NSW Health has released a revised policy directive on health care worker screening and vaccination PD2023_022 Occupational Assessment Screening and Vaccination Against Specified Infectious Diseases which continues to require mandatory vaccination and screening for certain diseases including COVID-19 and influenza vaccination requirements for workers employed in NSW Health facilities.
Transmission of vaccine preventable diseases (VPDs) and tuberculosis (TB) in healthcare settings has the potential to cause serious illness and avoidable deaths in workers, patients and other users of NSW Health agencies as well as others in the community. Under the Work Health and Safety Act 2011, risks must be eliminated or minimised through controls. NSW Health therefore has a duty of care and a responsibility under work health and safety legislation to control and minimise risks.
Vaccines work by triggering the immune system to fight certain infections. If a vaccinated person comes into contact with these infections, their immune system is able to respond more effectively, preventing the disease developing or greatly reducing its severity.
Vaccines used in Australia are safe and must pass strict safety testing before being approved by the Therapeutic Goods Administration (TGA). In addition, the TGA monitors the safety of vaccines once they are in use. More information about vaccine safety is available from the Australian Government Department of Health.
While there is a risk of adverse events following immunisation (AEFI) with any vaccine, most are mild and resolve quickly. The most common side effect is pain, swelling or redness at the injection site. Serious side effects are extremely rare. If you are concerned about any side effects after vaccination you should contact your local doctor who should also make a report to the local public health unit. Anaphylaxis is a severe allergic reaction that occurs very rarely after vaccination, however it is readily managed by trained nurses or doctors.
Workers employed in Category A and B positions must provide the documentation evidence as specified in Appendix 1 of the policy directive Evidence of Protection. The NSW Health Vaccination Record Card for Category A Workers (including Students) can be used to record vaccinations and serology results. The Vaccination Record Card must be completed by an appropriately trained assessor.
The Vaccination Record Card for Category A Workers (including Students) must be completed by an appropriately trained assessor. This is a person who is considered by the health agency or education provider as having the appropriate skills to competently assess a worker’s compliancy status. This may be a doctor, paramedic, registered nurse (RN) or enrolled nurse (EN) who has training on this policy directive in the interpretation of immunological test results, vaccination schedules, TB assessment and/or TB screening.
Appropriately trained pharmacists may complete the sections relating to COVID-19, hepatitis B, MMR (measles, mumps, rubella), dTpa (diphtheria, tetanus and pertussis), zoster and influenza vaccines.
Most people with medical conditions can be safely vaccinated. You should discuss your medical condition with your doctor who will assess and provide advice on whether you have a medical contraindication to vaccination. If you have a recognised medical contraindication to vaccination, you will be required to submit evidence to the assessor in your local health district (LHD) or Health Agency to support the application for a temporary or permanent medical contraindication.
The overwhelming evidence is that immunisation and the provision of population-wide vaccination programs remain one of the most effective public health measures to protect the community from preventable diseases. While no pharmacologic agent, including vaccines, is 100% effective, vaccination offers the best protection for individuals and for those they come into contact with.
The Australian Immunisation Register (AIR) was previously known as the Australian Childhood Immunisation Register (ACIR) and was expanded in October 2016 to record vaccinations given to individuals at all stages of life. There is no historical adult vaccination data held on the AIR so vaccination histories are unlikely to be complete at this stage. This will change over time as adult vaccinations are routinely reported to the AIR by immunisation providers. In addition to vaccination records, there are other requirements to demonstrate your compliance that are not available on the AIR, including serology results for hepatitis B protection and the TB checklist.
Vaccine preventable diseases can cause serious illnesses, and so NSW Health staff have a responsibility to do everything they can to minimise the risk of disease spreading to their patients. Workers with a medical contraindication to vaccination will not be terminated on the basis of their medical contraindication but will be risk managed as specified in the policy directive.
In the absence of a medical contraindication to vaccination, other alternatives will be explored to minimise the risk of transmission, including re-deployment to low risk areas. Where these alternatives have been exhausted and the risk of transmission cannot be acceptably managed and/or the worker refuses to comply with risk mitigation strategies specified in the policy directive, termination may be appropriate. The NSW Health agency will ensure procedural fairness during this process.
Yes. Students who have been assessed as compliant for the purposes of attending clinical placements will be required to undergo assessment and screening in accordance with the policy prior to employment in NSW Health. This information will then be recorded in a state-wide database known as VaxLink and will be available to all LHDs in NSW Health. If you move between facilities or LHDs you won't need to provide the same documents again.
Existing workers who have been previously assessed as compliant under the previous policy and apply for a new position in the LHD do not need to be reassessed if they remain compliant under the current Policy. Workers who have provided a previous verbal history of varicella prior to 2018 do not need to be reassessed. The Tuberculosis (TB) Assessment Tool must be completed again if there has been TB exposure where the contact screening has not been completed or when the worker has travelled for 3 months or more to high risk countries since their last assessment.
If the worker is transferring from a Category B to a Category A position, they must be assessed against the vaccination and screening requirements for Category A workers.
Yes. All agencies that provide workers to NSW Health facilities are obliged to comply with NSW Health policies including the requirements contained in the Occupational assessment, screening and vaccination against specified infectious diseases policy directive. Agencies must ensure that they only provide compliant workers to LHDs. Agency workers must ensure that they have evidence of their compliance available when presenting for shifts to assist with local compliance monitoring processes.
Yes. This is to ensure that any issues with compliance are identified early in the students candidature as those who are non-compliant will not be able to attend their placement which may impact on their course completion. The TB assessment tool should also be submitted in the first year of study.
No. The inclusion of a batch number is desirable where available but is not a requirement for the evidence to be accepted.
If the legal requirement, such as a Public Health Order relating to residential aged care facility workers, requires workers to be vaccinated against influenza, there are no allowances for workers who refuse vaccination, if the vaccine is available to them. You must comply with the legal requirements while it is in place.
In an emergency situation, such as an ambulance call out, or where officers from Fire and Rescue NSW, or NSW Police Force are attending a RACF in an emergency, or where tradespeople are required to attend to urgent repairs, it is considered reasonable for the officers or tradesperson to attend even if they have not been screened or cannot show they have a flu vaccination. If possible, the officers/tradespeople should limit contact with residents and staff. If such personnel are attending the RACF in a non-emergency or non-urgent situations (such as planned attendances), they must have been vaccinated against influenza, if the vaccine is available to them.
The vaccination declaration must be signed by an appropriately trained assessor. This may be a doctor, paramedic, registered nurse (RN) or enrolled nurse who has training on this policy directive in the interpretation of immunological test results, vaccination schedules, TB assessment and/or TB screening.
If a worker or student has previously provided evidence of anti-HBs level ≥10 mIU, they are considered to have immunity. No further boosters or serology will be required unless they undergo immunosuppressive therapy or develop an immunosuppressive illness.
The National Centre for Immunisation Research and Surveillance (NCIRS) has developed disease specific immunisation history tables that provide a summary of the significant events in vaccination practice in Australia. The hepatitis B immunisation history table provides a history of age-appropriate hepatitis B vaccination schedules.
No. Routine testing for varicella immunity following vaccination is not recommended because commercially available laboratory tests are not sensitive enough to detect all seroconversions after vaccination. If a person presents with a history of an age-appropriate dose(s) of varicella-containing vaccine (includes workers aged 50 years and over who have received a dose of Zostavax) and negative varicella serology, protection should be assumed irrespective of serological results.
No. Shingrix is not indicated for the prevention of primary varicella infection (chickenpox). There is insufficient evidence at this stage to confirm that the Shingrix vaccine can provide protection against varicella (chickenpox) in people who have not previously been infected or vaccinated.
No. Workers or students should be referred by the assessor to their local TB service. Workers or students that have previously had TB disease or a positive latent TB infection test need to be assessed by chest x-ray and clinical review. Those entering the health system with health susceptibilities that increase their risk of acquiring TB should be provided with appropriate education, information, advice on their risk; and, an individualised management plan if necessary.
All new recruits and students are required to meet the cost of initial TB screening (TST or IGRA test). A positive TST or IGRA indicates that follow up is required for active or latent TB, and as per the Principles for the Management of Tuberculosis in NSW (PD2022_007), all investigations for cases, or suspected cases, of TB (active or latent) carried out through admitted patient and non-admitted patient services (including ambulatory care services) in NSW public hospitals and health facilities must be provided free of charge to the patient. This includes chest x-ray following a positive TST or IGRA conducted under the Occupational Assessment, Screening and Vaccination Policy Directive (PD2023_022).
Services that can administer and read a TST where the results will be accepted under the OASV policy directive are:
Health students and prospective workers from countries with high TB incidence are now screened for TB infection (using TST or IGRA) as part of their visa medical examination.
Visa applicants settling in NSW who tested positive on this screening will be referred by the Department of Home Affairs to a NSW TB service/chest clinic for follow-up. This referral may be prior to or contemporaneous with OASV assessment.
Workers with a positive TST or IGRA on migration screening should answer 'yes' to having ever had a positive TB skin test (TST) or blood test (IGRA or QuantiFERON TB Gold+ in Part B of the Tuberculosis (TB) Assessment Tool. These workers should be referred to a TB service/chest clinic for clinical review unless the worker provides a summary of TB clinical review from a NSW TB service or the TB clinical review has been attended and updated in VaxLink.
A negative IGRA on migration screening performed within 3 months of arrival in Australia constitutes a valid TB screening test and these workers do not require further latent TB infection testing.
Re-screening is required where the result of migration screening was:
IGRA tests performed overseas may be accepted for OASV requirements provided they meet the requirements for a valid test. These are:
TSTs conducted overseas are not accepted unless the worker has had a positive TST on migration screening and been referred directly from the Department of Home Affairs to the TB service/chest clinic.
A laboratory report indicating a negative IGRA result can be signed off as compliant by an authorised immunisation assessor.
Where the IGRA result is positive, the worker will need to be referred to a TB service/chest clinic for a chest x-ray and clinical review.
A validated previous TB test result remains current if the worker has had no exposure to TB since that test, i.e.
For example:
Yes. All new recruits and students who have a positive TST or IGRA need to be referred for a chest x-ray and clinical review at a TB Service/chest clinic. This review is required to assess an individual’s risk of progressing from TB infection to disease, to provide education on disease progression, and consider TB preventative therapy if not previously treated since last known TB exposures.
Workers who have been previously referred to a NSW TB service/chest clinic for a Part B response on the Tuberculosis (TB) Assessment Tool and have been made compliant, and who are re-assessed and have no new or different responses in Part B do not need to be re-referred to a NSW TB service/chest clinic unless they have new risks identified in Part C.
The previous Tuberculosis (TB) Assessment Tool and evidence of compliance must be available to confirm no changes to responses provided previously in Part B. If the previous Tuberculosis (TB) Assessment Tool is not available, refer worker to their local TB service/chest clinic for advice (as per Appendix 3).
To facilitate commencement of employment for a new worker, TB temporary compliance can be granted once a chest X-ray has been undertaken and excludes active TB disease, and the worker has an appointment at a NSW TB service/chest clinic for TB clinical review.
If a worker requires treatment or monitoring supervised by the TB service, TB temporary compliance may be ongoing following TB clinical review. A 'next TB clinical review date' will be provided or entered in Vaxlink. Failure to attend for next TB clinical review may result in TB compliance being revoked.
NSW Health requires all Category A workers and new recruits to comply with the influenza vaccination requirements of PD2023_022 Occupational Assessment Screening and Vaccination Against Specified Infectious Diseases. While strongly recommended for all workers, influenza vaccination is a requirement during the influenza season (1 June to 30 September inclusive, unless another period is determined by the Chief Health Officer) for workers employed in Category A positions.
Category A workers and new recruits should receive the current years southern hemisphere vaccine once it becomes available and must have received it by 1 June each year. Category A new recruits employed outside of the influenza season (30 September to 1 June) may receive the vaccine, but it is not a requirement of employment.
Peak influenza activity in Australia varies each year but usually occurs between June and September. It is important to remember that influenza occurs all year round, it is never too late to get vaccinated. Workers should receive the current years southern hemisphere vaccine once it becomes available and must have received it by 1 June each year. Workers employed outside of the influenza season (30 September to 1 June) may receive the vaccine, but it is not a requirement of employment.
Yes. Annual influenza vaccine is strongly recommended for all students and is a requirement for students attending placement in Category A positions during the influenza season (1 June to 30 September inclusive, unless another period is determined by the Chief Health Officer).
It is recommended you receive the annual influenza vaccine before the influenza season starts. Influenza vaccine will be available for existing NSW Health workers through clinics in your workplace from April and staff in Category A positions should be vaccinated by 1 June each year.
Category A workers (including students) and new recruits who are non-compliant with the requirement to receive the influenza vaccine by 1 June annually, will be required to comply with all other infection control risk reduction strategies including the use of appropriate personal protective equipment (PPE), during the influenza season (1 June to 30 September inclusive, unless another period is determined by the Chief Health Officer).
Wearing a mask, in conjunction with hand and respiratory hygiene, reduces the risk of influenza transmission. However, wearing a mask is still secondary to vaccination in terms of preventing the transmission of influenza.
During a season with pronounced vaccine mismatch, health care workers who have been vaccinated may voluntarily wear a mask to further reduce the risk of transmission. However, this not a requirement of this policy. Influenza seasons with pronounced vaccine mismatch are, fortunately, uncommon.
To protect patients from influenza transmission, both vaccinated and unvaccinated staff members should consistently practice hand and respiratory hygiene and stay at home if they are experiencing influenza-like illness until symptom resolution.
Infected health care workers can pass the virus on to their patients before they even know they are sick. The most effective way to prevent the flu is by getting vaccinated and adopting additional preventative measures, such as proper hand hygiene and proper sneezing and coughing etiquette (more information is available at Influenza vaccination information for healthcare workers). Immunisation helps health professionals reduce their risk of contracting influenza and spreading it to their patients. It also reduces the risk of you catching influenza at work and taking it home to your family.
While we know that influenza vaccines do not provide complete protection against influenza (vaccine effectiveness ranges from 30-70% depending on the match with circulating strains and the immune response of the recipient), they remain the best way to prevent influenza and are an important control measure in conjunction with regular hand cleaning and respiratory hygiene.
No. It is impossible for the influenza vaccine (the flu shot) to cause ‘the flu’. The vaccines used in Australia contain only part of the influenza virus and cannot cause infection. Common reactions to the flu shot may include soreness, redness and swelling where the vaccine was given. Occasionally other symptoms can include fever, headache and aching muscles that may last one to two days.
Workers employed in Category A positions who cannot be vaccinated due to a medical contraindication, will be required to comply with all other infection control risk reduction strategies including the use of appropriate personal protective equipment (PPE) during the influenza season (1 June to 30 September inclusive, unless another period is determined by the Chief Health Officer). Evidence of the medical contraindication will need to be provided to the employing NSW Health agency (refer to Section 5.5. Contraindication to influenza vaccine of the Policy Directive).
Yes. Vaccination is the best protection pregnant women and their newborn babies have against influenza. Influenza infection during pregnancy can lead to premature delivery and severe disease in the mother. Vaccination during pregnancy also reduces the risk of the baby becoming ill with influenza in the early months of life. Pregnant women can have the vaccine at any stage of pregnancy or while breastfeeding.
Yes. Staff health programs can order this vaccine via the online ordering system. Facilities will need to ensure that it is clearly labelled to distinguish it from the quadrivalent influenza vaccine.
Health services are required to make vaccinations available to all workers, including those on a rotating roster. Your staff health unit should provide information for all employees about arrangements to access influenza vaccine.
Your doctor or authorised nurse immuniser or authorised pharmacist vaccinator must report the vaccination to the Australian Immunisation Register (AIR). You will be required to provide a copy of your AIR Immunisation History Statement to your staff health clinic. Existing workers can also upload a copy of the AIR Immunisation History Statement in StaffLink using the Employee Self Service portal.
Yes. The revised PD2023_022 Occupational Assessment Screening and Vaccination Against Specified Infectious Diseases requires all NSW Health workers* to have receive a COVID-19 primary vaccination course (2 doses) to work or be employed in connection with a NSW Health agency including:
*The term "worker" includes persons who are employed in NSW Health whether on a permanent, casual or temporary basis and includes employees, contractors who provide services for or on behalf of NSW Health at a NSW Health facility (including Visiting Medical Officers (VMOs) and agency staff), volunteers, students, researchers and researchers.
Further, and in addition, a determination made by the Health Secretary under section 116A(1) of the Health Services Act 1997 (NSW) on 12 November 2021 (the Determination) requires, as a condition of employment, all NSW Health Service employees to have received at least one dose of a COVID-19 vaccine as at the date of the Determination, and at least 2 doses of a COVID-19 vaccine by 30 November 2021, in order to be employed or remain employed, unless the employee had a valid medical contraindication.
The vaccine is highly effective against severe illness, hospitalisation and death from COVID-19. Previous SARS-CoV-2 infection combined with previous vaccination (hybrid immunity), provides a higher and longer level of protection against severe disease and death than previous infection alone.
NSW Health and other employers are required under Work, Health and Safety laws to implement "all reasonably practical control measures" to ensure the health and safety of staff.
All NSW Health workers, particularly those at risk of severe illness from COVID-19 infection, are strongly recommended to stay up to date with COVID-19 vaccinations as recommended by the Australian Technical Advisory Group on Immunisation (ATAGI).
All vaccines available in Australia are approved by the Therapeutic Goods Administration (TGA) for safety, quality, and effectiveness. Vaccine scientists from around the world are working together to ensure that rigorous processes are followed, and no testing or ethical approvals have been bypassed. COVID-19 vaccines must meet the same high standards as any other vaccine approved for use in Australia. For further information about the safety of COVID-19 vaccines visit NCIRS most frequently asked questions about COVID-19 vaccines.
The Janssen COVID-19 vaccine is provisionally approved by the TGA as a single dose primary vaccination course and is an acceptable COVID-19 primacy vaccination course for the purposes of complying with the Occupational Assessment Screening and Vaccination Against Specified Infectious Diseases (PD2023_022 ) Policy Directive.
You can get vaccinated if you are pregnant, breastfeeding or trying for a baby. Pregnant women are particularly vulnerable to COVID-19 and should get vaccinated now. Vaccination reduces the risk of severe disease during pregnancy and helps keep you and your unborn baby protected from the virus. mRNA vaccines (Pfizer or Moderna) are the recommended COVID-19 vaccines for pregnant women due to their safety profile. Please refer to the NCIRS COVID-19 FAQs for more information and the COVID-19 vaccination decision guide for women who are pregnant, breastfeeding or planning pregnancy.
NSW Health requires all workers to comply with the COVID-19 vaccination requirements of PD2023_022 Occupational Assessment Screening and Vaccination Against Specified Infectious Diseases. All NSW Health Service employees are also required to comply with the Determination. If you do not meet the COVID-19 vaccination two dose requirement, or do not have an approved medical exemption, you cannot continue to work within NSW Health.
You will be required to provide evidence of the medical contraindication using the Australian Immunisation Register (AIR) - Immunisation medical exemption form (IM011). You will need to speak to your medical practitioner and ask them to complete the form.
Medical exemptions will only be granted if you have a medical contraindication to all the available COVID-19 vaccines, or you have another medical reason for a temporary exemption. A temporary exemption may be granted for up to four months for people with conditions recognised in the ATAGI expanded guidance on acute major medical conditions that warrant a temporary medical exemption relevant for COVID-19 vaccines.
All medical exemptions are subject to the review and approval of your engaging NSW Health agency.
For more information about COVID-19 exemptions please visit the Department of Health's COVID-19 Vaccine Exemptions fact sheet.
You will generally continue to be able to work in your current role, noting that risk mitigation strategies will continue to be in place. Where the nature of the medical contraindication could adversely impact your ability to perform your role safely, a risk assessment will be undertaken to address any concerns.
If you have a temporary medical contraindication the medical contraindication will be reviewed at the end of the temporary contraindication period to determine if the medical contraindication remains valid. As more information becomes available on COVID-19 vaccines, the medical contraindication you currently experience, may not prevent you from receiving a COVID-19 vaccine in the future.
Medical contraindications will only be accepted if they are in accordance with the Australian Immunisation Register - Immunisation medical exemption form (IM011). If you have a medical contraindication to a specific COVID-19 vaccine, discuss with your medical practitioner whether you can receive an alternative COVID-19 vaccine.
If you do not have an approved medical exemption, you will be required to have at least 2 doses of COVID-19 vaccine to work in NSW Health.
Workers who have had COVID-19 infection may delay their COVID-19 vaccination for up to six months after their confirmed infection. Refer to What if I cannot be vaccinated because of a medical reason?
Rapid antigen testing is not an alternative to vaccination.
Please talk to your manager about when your appointment is so that rosters can be managed accordingly and/or flexible working arrangements to accommodate absence can be discussed.
If you are vaccinated in your own time you can claim a two-hour special leave payment on each occasion of COVID-19 vaccination.
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Under PD2023_022 Occupational Assessment Screening and Vaccination Against Specified Infectious Diseases, vaccines that are provisionally approved or recognised by the TGA are accepted.
Appointments can be made in the first instance, via the COVID-19 Service Finder at your GP or a community pharmacy.
There are a number of ways you can receive your 'proof of vaccination':
Your vaccination records should be sent to your local staff health unit at your local health district, network or health pillar. If you do not have a staff health unit, you will receive further advice from your manager.
If you were vaccinated at a NSW Health COVID-19 Vaccination Hub and provided your employee number, your vaccination details should already be stored in VaxLink (the Staff Vaccination and Compliance database for NSW Health). However, if you were vaccinated elsewhere such as your local GP or Pharmacy then evidence of you vaccination needs to be provided to NSW Health.
You can upload your vaccination records in Stafflink by using the Vaccination Evidence Form in the Employee Self Service menu that allows NSW Health employees to attach and submit evidence of their COVID-19 vaccinations. The evidence will be reviewed by your staff health unit or designated approver and updated in VaxLink.
All vaccination information is securely stored in the NSW Staff Health vaccination database called VaxLink. Only authorised staff can view vaccination records.
Managers will be able to view their staff member's vaccination compliance status only.
All employees can see their own vaccination status by logging into employee self service in StaffLink. Managers can view the vaccination status by logging into manager self service in StaffLink.
You can access available sick leave if you experience any side effects to the vaccination.
An employee can lodge a claim for workers' compensation if they suffer an illness or injury as a consequence of vaccination.
Any such workers' compensation claim will assessed in accordance with NSW Workers Compensation and Injury Management legislation.
If you are already on leave at the time vaccinations are due, you are still encouraged to get your COVID-19 vaccination as this in your best interest to protect you and your family. Please note, you are required to have had your vaccination(s) before you return to duty and will be required to provide evidence of your vaccination status prior to resuming duty.
For more information visit the National Centre for Immunisation Research and Surveillance.
