles, mumps, or rubella titers, be vaccinated prior to pregnancy. Pregnant women or those planning to soon get pregnant within 28 days should first discuss MMR vaccination with their obstetrician.
The CDC recommendations against live viruse MMR vaccination during pregnancy are also based, according to the AAP Redbook, on theoretical risks of infection to the unborn baby. Women have been unknowingly vaccinated during pregnancy without negative effects. Many physicians caring for expectant mothers are starting to check for the presence of measles antibodies. Women thinking about becoming pregnant or who are pregnant need to discuss MMR vaccination with their obstetrician.
Prenatal transfer a measure of their measles antibdoy to the children of mothers who are measles seropositive, which can last up until perhaps 4 months of age. Breast feeding does transfer some antibodies but I don’t think that the quantitative effect is really known there, and it cannot be relied on in lieu of prenatal seropositivity.
This policy should help significantly to narrow the susceptibility of healthy children who are being vaccinated. The problem with forcing the current vaccination schedule on all children seems politically driven rather than well-reasoned, though I understand the fear behind it. It will certainly not stop the entry of measles into our country across the border which is how the virus is getting here. Until we demand verifcation of an approved MMR vaccination by all citizens and non-citizens coming through customs, and until we fully control illegal entry at our borders, we will continue to be at risk for measles. Mandatory vaccination will gain nothing but the control of one group of people over another, and it will further limit the shrinking freedoms we as Americans have traditional enjoyed and fought and died for.
Those who are interested in MMR vaccination before the first birthday should call our office and discuss all the particulars of insurance coverage, risks, etc. More information about the current MMR recommendations are found at these web sites below to support the data that I have presented.
Ron Smith, MD, Pediatrics
History of Vaccines
The first vaccine was aimed at Polio, a virus which can render children and young adults permanently crippled or wheelchair bound or even ventilator dependent. Our experience in America is rife with the images of iron lungs, and even growing up in a small town of 10,000 I knew of an adult who was wheelchair bound from it.
Today, there are only pictures of that terrible past for us. In other countries, such as India, the disease ravages on. Access to the vaccine is the obstacle.
Whooping cough, known to me as a Pediatrician as Pertussis, used to be a rampant childhood illness also. Few of today’s Pediatricians have ever confirmed a case they have treated. It is hard, because the best test still requires a thin metal swab be inserted into the nose all the way to the very back of the nasal cavity. Very carefully the swab is rotated to sweep off some of the cuboidal epithelial cells of the mucous membrane there. Mucous and blood will not do and may cause the test to be falsely negative. Picture trying to do this in a 4 month old baby.
Now the swab has to be carefully rolled on the surface of a fresh, clean glass slide, so that the epithelial cells become adherent to it. The number of cells you get onto the slide is critical to the diagnosis of Pertussis. The bacteria adheres to these cells and the more you get the better. You see the slide must then be air dried and packed in a special cardboard transport package and sent off for testing. At the lab, the slide is treated with a special fluorescent antibody stain which sticks to the bacteria on the epithelial cells. If there are not enough bacteria or the epithelial cells that were collected didn’t have the bacteria attached to them, then there is no fluorescence. Thus a negative fluorescent antibody test for Pertussis, could mean that the test was truly negative, or falsely negative. There are few other tests that offer better results even today.
Measles is a viral infection which produces a rash and high fever. The tell-tale signs of the Koplik spots in the inside of the cheeks is very short lived. In addition to this, there are relatively few cases in the US because the vaccine is so effective. Because there are so many other viruses that causes rashes, what medical professionals call exanthems, most physicians have never seen a true case. I haven’t seen a bonafide case in my thirty-three years of Pediatrics, and if I ever considered the diagnosis, the clinical impression must be confirmed with serologic testing.
In the discussions about population immunity, what is referred to as herd immunity, the theory is that at some point if you get enough individuals vaccinated that you can eliminate the existence and spread of the disease. Those individuals who aren’t immune to the disease are then so spread apart by the individuals who are that all become protected. In cases of the original oral Polio vaccine, when you immunized a child, they shed that attenuated virus in their stool, and as a result other chidren and individuals who because infected with it, also could develop immunity.
Not all individuals who are vaccinated become immune to the targeted infectious agent. Developing an immunologic response to an infection is critical here. Vaccines are rated by their effectiveness at producing an immunologic response. I like to see vaccine responder rates of 90% to 92%. Rates of 95% are excellent.
Threats To Effective Herd Immunity And Infection Barriers
I see three threats with varying levels of concern toward the protection of population from diseases for which we vaccinate. Understanding these is very important especially when everyone is throwing in their two cents on how to deal with serious threats of infectious spread at the population level.
If the number of vaccinated individuals in the population drops to some certain level, then you will have more and more non-vaccinated individuals contacting other non-vaccinated individuals. Non-vaccinated individuals would include both those who were too young to produce a reliably adequate immunologic response, such as with measles and children under a year of age, and those individuals who have compromised immune health issues that precludes their vaccination.
It also includes those individuals who could have have gotten an immune response, but didn’t get the vaccine. The recent focus on American citizens who refuse the vaccines for their children however, have overlooked the more significant threat, which is individuals coming to our country unvaccinated. They pose a much bigger threat because by virtue of being outside our society, we have no way to monitor or encourage vaccination, nor do we know that the vaccines they received are ones that are effective, since vaccine manufacturers in other countries are not held to the higher standard generally required here in the United States.
Additionally, there is this thought that once you are vaccinated, that you’re good to go. That is not true however, as anyone sustaining a pentrating wound with a rusty nail would understand after they got a tetanus booster. This is particularly true of Pertussis which I mentioned already.
Not many medical studies really impact what Pediatricians actually recommend in the exam room. About a half dozen years or so ago, however a study came out which really caused me to tack in how I dealt with coughs in children. It turns out that an adult who has a cough that lasts two to three weeks has a 21% chance of actually having Pertussis. This is the prime reason we have to still be so vigilant even with a vaccination effort that has been effective but unable to mostly eradicate this disease. The repository of the bacteria is in the adult population whose childhood immunity has waned. As adults they don’t get as sick as infants, and most actually don’t go to a physician and get treated with the proper antibiotic. The usual antibiotics are all but ineffective agains Pertussis.
This adult repository is the reason that I recommend all parents of newborns that I see to get a Tdap, which is a tetanus vaccine that includes the Pertussis. Many hospitals are now starting to give the vaccine as well to the parents of newborns before they go home. I laud this, but the one problem in ERs and urgent cares is that many of them still give the Td tetanus vaccine which does not contain the Pertussis vaccine component.
Where Pertussis, which is called the Hundred Days Cough for good reason, can easily hide in the adult population by simply being a prolonged cough, Measles symptoms are not so easily undetected. High fever, coryza, and rash usually prompt an exam. Serious sequelae of measles is relatively higher than Pertussis. In the dozen or so cases of whooping cough that I’ve diagnosed in all my years have all responded well and none died. Measles can debilitate and kill.
To bring this all then back to three threats to preventing the spread of these infectious diseases in our country we have to pay close attention. The largest threat to our unvaccinated population of citizens comes from non-citizens who visit here or come illegally. Large amusement parks like Disneyland will promote the mix of those foreign individuals with our population. Similarly large warehouse-sized retail outlets are highly likely to be points of transmission of infectious disease. Personally I caution parents with newborns that Walmart and other large high-traffic stores are possibly a risk. Though I am guessing, I would suspect that many of the retailers might see 10,000 up to mabye even 50,000 people a day vist them. Contagion doesn’t have to be personal contact. I consider all the surfaces in those stores to be infection risk myself.
Clearly the biggest threat is the way our population mixes in normal life now compared with thirty years ago when superstores and large amusement were an rarity.
The second largest threat is from the waning immunity of our population. We are not vigilant enough as individuals toward vaccination as a lifelong thing. We associate vaccination with children.
Now we come the third threat I see from those individuals who are not vaccinated. While our citizens must be vigilant about Pertussis, these individuals can be vectors for disease. Unvaccinated popultions can include citizens of our country who can’t, or choose not to, be vaccinated. Those ‘antivaccine’ individuals actually make up a very small part of this. The problem is the non-citizens who are not vaccinated who visit or come and stay here illegally. The number of these individuals is so very much greater than citizens who choose not to vaccinate, yet I see this mostly ignored in discussions about forcing all citizens in this country to be vaccinated.
When a non-citizen comes to this country they do not have to show immunity to these diseases. Yellow fever is perhaps the exception. If you as a citizen visit certain areas of the world, you will be required to show proof that have been vaccinated upon reentry. This yellow fever certificate is as valuable as your passport. We don’t do this for measles. We don’t do it for Pertussis.
While presently there is a raging anger at those citizens who choose not to vaccinate, there is nothing said about foreign visitors who come to this country, and the conversation is even shunned when we discussed illegal visitors because of the current political correctness that is choking society.
What Should Be Our Priorities
If we are to eliminate the threat of such serious diseases like measles, then we must stop unvaccinated individuals at the border. We already do this for Yellow Fever so this is not novel. We must start admitting that illegal immigration carries more than political and ecomonmic implications. The health implications are the ones that will bring home the serious illness to our children.
We must stop being angry at those citizens who choose not to vaccinate their children. As a Pediatrician I think they should vaccinate and that the vaccines are safe. As a free citizen, however, I cherish the freedom that our country was founded and built on. It is no different than free speech. It is not only the ones who lose their freedom to choose, that lose their freedom. We all lose.
Many years ago in the new wake of the popularity of breastfeeding, I heard of a clinic in the Tulsa area where I trained, that stopped taking new infants whose mothers didn’t breast feed. Is that nonsense any different that medical practices who refuse to take children who aren’t vaccinated?
The most important way to prevent contagion in a medical office is to use appointment scheduling and stay on target with the exam schedule during the day. This prevents the mix of patients in the waiting rooms. Walk-in clinics are notoriously effective at transmitting infectious agents from one patient to another. Urgent cares and ERs are often very crowded, yet we see an alarming percentage of children who get almost routine healthcare there instead of establishing a regular physician relationship to private practitioners.
We stopped using paper on our exam tables long ago. The typical practice is in most practices to simply pull a fresh piece of paper over the exam table rather than actually clean the surfaces with an appropriate disinfectant.
Our policy is that we will try to take care of things that don’t need to be seen without a visit to our office. This makes not only good economic sense for parents, but good contagion prevention for the children we see.
I strive to develop good relationships with all my parents, even those who don’t want to vaccinate. Trying to force them goes against my grain, and will not be effective anyway. Developing a strong physician bond and trust can give parents a reason to decide to vaccinate. It is not that I’m trying to accommodate their decision, but rather give them access to my knowledge so they won’t be led astray by Dr. Google and all his non-medical cohorts. In a nation used to its freedom, there is marked push back when one group focuses on another over traditionally free-choice areas in our lives as though they are the bad guys
I’m always very careful not to lambast parents who choose not to vaccinate. The reason is that I want to persuade rather than force. This is supposed to be a free country and even if I think otherwise about vaccines, I do think we ought to respect the right to choose not to vaccinate.
Be that as it may, this post itself is to give parents who choose not to vaccinate an informed appreciation for the darker side of that choice.
In an article posted here on ABC News’ web site, there is a sad story of a six year old girl who contracted chickenpox, i.e., varicella, and then subsequently developed pneumonia. The storm of both infections was more than she could repel. She passed on in her mother’s arms.
Her mother was reportedly talked out of childhood vaccines that have proven efficacy against those infections by the child’s physician. He apparently told her he was suspicious of the vaccines and that the child should be exposed to the illnesses and develop immunity naturally.
At autopsy, Abby was found to not have a spleen, which predisposed her to fatal infection by encapsulated bacteria in particular. Her asplenia is what happens to children with Sickle Cell Disease where the malformed red cells destroy the spleen over time. We vaccinate those children to Pneumococcus to prevent those fatal kinds of infection.
So often anti vaccine proponents tend to point blame at reactions to vaccines. But the dark side is that not giving vaccines is not the same thing as doing no harm.
Let me repeat that I staunchly support a parents right to refuse medical care, including vaccines, (except of course in the case of child abuse), but it is vitally important to clearly understand that not vaccinating does not equate to no consequences.
If you have further questions about vaccines, come in for an appointment and I’ll be glad to tell you what I know. We will treat you with respect and courtesy and answer your questions honestly.
Ron Smith, MD
Just last week I published a work that some of you might be interested in. I teach Sunday school at my church and have been teaching Mere Christianity by C. S. Lewis. My book is called A Mere Christian and is the culmination of things I’ve learned and taught about what Christians should know about Christianity. If you are a Christian then this book is for you. The website is http://www.amerechristian.com for the book where you can read excerpts and learn more. It is available currently as an ebook on Amazon, Barnes & Noble, and iTunes for iBooks. I hope soon to have an on-demand print copy in Amazon as well.
Because of stricter guidelines for attendance at schools, parents are required to provide school notes for any days of school that will be considered “excused”. Most schools will allow parents to write notes for minor illnesses, but have a limited number of “non-excused” absences. For this reason, we are asked to supply school notes for various reasons. Therefore, we have put in place the following policies for school notes that we will write.
- Absence due to illnesses: We will provide an excuse for any patient who is seen in our office that is sick. If you child is running a fever the date of his office visit, he may not return to school until he is fever-free for 24 hours. If the student tests positive for illnesses such as strep or mono, we will adjust the days of excused absences accordingly. If you choose to keep your child at home additional days, then you may attach a parent’s letter to our office letter for the school office.
- If your child was seen in the ER or after-hours care, or by a specialist’s office, even if referred by our office, you must request a school note from that doctor or office. We cannot write school excuses for other providers.
- Some schools and daycares have begun asking parents to get “special request” letters from their doctor’s office. These letters include special diet requests, reduced activity requirements, special bathroom privileges, etc. These requests will be written for patients seen in the last 12 months and only if deemed medically necessary by the provider and documented in your child’s chart. For instance, if your child has a known food allergy, etc, that requires a special diet plan, that allergy must be noted in your child’s medical chart in our office in order for us to write a school note.
- If your child participates in sports at school, sports physicals can be done in conjunction with your child’s annual physical (well check). The sports participation forms required by schools can be provided at the end of the physical. These are good for only one calendar year. We can fax the forms, but please be aware that the forms have a page that must be completed by the parent.
Thank you for your understanding and help with this matter.
We strive to always see patients in our office for medical care. It is not only cheaper, but much more efficient. Sometimes however, your child may need treatment when my office is not open. We often are asked our recommendations and so we have put together a list of the best sources of after-hours care in our opinion. This is not to say that in an emergency you should ignore other places to get treatment. Sometimes situations demand other choices. These recommendations are intended to be a helpful list. Please note, all urgent care providers’ hours of operation may change during any holiday.
After-hours pediatric urgent care
4861 Bill Gardner Parkway
Locust Grove, GA
- Hours: Mon-Fri, 8 am-8 pm, last appt @ 7 pm. Sat-Sun, 9 am-6 pm, last @ 6 pm.
- Does not accept Medicaid or HMO plans
- Has x-ray capability
- Will see children 3 months and older
110 Regency Park Drive
- Hours: Mon-Fri, 5 pm-10 pm; Sat-Sun, 10 am-9 pm
- Accepts most insurance plans
- No x-ray capability
Kids Time Pediatrics
125 Eagles Walk
- Hours: Mon-Fri, 6 pm-9 pm; Sat-Sun, 10 am-5 pm
- Accepts most insurance plans
- Not an emergency care facility
Pediatric Emergency Care Facilities
Scottish Rite Children’s Hospital
Section A. Occupational Exposure Policy
1. The purpose of this policy is to prevent the occupational exposures of the staff to the following potentially infections materials: blood, semen, vaginal secretions, cerebrospinal fluid, synovial fluid, plural fluid, amniotic fluid, pericardial fluid, peritoneal fluid, saliva in dental procedures, and human tissue.
2. Occupational exposure means contact with skin, eyes, mucus membrane, or parenteral exposure by the potentially infectious materials.
3. Information and training: all employees involved in work that would involve occupational exposure must participate in a training program which must be provided at no cost to the employee, during working hours. The training shall be provided at the initial time of assignment and at least annually thereafter. Any new standards of or techniques shall be taught at the time of their inclusion into the program. The training program shall include:
- a general explanation of the epidemiology and symptoms of blood borne diseases and their modes of transmission;
- an explanation of the employer’s control plan and a copy of the control plan;
- and explanation of which activities involve exposure to potentially infectious materials and the methods which will prevent or reduce exposure to them;
- the proper handling and disposal of potentially infectious materials and protective equipment;
- all necessary information on the hepatitis vaccination
- information on what action is to be taken in case an emergency occurs, or an exposure incident occurs; and
- information on post-exposure follow-up.
4. Training session records shall include: the date of the session; a summary of the session; the names and titles of all persons attending the session. These records shall be kept for at least three years from the time of the session and shall be made available to the appropriate person(s) if requested. These records shall be available for transfer as required by the Director (the Director, Department of Labor, Occupational Safety and Health Administration). If the business ceases and there is no one to transfer the records to them the Director shall be notified and he shall receive the records; if he so desires.
5. The employer shall establish and maintain an accurate record for each employee with occupational exposure which shall include:
- the name and social security number of the employee;
- a copy of their hepatitis B vaccination status; a copy of all results of medical exams and testing;
- a copy of the health care professional’s written opinion of the situation; and
- a copy of information provided to the health care professional.
The employee’s medical record shall be kept confidential and not divulged except with the written consent of the employee. These records shall be kept for the duration of the employee’s employment plus 30 years.
6. Definitions of contamination and decontamination: If something is contaminated it has the presence of a potentially infectious material on it. Examples of potentially contaminated items include laundry and sharpes (sharpes are any objects that can penetrate the skin). To decontaminate something means by the use of physical or chemical means to inactivate or to destroy infectious materials on the item to the point where they can’t transmit disease.
7. Personal protection equipment (which shall be impermeable to all potentially infectious materials) will be worn when there is a risk of occupational exposure to potentially infectious materials. This equipment included the following: gloves, gowns protective equipment shall be available at the work site whenever there is risk of occupational exposure. When the employee leaves the work area, the equipment shall be removed and stored, cleaned, or disposed of by the employer. If a protective garment is penetrated by a potentially infectious material it shall be removed as soon as feasible. If gloves are penetrated they shall be replaced as soon as feasible. Disposable gloves shall not be reused. If an employee declines to use protective equipment this event has to be documented and a wavier has to be signed by the employee. Masks and goggles shall be used whenever there is danger of contamination of the face or eyes by potentially infections materials.
8. Handwashing facilities shall be available in every work site. If these are not readily available an appropriate antiseptic hand cleaner in conjunction with appropriate clean clothe or paper towels shall be available. Employees shall wash their hands as soon as feasible after removing protective equipment. If they come in contact with potentially infectious material they shall wash their skin with soap and water and flush mucous membranes with water. The work site shall be maintained in a clean and sanitary condition. All equipment and working surfaces shall be cleaned and decontaminated after contact with potentially infectious materials as soon as feasible. Such equipment includes bins and pails. Broken glassware which may be contaminated shall not be directly picked up with you hands. Housekeepers need to use gloves and other appropriate equipment when cleaning a work site. Use appropriate antiseptics. Bleach at 1:10 or metri spray-cetylcide or autoclave for instruments.
9. Eating, drinking, and applying cosmetics are prohibited in work areas where contamination is possible. Food and drinks shall not be kept in these hazardous areas. All procedures involving potentially infectious materials shall be done as carefully as possible to minimize splashing, spraying, spattering, and droplets of these materials. Mouth pipetting is prohibited.
10. Contaminated needles shall not be recapped but carefully placed in the appropriate container. These containers shall be OSHA approved. All potentially infectious materials shall be disposed of in the appropriate OSHA approved containers. The containers shall be closed prior to removal from the work area and prior to shipment to the appropriate facility for disposal. Disposal containers shall be available in each work area. Contaminated laundry shall be transported in the appropriate bags which can be closed and are leak proof for all potentially infectious materials. The bags shall then be transported to the appropriate facility for disposer. Protective gloves shall be worn when handling such materials if there is risk to the face.
11. Hepatitis B vaccination shall be offered to all employees who are at risk of exposure. This shall be offered to them within ten working days of employment. The schedule for vaccinations is as given by the state health department recommendations for Hepatitis B.
12. Post-exposure evaluation and follow-up: following a report of an exposure incident, the employer shall make available to the employee a confidential medical evaluation and follow-up including the following documents:
- documentation of the route of exposure and the circumstances under which the incident occurred; and
- identification and documentation of the source individual if feasible.
The source individual’s blood shall be tested as soon as feasible for HBV and HIV infectivity if consent is obtained (unless consent is not needed) from the individual. Results of the source individual’s testing shall be made available to the exposed employee. If consent is obtained the exposed employee’s blood shall be tested as soon as feasible. All of the above are to be documented (as well as results of medical exams and blood testing) Within fifteen days of the completion of the evaluation the employee shall be given a written opinion of the evaluation.
13. Dates: this plan is currently effective in all aspects for all office locations.
14. Hepatitis B vaccination schedule: per current health department recommendations. Post-exposure management policy is included in the training also.
15. Gowns- at least 12, masks- at least 12, goggles- at least 4 per office.
Section B. Application Of The Occupational Exposure Policy
1. A Staff Exposure Assessment List will be kept on the premises and will include:
- A list of all staff and those who are at risk
- Indication of those who have reviewed the occupational exposure policy and discussed it
- Indication of those who have been offered the Hepatitis B vaccine
- Indication of those who were given the opportunity to sign any necessary waivers concerning vaccinations and protective equipment
- Indication of those who have had occupational exposure incidents
2. Regular inspection and replacement of any defective equipment shall be on a monthly basis and more often as needed.
3. Sharpes containers shall be replaced when full and picked up by a licensed disposal company. They shall be sealed while waiting to be picked up. Needles can be removed from syringes and deposited in sharpes containers and the syringes disposed of in the regular garbage if no blood was drawn into syringe. If blood was drawn into the syringe the syringe and the needle are to be disposed of in a sharpes container. The needle is to be removed from the syringe with a hemostat or other appropriate device. Do not bend, shear or break contaminated needle. Needles are never to be recapped. Broken glass is to be cleaned up with a dust pan and brush. Capillary tubes need to be put into sharpes containers.
4. Any containers that may be contaminated or leak must be placed in a second container: containers must be maintained in an upright position during transport..
5. The work areas that are contaminated will be cleaned as soon as feasible after a procedure and then daily by the cleaning crew. Appropriate antiseptic will be used.
6. Contaminated laundry is to be bagged in labeled containers using gloves (and gowns if necessary). It is then to be transported to the laundry facility where it is again handled with gloves. It is then washed and brought back to the office where it is autoclaved before additional surgical use.
7. The following categories associate tasks with the required protective equipment.
Job Category Nature Of Task Personal Protective Equipment Available Worn I Direct contact with blood or other body fluids to which universal precautions apply Yes Yes II Activity performed without blood exposure but exposure may occur in emergency Yes No III Task/activity does not entail predictable or unpredictable exposure to blood No No
8. Urine slide covers will be disposed of in sharpes containers, and slides will be cleaned and soaked in antiseptic and reused. Cotton swabs and tongue depressors will be disposed of in the regular garbage. Used gloves, masks, and gowns will be disposed of in the regular garbage.
9. Throat cultures and urine cultures will be disposed of in red bags marked as hazardous waste.
10. Documentation for the following will be maintained:
- Vaccination forms
- Training forms
- Incident forms and follow-up
- Inspection (monthly) forms
- Annual training forms
Section C. Hepatitis B Vaccination Policy
1. Hepatitis B vaccination will be made available to all employees who are at risk for occupational exposure to bloodborne pathogens. The vaccine will be offered in accordance with existing employee health protocols:
- within 10 working days of initial assignment to all employees who have occupational exposure unless the employee has previously received the complete Hepatitis B vaccine series, antibody testing has revealed that the employee is immune, or the vaccine is contraindicated for medical reasons.
- A prescreening program is not a prerequisite for receiving the Hepatitis B vaccination.
- If the employee initially declines Hepatitis B vaccination but at a later date decides to accept the vaccination while still employed and still at risk for occupational exposure to bloodborne pathogens, the Hepatitis B vaccination will still be available.
- The employees who decline to accept Hepatitis B vaccination offering will sign a statement of refusal.
- Routine booster doses of Hepatitis B vaccine which are recommended by the US Public Health Service at some later date will be made available to employees free of charge.
- and after the employee has received the required training, including information on Hepatitis B vaccine safety, efficacy, method of administration, vaccine benefits, and its provision to the employee free of charge.
2. Hepatitis B vaccine will be administered in accordance with existing employee health protocols for administration of the vaccine..
3. Our office has administrative responsibility for overall compliance with this protocol.
4. Hepatitis B Vaccine. Please read the following carefully. Employees will have the opportunity to ask questions and have them answered to their satisfaction before making a decision about receiving the Hepatitis B vaccine.
- Hepatitis B is an inflammation of the liver caused by the Hepatitis B virus. You may not be very ill with the virus or you may have severe symptoms that require hospitalization.
- The symptoms of Hepatitis B include loss of appetite, fatigue abdominal discomfort or pain, an enlarged liver, jaundice (yellow skin tone) and abnormal liver function tests (blood tests).
- People who have Hepatitis B can develop long term consequences that include chronic active Hepatitis, cirrhosis, and liver cancer.
- Health care workers are 20 times more likely to contract the virus than the general public.
- Everyone who has contact with blood or body fluids is a risk. Your job description signifies whether you are at risk.
- The Hepatitis B virus can survive for seven days in dried blood. Every contact with the Hepatitis B virus is capable of causing infection.
- You have as high as a 30% chance of contracting Hepatitis B from a single contaminated needlestick.
- Shot-term consequences of Hepatitis B include an average of seven weeks lost from work, and the risk of permanent liver damage.
- Long-term consequences include chronic active hepatitis and cirrhosis of the liver, as well as a 12-300 times greater risk of developing liver cancer.
- Every week 4 to 5 health care workers die of Hepatitis B or its complications.
- The vaccine, Engerex-B, is a noninfectious synthetic vaccine, containing no blood or blood products.
- Three doses of the vaccine administered appropriately (IM in the deltoid_ over a six month period will provide protection to over 90% of recipients. Immunity is thought to be for life.
- Local reactions may include soreness, redness, and swelling at the injection site.
- Contraindications to receiving the vaccine include; sensitivity to yeast, sensitivity to thimerosal (vaccine prior to the middle of 2000), pregnancy, breastfeeding, cortisone therapy.
- The vaccine will only protect you from Hepatitis B.
- You may donate blood if you receive the vaccine.
- The Hepatitis B vaccine is offered free of charge to all employee who are at risk for occupational exposure to blood and/or body fluids.
Section D. Bloodborne Pathogens Exposure & Post-exposure Policy
1. Exposure Incident will be defined as a specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials that results from the performance of an employee’s duties.
- Blood will be defined as human blood, human blood components, and products made from human blood.
- Bloodborne pathogens will be defined as pathogens microorganisms that are present in human blood an can cause disease in humans. These pathogens include, but are not limited to, Hepatitis B Virus (HBV) and Human Immunodeficiency Virus (HIV).
- Potentially infectious materials will be defined as the following human body fluids:
- semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids;
- any unfixed tissue or organ (other than intact skin) from a human (living or dead);
- HIV-containing cell or tissue cultures, organ cultures, and HIV or HIV-containing culture medium or other solutions.
2. Medical evaluation, procedures, and follow-up will be:
- Made available at no cost to the employee through the practice
- Made available to the employee at a reasonable time and place.
- Performed by or under the supervision of a licensed physician or by or under the supervision of another licensed healthcare professional.
- Provided according to recommendations of the US public health service current at the time these evaluations and procedures take place. The doctor will review and update post-exposure management guidelines as new directives are issued, but at least annually.
- All lab tests will be conducted by an accredited laboratory at no cost to the employee.
3. Post-exposure evaluation and follow-up will include at least the following elements:
- Documentation of the route(s) or exposure, and the circumstances under which the exposure incident occurred
- Identification and documentation of the source individual, unless identification is infeasible
- The source individual’s blood will be tested as soon as feasible for HBV; and as soon as consent is obtained, for HIV infectivity. Individuals who will not consent can be tested in accordance with policy.
- When the source individual is already know to be infected with HBV or HIV, tested for the source individual’s known HBV or HIV status need not be repeated.
- Results of the source individual’s blood, if available, will be made available to the exposed employee, and the employee will be informed of applicable laws and regulations concerning disclosure of the identity and infectious status of the source individual.
- Collection and testing of blood or HBV and HIV serological status of the employee:
- The exposed employee’s blood will be collected as soon as feasible and tested after consent is obtained.
- If the employee consents to baseline blood collection, but does not give consent at that time for HIV serologic testing, the sample shall be preserved for at least 90 days. If, within 90 days of exposure incident, the employee elects to have the baseline sample tested, such testing shall be done as soon as feasible.
- Post-exposure prophylaxis, when medically indicated, will be as recommended by the US public health services, to include counseling and evaluation of reported illnesses.
4. Information provided to the healthcare professional responsible for the employees Hepatitis B vaccination and/or the employees evaluation after an exposure incident will include at least the following:
- A copy of the OSHA regulation 29cfr part 11910.1030 Occupational Exposure To Bloodborne Pathogens; Final Rule
- A description of the exposed employee’s duties as they relate to the exposure incident
- Documentation of the route(s) of exposure and circumstances under which exposure occurred
- Results of the source individual’s blood testing, if available
- All medical records relevant to the appropriate treatment of the employee including vaccination status
5. The healthcare professional’s written opinion will be obtained and provided to the employee within 15 days of the completion of the evaluation.
- The healthcare professional’s written opinion for post-exposure evaluation and follow-up will be limited to the following information:
- Whether Hepatitis B vaccination is indicated for the employee has received such vaccination
- That the employee has been informed of the results of the evaluation
- That the employee has been told about any medical conditions resulting from exposure to blood or other potentially infectious materials which require further evaluation or treatment.
- All other findings or diagnoses will remain confidential and will not be included in the written report.
6. Medical recordkeeping: the office of Ron Smith MD will establish and maintain an accurate record for each employee with occupational exposure to include:
- The name and social security number of the employee
- A copy of he employee’s Hepatitis B vaccination status including the dates of all the Hepatitis B vaccinations and any medical records relative to the employee’s ability to receive vaccination
- A copy of all results of examinations, medical testing, and follow-up procedures
- The employer’s copy of the healthcare professionals’ written opinion
- A copy of the information provided to the healthcare professional
- All medical records will be kept confidential and will not be disclosed or reported without the employee’s express written consent to any person within or outside the workplace expect as required be law, and will be maintained for at least the duration of employment plus 30 years.
Section E. Post Test
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Online For Life has an amazing video created in partnership with John Elefante. I think this tells the argument for life with amazing visual clarity. Thanks to Online For Life for graciously permitting me to link to the music video here. If you think that your situation is too hard, then I would suggest you read our Laura’s ebook story, Forever And A Day For Laura Michelle, available free on iTunes. May I also suggest full screen viewing.
The ACA is affecting hospital and medicine even from an employer viewpoint. Here are two articles for your perusal.
This article, primarily written to address Governor Christie’s signing of New Jersey legislation that seeks to bar free speech to minors, has some other information about the association of homosexual abuse of children and their later tendencies to choose homosexuality. I was frankly a little disturbed by some of the quoted points.