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#4 – Personal Medical History

Each member of our staff has a separate health file that is held in confidence for you located at ________________.  All information in this file is only available to you and your employer.  You may ask to see your file at any time. You are responsible at your own expense for keeping up your general immunizations.  They are available from your personal physician or the local County Board of Health.

Tetanus – Diphtheria

  1. An infectious complication of an open wound
  2. Boosters are required every 10 years.
  3. If not previously immunized, 2 doses four weeks apart followed by a booster 6 months later.
  4. Get a booster every 10 years

Rubella (German measles)

  1. Immunization is universally recommended for all health care workers
  2. Critical for non-immunized women of child bearing age (severe birth defects possible)
  3. 30% of cases are in adults who didn’t have as a child.
  4. More severe in adults than in children
  5. If exposed and not immunized don’t work from 7th-21st day after exposure

Measles/Mumps

  1. Most have us have been exposed and are immune. Mumps vaccine (one lifetime shot) can be given if there is any question.
  2. Recommended for all health care personnel
  3. 30% of cases are in adults who didn’t have as a child. Symptoms worse as an adult.
  4. Only two shots are needed for immunity to Rubella, Measles and Mumps. A person shouldn’t get pregnant for 3 months after the shot.
  5. If exposed and not immune don’t work from 5th-21st day after exposure

Poliomyelitis

  1. All healthcare personnel should be vaccinated
  2. Requires 3 shots
  3. Boosters are recommended if you come in contact with blood or oral secretions of someone with polio

Chicken Pox (Varicella)

  1. One in 10 adults have never had disease.
  2. Unprotected adults can have relatively severe infections with complications
  3. Spread by contact with an infected person’s chicken pox sores
  4. Early symptoms are aching, tiredness, fever, or sore throat
  5. If you didn’t have chicken pox as a child, get a vaccination.
  6. If exposed and not immunized don’t work from the 10th-21st after exposure

Flu (Influenza) shots are recommended.  They will reduce the symptoms and the potential of transmitting the flu to others.  The 3 flu strains most likely to strike during that November 1st to February 1st flu season.  We need a new flu shot each year because the virus mutates each year.  A new vaccine is devised each year to protect us from the strains they believe are most likely to effect us. The vaccine is usually 70% effective.

Flu shots can help by:

  1. Avoid going through the experience of the flu symptoms    (headaches, body aches, and high fever)
  2. Avoid losing one or more days at work
  3. Avoid passing the flu on to our older clients
  4. Help build some future immunity in years to come.  Flu shots don’t always work.  Every year, the government attempts to figure out which bacterial strains are most likely to affect us.  The shot is to protect us from those strains only.  Most years they guess right.
  5. Even if you get the flu, the symptoms will be less severe.

Tuberculosis (TB)

28,000-180,000 new cases develop annually in the U.S. and 8-10,000 die annually.  4 million Americans are infected. Suggest an immunization.

HEPATITIS

Hepatitis is an inflammation of the liver caused by the Hepatitis virus. The liver has several essential functions:

  1. Changes food into energy
  2. Cleans toxins out of the blood
  3. Helps with digestion

Health care workers in general have a three to five times increased risk of getting this disease.  Luckily , Dental staff have a low infection rate.  I recommend everyone on staff have the vaccine to protect himself or herself. Only 20% of the people who have Hepatitis have symptoms strong enough that they even know that they are carriers and could infect us.  Symptoms of the 3 most common forms are the same

  1. Vomiting
  2. Fever
  3. Abdominal pain
  4. Lethargy
  5. Loss of appetite
  6. Yellowing of eyes and skin
  7. Dark yellow urine

Everyone that treats clients must have their vaccinations. Secretaries don’t come in direct contact with patients.  However, they are not risk free.  Here are some examples of exposure:

  1. Touching a folder that has been splattered with blood or saliva
  2. Using a pen or pencil that was used by treatment room personnel
  3. Organisms or chemicals in the air.

How can we help you avoid exposure?

  1. Mark all pens/pencils used in the treatment rooms with tape.
  2. Place a plastic cover over records to avoid contamination.
  3. Dental personnel should remove gloves before writing in folders. They should never come to the front desk with gloves on.
  4. You may want to wear protective outer clothing over your regular clothes.
  5. Don’t handle lab models unless they have been disinfected.
  6. Wash your hands with the treatment area antibacterial soap after using the bathroom and before eating and at the end of your shift
  7. Bandage cuts and wounds
  8. Don’t share personal care items (cups, silverware, toothbrushes, toothpaste, nail clippers, etc.)

Get all your questions answered, and, when you are ready, sign the consent form and arrange for your injections from the local County Health Department. You must have your immunization to Hepatitis B within 10 days of starting to work unless

You have previously completed a Hepatitis B vaccination series. Immunologic memory remains intact for at least 23 years (CDC guidelines 2008)

Your immunity has been confirmed by antibody testing

The vaccine is contraindicated for medical reasons

The cost of these immunizations is covered by many health insurance plans as part of their preventive care program.  We will cover all non-covered expenses. If you are pregnant, check with your physician before you take any of these immunizations.  To complete this level, fill out the following chart, your physician will need it to send us written verification that these immunizations are current. Get all your questions answered, and, when you are ready, sign the consent form and arrange an appointment with the local County Health Department for hepatitis immunizations.

Hepatitis has many variations (A,B,C,D,E and G) but, the most common are:

Hepatitis A – Transmitted from feces to mouth, usually when a person ingests food or water contaminated by someone who didn’t wash following a bowel movement.  Treatment – bed rest and healthy diet.  Symptoms last up to 2 months.

Hepatitis B & C transmitted from person to person through the transfer of body fluids (delivery of a child, contamination through wound, sex, etc.)  Treatment – antiviral drugs.  Symptoms last up to 2 months.

Remember, a cut, a needle stick, a splash in the eye, a contaminated sore on your finger, all these events can lead to Hepatitis. The office will pay for your Hepatitis immunization series. Most people who develop Hepatitis aren’t exposed while treating people with Hepatitis. Please read this article dateSunday March 30, 2008

Diners May have Been Exposed to Hepatitis A

Anyone who ate at the P.F. Chang’s in West Chester Twp. Between March 14 through 25 should call hot line.

By Richard Wilson [Dayton Daily News]

WEST CHESTER TWP., Butler County – A restaurant worker may have contaminated ice and other food items with hepatitis A, according to the Butler county Health Department. A food service worker was sick with the virus while working between March 14 and March 25, at P.F. Chang’s, 9435 Civic   Centre Blvd. in West Chester Twp., according to the health department.

               Anyone who dined or had drinks with ice or lemons at the restaurant during that time should contact their health care provider or local public health department to be assessed and possibly vaccinated, according to butler County health officials.

               Judy Adams of Trenton said she ate at the restaurant with friends on Monday, March 24, and ordered the lettuce wraps with sweet and sour chicken and had a Diet Coke with two lemons.   The 38 year old said she plans to call her doctor after the weekend, though she said the manager at the restaurant told her not to worry unless she developed symptoms, which according to health officials, can include nausea, fever, stomach pain, dark urine, diarrhea and jaundice.

               “I’m thinking I’m not going to wait,” Adams said. “It’s sad. You can’t trust to go out and eat anymore.” According to the centers for Disease Control, hepatitis A is a viral infection that attacks the liver and is spread primarily by close person-to-person contact of by consuming contaminated food.

ALL STAFF WILL BE IMMUNIZED.  IF YOU ARE INVOLVED WITH TREATING CLIENTS YOU SHOULD HAVE THIS IMMUNIZATION WITHIN 10 DAYS AFTER STARTING WORK.

Employee Health Information         Please copy the following pages, fill them out and give them to your dentist. OSHA requires that we keep your health history confidential at an off site location.

Name________________________________________

Social Security Number_________________________________

1.  Fill out Dental/Medical history form that we use in the office

2.  Your job here and therefore your level of employee exposure (see your team leader)

_______________________________________________

3.  If you have any questions about infection control or health/safety matters, you may call the Center for Disease Control at: (404) 332‑4552.

To complete this level, your physician will need to send us written verification that these immunizations are current.  Indicate with a checkmark, in the appropriate column, what your status is for each disease listed below:

Disease Immunized Have had   thedisease Notimmunized Have not   hadthe   disease Do not   know
Hepatitis   B
Influenza
Measles
Mumps
Polio
Rubella
Tetanus
Tuberculosis

Employee Medical Record                                                        Confidential                                                                                   ***

Employee name  _______________________________________________

Employee address _____________________________________________

Employee social security number ___________________________________

Employee starting date ____________________________________

Employee termination date _______________________________________

History of HBV vaccination ______________________________________(date received, or, if not received, a brief explanation of why not)

History of exposure incidents (dates, brief explanation, attachments)

 

Results of medical exams, if any, and follow-up procedures regarding exposure incident or hepatitis B immunity, including written opinion of healthcare professional (dates, brief explanation, attachments)

 

Information provided to the healthcare professional regarding hepatitis B vaccination and/or exposure incidents found in General Level 1 Training Manual  “Exposure Control Plan”.

 

Note: This confidential record will be maintained for duration of your employment plus 30 years off site.

CONSENT FORM: EMPLOYEES RECEIVING VACCINE

Dr. _____________________                     Date____________________________

I have been advised that I am an “at risk” employee, subject to occupational exposure to Hepatitis B. In addition, I have been advised of the possible effects of this disease by my employer, read the literature provided, and discussed all questions to my satisfaction. I understand that the Hepatitis B vaccine has been reported to be 85-96% effective in providing protection from Hepatitis B when the three dose series had been administered, as recommended.

I further understand that, in addition to acute illness, Hepatitis B virus infection can lead to a chronic carrier state, Hepatitis, Cirrhosis, and is associated with a higher risk of liver cancer. In, addition, I understand that there is no effective treatment or cure for Hepatitis B.

I understand the risks of hepatitis B, and of the Hepatitis B vaccine. I have read the literature provided, discussed the matter with my employer, and I WOULD LIKE TO RECEIVE THE VACCINE. I understand that the three dose series does not guarantee my immunity from disease, and although they are rare, I recognize that side effects of the vaccine are possible.

___________________________________________________________________________

Employee’s name                                                                                     Date

Signature of Employee

Signature of Employer                                                                        Date

 Signature of Witness                                                                           Date

Injection Dates

_______________________  ______________________________   ________________________

First                                          second (2 months later)                        third (6months later)

REFUSAL FORM: EMPLOYEES NOT RECEIVING VACCINE

Dr. ________________________                Date_________________

I have been advised that I am an “at risk” employee, subject to occupational exposure to Hepatitis B. In addition, I have been advised of the possible effects of this disease by my employer, read the literature provided, and discussed all questions to my satisfaction. I understand that the Hepatitis B vaccine has been reported to is 85-96% effective in providing protection from Hepatitis B when the three dose series had been administered, as recommended.

I further understand that, in addition to acute illness, Hepatitis B virus infection can lead to a chronic carrier state, Hepatitis, Cirrhosis, and is associated with a higher risk of liver cancer. In, addition, I understand that there is no effective treatment or cure for Hepatitis B.

I understand the risks of hepatitis B, and of the Hepatitis B vaccine. I have read the literature provided, discussed the matter with my employer, and I ELECT NOT TO RECEIVE THE VACCINE. Therefore I release my employer, his agents, and assigns from any and all responsibility, except for insurance benefit, or other benefit that has accrued to me should I develop Hepatitis B, or any of its sequallae.

______________________________________________________________________________

Employee’s name                                                                                     Date

Signature of Employee

Signature of Employer                                                            Date

Signature of Witness                                                                           Date