Authored by SLHD Clinical Placement Unit & SLHD Staff Health 2013 Reviewed July 2014

Reviewed March 2016 Reviewed August 2016

Reviewed November 2016 Reviewed March 2017

Reviewed by NSW Health and advice approved April 2017

Dear Student,

Information to assist you with mandatory immunisation compliance PLEASE READ!

The following information is supplied to you to ensure that you provide the correct information

regarding your immunisation history/status when being screened to attend a clinical placement

within a NSW public health facility. Compliance with NSW Health policy directives regarding

immunisation is mandatory for all local, national and international students enrolled at both the

undergraduate and postgraduate level. There are no exceptions to these requirements.

Please ensure that your GP or vaccination provider completes the supplied ‘vaccination record card’

as outlined in this advice - a blank vaccination record card and an example of how this document is

to be completed are supplied as part of this information package. You will also be required to

complete and submit ‘form 2’ and ‘form 3’. Following review, you will be provided with a

classification status which will determine whether you can commence a clinical placement.

Ensure the GP records your entire immunisation history from childhood records.

The classifications relating to an immunisation status are:

1. ‘Non-Compliant’ – Immunisation status does not comply with NSW Health policy directives.

Students who are assigned this classification ARE NOT eligible for a placement within any

NSW Health public health facility. This will cancel your proposed clinical placement.

2. ‘Compliant’ – Immunisation status meets all mandatory policy requirements and the

student may proceed to placement.

Please note; NSW Health is not responsible for factors that affect a student meeting these

mandatory requirements. If a student is unable to meet any of these requirements the placement will

not proceed. NSW Health strives to ensure that all patients, staff and students are not placed at risk

when attending a clinical placement.

Authored by SLHD Clinical Placement Unit & SLHD Staff Health 2013 Reviewed July 2014

Reviewed March 2016 Reviewed August 2016

Reviewed November 2016 Reviewed March 2017

Reviewed by NSW Health and advice approved April 2017

Adult Diphtheria, Tetanus, and Pertussis (Whooping Cough) or dTpa

Student Instructions:

• You must provide evidence of having received one adult diphtheria, tetanus, and pertussis (Whooping Cough) vaccine in the last 10-years. If the vaccine was administered

more than 10-years ago or is due to expire during your clinical placement, a booster dose

will be required. Ensure that your GP administers diphtheria, tetanus and pertussis (dTpa)

vaccine and not an adult diphtheria and tetanus (DT) vaccine. Correct documentation by the

GP or vaccination provider must include the ‘batch number’, ‘date of vaccination’, ‘provider’s

name’, ‘signature’ and ‘practice stamp’ to validate the entry. Ensure the GP records on the

vaccination card that the vaccination administered contained the diphtheria, tetanus and

pertussis component. If a batch number is not available, simply have the GP or vaccination

provider supply a letter in English confirming that the vaccine administered was a dTpa

vaccine. If it is not possible to obtain a dTpa vaccination record, one dTpa vaccine must be

administered and recorded as detailed above. NSW Health must be able to identify that the

student has received the correct vaccination.

• Serology results for diphtheria, tetanus and pertussis vaccination are NOT ACCEPTED.

Hepatitis B Student instructions:

• The student must provide evidence of an age-appropriate course of hepatitis B and serology to show immunity. An age-appropriate course of hepatitis B consists of three

vaccinations which can be completed over a period of a minimum of four months (at least

one month between doses one and two and at least four months between dose one and

dose three). Alternatively, if you received the Hepatitis B vaccine course at school, you will

have received two doses of vaccine four to six months apart, this is also an age-appropriate

course of hepatitis B vaccine and is acceptable. All Hepatitis B vaccination history must be

recorded on the vaccination card for assessment. Serology must be recorded as a numerical

value - the phrase “positive”, “immune” or “detected” is not appropriate and will not be

accepted. If you are unable to provide an initial history of a primary hepatitis B course, a

verbal history is acceptable. If serology indicates you are a ‘non-responder’ to hepatitis B

vaccine, you will need to discuss this with your GP as you may require additional doses and

Authored by SLHD Clinical Placement Unit & SLHD Staff Health 2013 Reviewed July 2014

Reviewed March 2016 Reviewed August 2016

Reviewed November 2016 Reviewed March 2017

Reviewed by NSW Health and advice approved April 2017

will require serology to demonstrate immunity. You can contact the SLHD Clinical Placement

Unit at ccpu@sswahs.nsw.gov.au for further advice.

• Correct documentation from the GP or vaccination provider must provide; evidence of a full

hepatitis B course or verbal history of hepatitis B vaccination course; ‘batch number’, ‘date of

vaccination’, ‘provider’s name’, ‘signature’ and ‘practice stamp’ to validate the entry and serology - remember serology must be recorded as a numerical value; not ‘positive’,

‘negative’ or ‘immune’. Measles, Mumps and Rubella (MMR) Student Instructions:

• You must provide evidence of two doses of MMR vaccine (at least one month apart) or positive serology to all three diseases (include the serology report with your application for

assessment which must be in English) or if you were born before 1966, evidence of

vaccination or serology is not required. If you do not have a complete MMR vaccination

record of vaccination and your serology indicates a ‘negative’ result, you will require two

doses of MMR vaccine at least one month apart with no follow-up serology required. Correct

documentation the GP or vaccination provider must include, ‘batch number’, ‘date of

vaccination’, ‘provider’s name’, ‘and signature ’and‘ practice stamp’ to validate the entry.

Varicella (Chicken Pox)

• Student Information: If you were vaccinated when you were 14 years or older, you must

provide a vaccination record with evidence of two varicella vaccinations (one month apart)

recorded. If you received your varicella vaccination when you were less than 14 years of

age, you only require evidence of one dose of varicella vaccine. Alternatively, evidence of

positive varicella serology (which must be positive) or a history of having had the chicken

pox disease, may be provided as evidence.

• Correct documentation the GP or vaccination provider must include; ‘batch number’, ‘date of

vaccination’, ‘provider’s name’, ‘signature’ and ‘practice stamp’ to validate the entry.

Authored by SLHD Clinical Placement Unit & SLHD Staff Health 2013 Reviewed July 2014

Reviewed March 2016 Reviewed August 2016

Reviewed November 2016 Reviewed March 2017

Reviewed by NSW Health and advice approved April 2017

Tuberculosis Screening Student Information:

• A completed ‘Form 2’ and ‘Form 3’ must be included with your documentation. Form 2 is a

legal declaration that assists in determining if you require TB screening; please ensure you

have completed this document fully noting all countries to which you have lived in or

travelled to and note the length of time in that country in order to assist in determining if you

require screening for tuberculosis. If you have had a BCG, ensure the GP records the

approximate year that your BCG was administered. If you have lived in or travelled to a

country with a high incidence of TB (list of countries included in this information pack), for a

period of more than three-months within a three year period, or you have been in contact

with a person who has tuberculosis in any circumstance, you will be required to have a

Mantoux test and provide the result ensuring that the GP has recorded whether you have or

have not had a BCG administered.

• At this time a Mantoux test is the only test that is acceptable to NSW Health to determine if

you have been exposed to tuberculosis.

• If the Mantoux test shows a reaction greater than 8mm without having had a BCG or 10mm

having had a BCG you will be required to have a chest X-Ray.

• If the first Mantoux test result was ‘negative’ with the student having had a BCG, you will be

required to have what is called a “two-step Mantoux”, i.e. another Mantoux test within one-

month of screening to ensure the first result was not a ‘false-negative’.

• NSW Health advises that at this time ‘Quantiferon Gold’ assay tests are not accepted.

• Live vaccines such as MMR and Varicella should be given 1-month after a Mantoux test as

they can have an effect on the Mantoux test reading. Please record all tuberculosis

screening on the ‘vaccination record card’ and the results of any further investigations such

as CXR. Ensure the GP or vaccination provider signs the vaccination record card entry and

provides their practice stamp to validate the entry.

Authored by SLHD Clinical Placement Unit & SLHD Staff Health 2013 Reviewed July 2014

Reviewed March 2016 Reviewed August 2016

Reviewed November 2016 Reviewed March 2017

Reviewed by NSW Health and advice approved April 2017

Final Advice to students

• If the student in unable to obtain ‘compliant’ status, this will prevent the student from

attending a clinical placement within any NSW Health facility. There are no exceptions to this

requirement.

• The student should commence an immunisation review immediately as it may take several

weeks to obtain documentation to demonstrate compliance with mandatory immunisation

requirements.

• The student should review all advice before submitting any documentation for review to

ensure what has been advised is in the format requested.

• Pictures of documentation taken on smartphones are not acceptable - documentation must

be in pdf format only. JPEG or other graphic files are not acceptable.

• Student verification video’s (produced by HETI) to assist with what it is required are

accessed from this URL http://www.heti.nsw.gov.au/verification

Occupational assessment, screening and vaccination against specified infectious diseases

PROCEDURES

PD2011_005 Issue date: January 2011 Page 24 of 25

FORM 2. – Tuberculosis (TB) assessment tool

- A New Recruit/Student will require TST screening if he/she was born in a country with a high incidence of TB, or has resided for a cumulative time of 3 months or longer in a country with a high incidence of TB, as listed at: http://www.health.nsw.gov.au/publichealth/Infectious/a-z.asp#T.

- The Health Service will assess this form and decide whether clinical review/testing for TB is required. Indicate if you would prefer to provide this information in private consultation with a clinician.

- New recruits will not be permitted to commence duties if they have not submitted this Form and Form 1: New Recruit Undertaking/Declaration to the employing health facility. Failure to complete outstanding TB requirements within the appropriate timeframe(s) may affect the new recruit’s employment status

- Students will not be permitted to attend clinical placements if they have not submitted this Form and the Form 3: Student Undertaking/Declaration to their educational institution’s clinical placement coordinator as soon as possible after enrolment. Failure to complete outstanding TB requirements within the appropriate timeframe(s) will result in suspension from further clinical placements. The educational institution will forward the original or a copy of these forms to the health service for assessment.

Clinical History Cough for longer than 2 weeks Yes No Please provide information below if you have any of the following symptoms: Haemoptysis (coughing blood) Yes No

Fevers / Chills / Temperatures Yes No

Night Sweats Yes No

Fatigue / Weakness Yes No

Anorexia (loss of appetite) Yes No

Unexplained Weight Loss Yes No

Assessment of risk of TB infection Were you born outside Australia?

Yes No If yes, where were you born? ……….…………………………………………………. Have you lived or travelled overseas?

Yes No

Country Amount of time lived/ travelled in country

……………………………. …………..…….…

……………………………. …………..…….…

……………………………. …………..…….…

Have you ever had:

Contact with a person known to have TB? If yes, provide details below Yes No

Have you ever had: TB Screening Yes No

If yes, provide details below and attach documentation

If you answered YES to any of the questions above, please provide details (attach extra pages if required).

I declare that the information I have provided is correct

Name ____________________________________________________________________________________

Phone or Email ____________________________________________________________________________

Student ID (or date of birth) __________________________________________________________________ Educational institution (student) ______________________________________________________________

Health Service/Facility (new recruit) ___________________________________________________________

Signature _______________________________________________ Date _____________________________

Occupational assessment, screening and vaccination against specified infectious diseases

PROCEDURES

PD2011_005 Issue date: January 2011 Page 25 of 25

FORM 3. – Student Undertaking/Declaration All students must complete each part of this Form 3: Student Undertaking/Declaration Form and the Form 2: Tuberculosis (TB) Screening Assessment Tool and return these forms to their educational institution’s clinical placement coordinator as soon as possible after enrolment. (Parent/guardian to sign if student is under 18 years of age.)

Students will not be permitted to attend clinical placements if they have not submitted Form 3: Student Undertaking/Declaration Form and Form 2: Tuberculosis Assessment Tool.

Failure to complete outstanding hepatitis B or TB requirements within the appropriate timeframe(s) will result in suspension from further clinical placements and may jeopardise the student’s course of study. The educational institution will:

- ensure that all students whom they refer to a health service for clinical placement have submitted these forms, and

- forward the original or a copy of these forms to the health service for assessment.

The health service will: - assess these forms along with evidence of protection against the infectious diseases specified in this

policy directive.

Part 1 I have read and understand the requirements of the NSW Health Occupational Assessment, Screening and Vaccination against Specified Infectious Diseases Policy Directive.

Part 2 I undertake to participate in the assessment, screening and vaccination process and I am not aware of any personal circumstances that would prevent me from completing these requirements.

OR I undertake to participate in the assessment, screening and vaccination process, however I am

aware of medical contraindications that may prevent me from fully completing these requirements and am able to provide documentation of these medical contraindications. I request consideration of my circumstances.

Part 3 I have evidence of protection for: pertussis diphtheria tetanus

varicella measles mumps rubella

Part 4 I have evidence of protection for hepatitis B. OR

I have received at least the first dose of hepatitis B vaccine (documentation provided) and undertake to complete the hepatitis B vaccine course (as recommended in the Australian Immunisation Handbook, current edition) and provide a post-vaccination serology result within six months of commencement of enrolment.

Part 5 I have been informed of, and understand, the risks of infection, the consequences of infection and management in the event of exposure (refer Information Sheet 3: Specified Infectious Diseases: Risks, consequences of exposure and protective measures) and agree to comply with the protective measures required by the health service.

I declare that the information I have provided is correct Name _____________________________________________________________________________________ Phone or Email _____________________________________________________________________________

Date of Birth or Student ID ____________________________________________________________________

Educational institution _______________________________________________________________________

Signature ________________________________________________ Date _____________________________