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Ki
M
Pu
Di
Kingdom of
Ministry of H
ublic Healt
iseases Con
POLIC
f Bahrain
Health
th Director
ntrol Secti
CY FOR
ME
rate
ion
R IMM
EDICAL
MUNIZA
L, DENT
ATION A
TAL, N
S
AND IN
FOR
NURSIN
STUDE
201
NFECT
R
NG, AN
ENTS
0
TIOUS D
ND PHY
DISEAS
YSIOTH
SES SCR
HERAPY
REENIN
Y
1
NG
De
W
1‐
2‐
3‐
fa
4‐
in
im
5‐
HB
• D
sim
co
• R
• M
HC
6‐
po
us
efinitions
Wherever us
“Section”
“Student”
"Direct pa
cility.
“Blood bo
humans. T
mmunodefi
“Exposure
BV, HCV or
Digital palp
multaneou
onfined ana
Repair of m
Major cutt
CW may be
"Health c
ortion ther
sed, operat
sed in this
” means th
” means m
atient cont
orne patho
These path
iciency viru
e‐prone pr
r HIV from
pation of a
us presence
atomic site
major trau
ting, or rem
e exposed
care facility
reof, wheth
ted, or eng
policy, the
e Diseases
medical, de
tact" mean
ogens” me
hogens inc
us (HIV).
rocedures”
a Health C
a needle tip
e of the HC
e, e.g. duri
matic injur
moval of an
to the pat
y" means a
her a partn
gaged in pr
e following
s Control Se
ntal, nursi
ns any rou
eans patho
lude, but a
” means pr
Care Worke
p in a body
CW's finge
ng major a
ries, or
ny oral or p
tient's ope
any institu
nership or
roviding he
g terms sha
ection.
ing, and ph
tinely anti
genic micr
are not lim
rocedures
er (HCW) t
y cavity (a
rs and a ne
abdominal
perioral tis
n tissues.
tional hea
corporatio
ealth care
all be cons
hysiothera
cipated fac
roorganism
mited to, he
during wh
to a patien
hollow spa
eedle or ot
, cardiotho
ssue, includ
lth service
on, whethe
services.
strued as fo
apy studen
ce‐to‐face
ms that are
epatitis B v
ich transm
nt is most l
ace within
ther sharp
oracic, vag
ding tooth
provider,
er public o
ollows:
nts
interactio
e present in
virus (HBV)
mission of
ikely to oc
the body o
p instrumen
ginal and/o
h structure
facility or
r private, w
on with pat
n human b
), hepatitis
cur and inc
or one of i
nt or objec
or orthoped
s during w
institution
whether o
tients in a h
blood and c
C virus (H
cludes the
ts organs)
ct in a blind
dic operati
which blood
n, place, bu
rganized fo
health care
can cause d
CV) and hu
e following
or the
d or highly
ions, or
d from an i
uilding, age
or profit or
2
e
disease
uman
:
y
njured
ency, or
r not,
7‐
fa
so
ho
sc
m
St
A.
B.
C.
T.
“Health C
cility. This
ocial worke
ousekeepin
ope of his
ean other
andard Op
. Immuniza
All s
All s
pers
All s
Testing fo
Stud
tube
Stud
Tube
Thes
A stu
infec
If a p
repa
The
For the m
B. and join
Foll
The
Stud
Com
Shou
of th
Care Worke
may includ
er, pharma
ng staff, se
or her em
staff, such
perating P
ation prog
students m
students m
sonnel toge
students m
or infectiou
dents must
erculosis in
dents who
erculosis s
se tests sh
udent with
ctions and
positive re
atriated.
e College sh
managemen
ned the Co
ow Annex
enrolmen
dents who
mmission to
uld the exp
he Student
er (HCW)”
de, but no
cist, labora
ecurity pers
ployment
h as volunt
rocedures
gram
must partici
must comp
ether with
must comp
us disease
t arrange f
n their cou
o conduct t
creening w
ould also b
h negative
tuberculo
esult is rece
hould notif
nt of a stu
ollege befo
2.
t with the
o joined the
o be interv
pert panel
t’s Respons
means an
t be limite
atory work
sonnel, an
or agency
eers, who
:
ipate in the
lete the co
h the stude
lete the re
es:
for themse
ntry of the
the tests o
will include
be repeate
tests shou
osis.
eived, a stu
fy the Dise
dent who
ore 2010:
College sh
e College b
viewed by t
decide tha
sibility, be
y person w
ed to, a phy
kers psych
d any offic
related to
are involv
e immuniz
onsent form
ent applica
equired im
elves to be
eir residen
utside Bah
e a two‐ste
ed before j
uld be coun
udent will
eases Cont
is infected
hould be di
before 201
the expert
at a studen
low. D. Stu
who has or
ysician, de
ologist, stu
cer, emplo
o or suppor
ved in direc
zation prog
m for imm
tion form.
munizatio
tested for
ce.
hrain will h
ep Tubercu
oining the
nseled rega
not be elig
rol Section
d with a bl
iscontinue
10 and pres
t panel.
nt will be a
udent’s Re
r may have
ntist, nurs
udent, on‐
yee or age
rtive of hea
ct patient c
gram.
unization a
ns before j
r infection
ave to rep
ulin Skin Te
clinical co
arding avo
gible to join
n about the
ood born
d for all HI
sent positi
allowed to
esponsibilit
e direct con
e, optome
site faculty
ent of that
alth servic
contact.
and hand i
joining the
with HIV, h
peat these
est (TST) (A
ourse.
oiding risk f
n the cour
e test resu
infection a
IV positive
ve results
continue,
ty
ntact with
etrist, podia
y, receptio
provider a
es. "Health
it to the ap
e College.
hepatitis B
upon arriv
Annex 1) an
factors for
se. A non‐
ults for all s
and
students j
should be
he/she mu
a patient i
atrist, phys
onist, dieta
acting in th
h Care Wo
ppropriate
B, hepatitis
val in Bahra
nd chest x‐
r contractin
Bahraini st
students im
joining bef
referred t
ust strictly
in a health
sical thera
ry staff,
he course a
rker" shall
program
s C and
ain.
‐ray.
ng blood b
tudent wil
mmediately
fore 2010.
to the Med
y follow the
3
h care
pist,
and
l also
born
l be
y.
dical
e steps
1.
2.
re
3.
as
4.
to
5.
of
oc
6.
7.
te
8.
inf
9.
b.
c.
d.
e.
Students h
Students m
gardless o
Students h
ssociated w
Students h
o others.
Students h
f students b
ccupation o
Students s
Students m
sted. The s
Students m
fections.
Students w
read and
agree to c
been teste
understoo
have a res
must learn
of their diag
have a res
with health
have a res
have a res
before com
or other ac
should see
must repo
source of e
must unde
will provid
understoo
comply wit
ed for HIV,
od the imp
ponsibility
n and pract
gnoses.
ponsibility
h care.
ponsibility
ponsibility
mmencing
ctivities) co
ek post‐exp
rt an even
exposure w
ergo testin
de the Colle
od this docu
h the polic
, hepatitis
portance of
y to "first d
tice standa
y to ensure
y to take m
y to know t
studies an
ontinues.
posure foll
t of patien
will not be
g for blood
ege with a
ument,
cies and re
B, hepatit
f ongoing p
o no harm
ard and ad
e that they
measures to
their infect
nd periodic
ow‐up if e
nt exposure
revealed t
d borne pa
signed de
equirement
is C and tu
periodic te
m"
ditional in
are protec
o prevent t
tious statu
c testing, a
xposed to
e to a stud
to the pati
athogens a
claration t
ts set out i
uberculosis
esting.
fection co
cted from
transmissio
s for hepa
s long as t
an infecte
dent’s bloo
ent.
s requeste
that they h
in this doc
s, and
ntrol preca
infection w
on of acute
titis B and
he risk of e
ed patient’
od so that b
ed by the h
have: a. rec
ument,
autions. Th
with the va
e infectiou
hepatitis C
exposure t
s blood.
both stude
hospital, if
ceived this
his applies
accine‐prev
us diseases
C. This invo
to these vir
ent and pat
implicated
document
to all patie
ventable d
from them
olves the t
ruses (thro
tient can b
d in patient
t,
4
ents
diseases
mselves
testing
ough
be
t
In
As
inf
Th
Co
sc
co
Inf
th
1.
2.
3.
St
Ea
pr
wa
ste
go
pr
Va
ac
wi
im
Th
St
Ce
pa
Fo
ye
HC
sh
troduction
s students
fection tha
hese risks c
ontrol Sect
hool shou
ommence t
fectious di
ree ways:
The HCW
The HCW
The HCW
trategies to
arly in their
recautions”
ashing, ase
erilization
owns, mask
recautions
accination
ccording to
ith the prio
mmunity to
he program
tudents an
ertain bloo
articular im
ollowing in
ears, even
CWs may b
hould be no
n
prepare to
at may occ
cannot be
tion at the
ld provide
their cours
iseases aff
may trans
may beco
who is ill,
o Minimize
r studies, s
”. These in
eptic techn
and disinf
ks and eye
is a key pr
provides p
o the immu
or written
o various in
m (describe
d Blood‐Bo
od‐borne v
mportance
fection wit
life‐long. M
be involved
oted that :
o embark o
cur betwee
totally elim
Ministry o
this docum
se.
fect health
sfer infectio
me infecte
incubating
e These Inf
students sh
nclude asse
nique, disp
ection of r
e protectio
rofessional
protection
unization p
approval o
nfectious d
ed below) i
orne Virus
iruses such
in health c
th these vi
Many peop
d in the tra
on a health
en health c
minated, b
of Health h
ment to en
care work
ous agents
ed with inf
g or carryin
fectious Di
hould be ta
essing the
posal of sha
re‐useable
n), and ma
l skill.
against th
policy of th
of the Dea
diseases, an
is confiden
s Infections
h as human
care settin
iruses, indi
ple infected
ansmission
h care train
care worke
ut it is esse
as recomm
nsure that
kers (HCW)
s (bacteria,
ectious ag
ng infectio
isease Risk
aught infec
risk posed
arps and cl
equipmen
anaging pa
e infectiou
he Ministry
n. The med
nd offered
ntial betwe
s6
n immuno
gs.
ividuals ma
d with thes
n of these v
ning progra
ers and the
ential to ta
mended re
their stude
) and stude
, viruses, p
ents acqui
us agents,
ks
ction contr
by person
linical was
nt, the use
atients in v
us hazards
y of Health
dical schoo
vaccines t
een the stu
deficiency
ay carry th
se viruses
viruses in e
am it is im
eir patients
ake all pos
asonable m
ents consid
ents during
parasites) f
ired from p
may infec
rol strateg
ns with par
te, use of s
of persona
arious form
of health
. A student
ol provides
to protect
udent and
virus (HIV
he virus in t
feel comp
each of the
portant th
s or contac
sible steps
measures t
der these i
g their trai
from patie
patients.
ct patients
gies known
rticular infe
single‐use
al protecti
ms of isola
care settin
t can only
s a program
them in he
the progra
V), hepatitis
their blood
letely well
e three wa
at they un
cts.
s to minim
to minimiz
important
ining and i
nt to patie
or other H
as “stand
ections and
only equip
ve equipm
tion. Exem
ngs. Studen
opt out of
m in which
ealth care
am’s medic
s B virus an
d and rema
and are u
ys describ
nderstand t
ize them. T
ze these ris
issues bef
n their pro
ent.
HCWs.
ard and ad
d clinical s
pments, as
ments (such
mplary perf
nts must b
f the immu
h students
settings.
cal provide
nd hepatit
ain infectio
naware of
ed in the in
the risks of
The Diseas
sks. The m
fore they
ofessional l
dditional
yndromes,
spects of
h as gloves
formance o
e vaccinat
unization p
may be tes
ers.
is C virus a
ous for ma
f their infec
ntroductio
5
f
ses
edical
lives in
, hand
s,
of these
ed
program
sted for
are of
any
ction.
on and it
1.
2.
he
co
he
3.
blo
po
th
Th
de
th
ex
th
bo
In
pr
av
tra
Th
Ba
th
Po
pr
Th
Transfer o
HCWs hav
epatitis B v
ontaminate
epatitis C in
Transmiss
ood‐borne
otential stu
roughout t
he risk of tr
epends on
e blood). T
xposure‐pr
e HCW an
ody sites (i
our societ
rotect both
vailable to
ansmission
he Student
ahrain has
is program
olicies and
rior written
he Student
Imm
A p
imm
Tube
clini
Follo
vacc
A co
Expe
of blood‐bo
ve rarely b
vaccination
ed with the
nfection. T
sion of a bl
e virus infe
udents of h
their caree
ransmittin
several fac
The proced
rone medic
d sharp su
ncluding th
ty, the resp
h patients a
citizens. M
n of blood‐
ts Immuniz
provided s
m, which pr
Programs
n approval
ts’ Immuni
munization
rimary cou
munity afte
erculosis s
cal years o
ow‐up, and
cination, o
onfidentia
ert confide
orne viruse
een infecte
n virtually e
e body flui
Treatment
lood‐borne
ected HCW
health care
er.
g a blood‐
ctors, inclu
dure being
cal or dent
rgical instr
he mouth)
ponsibility
and HCWs
Measures m
‐borne viru
zation Prog
students w
rovides a s
for Medic
of the Dea
zation Pro
n (typically
urse of hep
er vaccinati
creening b
of the cour
d (if indicat
r have une
l personal
ential advic
es from on
ed by bloo
eliminates
ds of a pat
may be in
e virus from
causing se
e sciences
borne viru
uding the p
g performe
tal procedu
ruments, n
) of the pat
for minim
s from infe
must also c
uses to or f
gram
with an ext
service and
al Student
an.7
gram offer
a booster
patitis B va
ion.
by tubercu
rse. BCG va
ted) referr
explained p
report of t
ce on vacc
ne patient t
od‐borne v
the risk of
tient requi
dicated to
m an infect
erious harm
must perso
us from an
particular v
ed by the H
ures pose a
needles, or
tient.
izing this r
ctions in h
consider th
from HCW
ensive and
d documen
ts in Bahra
rs the follo
dose) for
ccination (
lin skin tes
accine is no
ral for spec
positive tu
tests and i
ination ma
to another
iruses. Goo
f significan
re immedi
reduce th
ted HCW t
m to patie
onally con
infectious
virus, and t
HCW is ano
a risk for d
r sharp tiss
risk to pati
ealth care
he training
Ws.
d confident
ntation tha
in. A stude
owing tests
any of the
(for those
sting in the
ot recomm
cialist advi
berculin sk
mmunizat
atters.
r is very ra
od infectio
nt hepatitis
iate on‐site
e risk of in
to one or m
nts is an im
sider this i
HCW to a
the degree
other very i
irect conta
sues (broke
ents falls l
settings s
and exper
tial immun
at meets th
ent can onl
s, immuniz
diseases c
not previo
e first year
mended.
ce, for stud
kin tests.
ions.
re in Bahra
on control
s B infectio
e assessme
nfection.
more patie
mportant p
issue befor
patient (o
e of infecti
important
act betwee
en bone or
argely on t
hould be c
rtise of HCW
nization pr
he recomm
ly opt out
zations and
covered in
ously vaccin
. Further s
dents who
ain.
practice re
on. HCWs w
ent of any
nts is very
public and
re embark
or an infect
ousness (t
considera
en the skin
r teeth) in
the HCWs
compatible
Ws in addr
ogram. Stu
mendations
of the imm
d services:
the exten
nated) foll
creening m
o fail to res
educes this
who suffer
risk of HIV
y rare. How
profession
ing on the
tious patie
the concen
tion. In pa
n (usually f
poorly see
themselve
e with exist
ressing the
udents mu
s of the Inf
munization
ded EPI pr
owed by a
may be off
spond to he
s risk. Adeq
r an injury
V, hepatitis
wever, the
nal concern
ir training,
nt to a HC
ntration of
articular,
inger or th
en or confi
es. Measur
ting protec
e risk of
ust particip
fectious Di
program w
rogram in B
a test to co
ered durin
epatitis B
6
quate
s B or
risk of a
n. All
, and
W)
virus in
humb) of
ned
res to
ction
pate in
seases
with the
Bahrain.
onfirm
ng the
Sc
A)
St
wi
St
Co
Th
th
He
wh
Fe
St
Sc
An
be
m
B v
If
“n
B)
If t
no
St
Co
St
The
pers
creening an
) Hepatitis
udents wil
ill not be e
udents wh
ommission
he vaccinat
e first dos
epatitis B (
ho have no
ebruary 1st
udents wh
creening fo
n HBsAg te
e given and
onth. If the
vaccine se
a student
non‐respon
) HIV and H
the result
on Bahrain
udents wh
ommission
udent who
e attached
sonnel at t
nd Vaccina
B
ll be screen
eligible to j
ho joined t
to be inte
tion for He
e, and the
anti‐HBs) s
ot been pr
t prior to p
ho have be
orm and th
est is requi
d the Anti H
e antibodi
ries and re
continues
nder” and w
Hepatitis C
of any Hep
i should be
ho joined t
to be inte
o joined m
consent fo
he time of
ation Guid
ned for He
oin the me
he medica
erviewed b
epatitis B c
third shou
should be
eviously va
possible reg
een vaccina
e results o
red before
HBs should
es to the H
epeat the H
to be non‐
will be refe
C
patitis C or
e repatriat
he medica
erviewed b
edical scho
orm must b
f first atten
delines
epatitis B s
edical scho
al school be
by the expe
onsists of
uld be adm
done at le
accinated f
gistration.
ated for He
of their sur
e joining th
d be carrie
Hepatitis B
Hepatitis B
‐immune a
erred to th
r HIV test is
ted.
al school be
by the expe
ool before
be signed b
ndance at t
urface ant
ool, and no
efore 2010
ert panel.
a series of
ministered
east one m
for Hepatit
epatitis B m
rface antib
he medical
ed out with
surface an
B surface a
after a seco
he appropr
s positive,
efore 2010
ert panel.
2010 with
by the stud
the immun
igen (HBsA
on Bahrain
0 with a po
f 3 doses. T
6 months a
onth after
tis B shoul
must provi
ody level (
school. If
hin 6 mont
ntigen test
ntibody te
ond series
riate specia
the studen
0 with a po
h positive (
dent and h
nization pr
Ag). If the r
is should b
ositive (HBs
The second
after the f
the vaccin
d begin th
de the vac
(anti‐HBs) f
a student
hs after co
t are negat
est (anti‐HB
of Hepatit
alist, and r
nt will not
ositive (HCV
(HIV) will b
handed ove
ogram.
result of th
be repatria
sAg) result
d dose sho
irst one. Te
ne series is
is vaccinat
ccination d
for Hepatit
is HBsAg n
ompleting t
tive, the st
Bs).
tis B vaccin
eceive car
be eligible
V) result sh
be not eligi
er to the a
he (HBsAg)
ated.
t should be
ould be adm
esting for t
s complete
tion proces
ates on th
tis B.
negative, th
the third d
tudent mu
ne, he/she
eer counse
e to join th
hould be re
ble to con
ppropriate
) test is pos
e referred t
ministered
the surface
ed. Medica
ss no later
e Commun
hree doses
dose, prefe
st begin a
will be co
eling.
he medical
eferred to
tinue train
e program
sitive, the
to the Med
one mont
e antibody
l school ap
than the
nicable Dis
s of vaccine
erably afte
second He
nsidered t
school, an
the Medic
ning.
7
student
dical
th after
y to
pplicants
sease
e should
r one
epatitis
o be a
nd any
cal
C)
Pr
(in
ins
D)
Ea
ea
E)
St
F)
Im
St
St
ad
G)
St
co
Tuberculo
revious pos
nduration m
stead to ha
All o
If a p
docu
A si
If th
caus
refe
repa
) Influenza
ach studen
ach academ
Measles/
udents are
Tetanus /
mmunizatio
udents mu
udents are
dmitted to
) Polio
udents are
onsists of 5
Stud
doc
osis
sitive Tube
measuring
ave a ches
other stude
previous 2
umentatio
ngle step T
e results o
se) the stu
rred for co
atriated.
a
t is require
mic year an
Mumps/R
e required
/Diphtheria
on against
ust provide
e responsib
the medic
e required
5 doses for
dents who
umentatio
erculin Skin
g equal to o
st x‐ray.
ents are re
‐step TST h
n of a sing
TST is requ
of either th
dent must
ounseling a
ed to obta
nd docume
Rubella
to provide
a
tetanus an
e proof of r
ble for ens
cal school.
to provide
children u
o do not su
on is provi
n Test (TST
or greater
equired to
has been d
gle step TST
uired annu
he initial 2‐
t supply the
and for app
in an annu
entation fo
e evidence
nd diphthe
receipt of
suring that
e documen
up to 6 yea
ubmit the a
ded.
T): If the stu
than 10 m
provide do
documente
T.
ally, begin
‐step TST o
e results o
propriate m
ual influenz
orwarded t
of two do
eria is effec
a primary
these boo
ntation of a
ars of age,
appropriat
udent has
mm), a repe
ocumentat
ed within t
ning in the
or single ste
of a chest x
medical as
za immuni
to the med
oses of mea
ctive for ap
series of v
osters to te
a complete
and 3 dose
te immuni
a docume
eat TST is n
tion of a 2‐
the past 12
e second y
ep TST are
x‐ray. If this
ssessment
zation. Thi
dical schoo
asles, mum
pproximate
accines or
etanus and
e primary s
es after ag
ization rec
nted histo
not require
‐step TST u
2 months, s
ear and fo
e positive (d
s x‐ray sug
and treatm
is immuniz
ol by the st
mps and ru
ely ten yea
booster re
d diphtheri
series of po
e 7.
cords will b
ory of a pre
ed and the
upon entry
students a
or the dura
due to BCG
ggestive of
ment. Non
zation mus
udent.
ubella vacc
ars from th
eceived wi
a remain u
olio vaccin
be suspend
evious posi
student w
y to medica
are only req
tion of the
G vaccine o
T.B, the st
Bahrainis
st be receiv
ine.
he date of i
ithin the la
up to date
ne. A comp
ded until p
itive TST
will proceed
al school.
quired to p
e course.
or any othe
tudent will
should be
ved by Oct
immunizat
ast 10 year
after bein
plete series
proper
8
d
provide
er
l be
tober of
tion.
rs.
g
s
Co
Th
aff
his
co
St
St
pr
onclusion
he informa
fect the pa
s represen
onfidential
udents are
udents are
ractitioner
tion conta
atients wit
ntative if th
basis.
e required
e required
for the pu
ained in thi
h whom th
here are an
to read an
to be vacc
urpose of u
is policy co
hey come i
ny matters
nd underst
cinated aga
undergoing
oncerns im
into conta
s which req
tand this po
ainst certa
g blood tes
mportant qu
ct. Student
quire clarif
olicy
in infectio
sts.
uestions of
ts are enco
ication. All
us disease
f public he
ouraged to
l enquiries
es and are f
ealth which
o discuss th
s will be we
further req
h affect stu
his policy w
elcomed an
quired to v
udents and
with the De
nd treated
visit a med
9
d may
ean or
d on a
ical
Annex
Some peoafter infecnegative, reaction tthe boost Use two‐sworkers). infection, • Return t• If first te• If first te• Return t• If secon• If secon A person recommetuberculo N.B: The rrepeated
x 1
ople who werction, as the imay stimulatto a subsequeted reaction t
step testing foThis ensuresrather than s
to have first test is positiveest is negativeto have second test is positd test is nega
who is diagnondation that osis infection
result of the test will be c
re previously immune systete (boost) theent test may bo an old infec
or initial skin that any futusimply a react
test read 48–7e, consider thee, give secondnd test read 4tive, considerative, conside
osed as "infecprior BCG‐vain people wh
TST done at cconsidered as
Two-s
infected withem response e body's abilitbe misinterprction.
testing of adure positive ttion to an old
72 hours aftee person infed test 1–3 we48–72 hours ar person prever person unin
cted" on two‐ccination be o have had B
country of res the second
step test
h TB may havemay graduallty to react to reted as a new
ults who will ests can be ind infection.
er injection cted. eeks after firsafter injectioniously infectenfected
‐step testing ignored resuCG (mostly fo
esidence will bstep.
ting
e a negative rly wane. This tuberculin inw infection, w
be retested pnterpreted as
st injection n ed
is called a "tults in almost uoreign nation
be considere
reaction whe initial skin ten future tests.when in fact it
periodically (s being caused
uberculin conuniversal falsnals).
ed as the first
n tested yearest, though Thus, a positt is the result
e.g., health cd by a new
nverter". The se diagnosis o
t step and the
10
rs
tive t of
are
of
e
11
12
