Questions and Answers About Infection Control Issues for Vaccinated Healthcare Workers

Can hospitals and health care personnel assume that an immediate return to work after vaccination (as long as appropriate bandaging and hygiene are maintained) is acceptable regardless of the type of patients seen by the health care worker?
Yes, as long as appropriate bandaging and hygiene are maintained, vaccinated health care workers can immediately return to work. Health care workers who receive the smallpox vaccine should be seen daily upon reporting to work for 21-28 days following vaccination to monitor bandaging of the site and the development of complications that could put patients at risk.

Are there any health care workers who may not work following vaccination? Any limits on health care workers providing care to immunosuppressed patients?
The ACIP has stated that furlough of health care workers is not necessary. Those health care workers who have direct patient contact, should have a semipermeable dressing over the dry gauze pad, with a long sleeve shirt and a lab coat. This should be sufficient to prevent any transmission. In addition, they are to have their dressing checked and replaced while at work. They should be reminded that vigorous hand-washing hygiene should be exercised. The Healthcare Infection Control Practices Advisory Committee (HICPAC) has deliberated infection control recommendations related to vaccinia. The recommendations were summarized and disseminated in the form of an MMWR supplement --- Recommendations for Using Smallpox Vaccine in a Pre-Event Vaccination Program, which was published Feb.26, 2003, on the CDC Web site: http://www.cdc.gov/mmwr/preview/mmwrhtml/m2d226.htm. To date there have been no healthcare provider vaccinia transmission to patients in wither the civilian or military vaccination programs.

How should vaccination dressings, and other contaminated smallpox vaccination waste be disposed of in the home?
In the home setting, CDC recommends that dressings and scabs that contain vaccinia first be bagged and then disposed of in the general household trash. Then wash hands with soap and warm water. However, local laws may dictate otherwise.

How should dressings, and other contaminated smallpox vaccination waste be disposed of in a hospital setting?
Contaminated bandages and, if possible, the vaccination site scab after it has fallen off, should be placed in sealed plastic bags (to further decrease the potential for inadvertent transmission of the live virus contained in the materials), then disposed as per hospital regulations for infectious waste. See the Supplemental Recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Healthcare Infection Control Practices Advisory Committee (HICPAC) at http://www.cdc.gov/mmwr/preview/mmwrhtml/m2d226.htm

To save money, how about using the surgical gloves to dispose of bandages versus using a zip-loc bag or double plastic bag? By tying a knot in the end of the glove it becomes a sealed bag?
This seems reasonable, as long as the glove is intact. This is a concept that is used in hospitals for other small dressings (without the knot). There's a question of how easy can one tie a knot in the glove without accidentally contaminating hands and/or the outside of the glove. It may depend on how much dressing mass there is. One other variable would be the quality of glove being used -- some will tear if stretched that much.

In accordance with U.S. Department of Transportation requirements, we know that waster materials may be transported as regulated medical waste. Before transporters/ disposal facilities can accept waste materials, we need to know whether CDC has procedures for registration or is exempting vaccine-related waste materials from registration requirements.
The smallpox vaccine (and anything related to the vaccinia virus) is not a "select" agent (biological agents or toxins deemed a threat to public health). The smallpox vaccine is not the smallpox virus. That means that waste materials containing vaccinia may be handled as medical waste and are not subject to select agent waste handling requirements. Please contact your state health department or environmental protection agency to determine your local state waste handling requirements.

At many hospitals, the staff uniforms are washed in the hospital laundry. Are there any precautions that hospital laundry staff needs to take when washing uniforms from vaccinated staff?
Clothing or any other material that may have come in contact with the vaccination site and therefore be contaminated with vaccinia should be handled and laundered in the same manner as other contaminated linens according to hospital policy. Handling of soiled linens should be kept at a minimum, and they should be placed in single laundry bags regularly used in the hospital. After handling any contaminated or potentially contaminated clothing, wash hands with water and antimicrobial soap, or use an alcohol-based hand rub.

As a health care worker who has just been vaccinated, what is considered adequate hand washing? Can I use alcohol wipes?
Hand hygiene is necessary after direct contact with the vaccine, the vaccination site, the bandage, or anything else that might be contaminated with the virus. This is vital in order to remove virus from the hands and prevent contact spread of vaccinia. You can either wash your hands with soap and water or use alcohol-based hand rubs, such as gels or foams. If your hands are visibly contaminated with fluids, then you must wash your hands with soap and water.

If a clinician is treating a person with an adverse event, should they also be vaccinated?
Physicians such as infectious disease specialists, dermatologists and other clinicians who are likely consultants for a severe adverse event may also be good candidates for a hospital’s smallpox response team and already be vaccinated. However, it is impossible to predict which physicians may see a person with a severe adverse event. The treating physician’s best means of protection against contact vaccinia infection is good infection control practices. Vaccination is not necessary.

If a health care worker is inadvertently exposed to a patient's smallpox vaccine site pustule, should that worker be vaccinated?
No, he should not be vaccinated. Standard precautions taken by health care providers (wearing gloves, etc.) should prevent significant exposure. If contact is made with uncovered skin, the area should be washed with soap and water, and the worker monitored for signs of vaccinia infection (i.e., a lesion at the site of contact).

If someone has generalized vaccinia with 5 lesions scattered about his body, does each lesion need to be covered with gauze and a semipermeable dressing?
Each of the lesions should be considered infectious until the scab has detached. If the person is a health care provider, they are to restrict their activities so as to not see patients, and they should cover the sites with gauze and a semipermeable dressing. In addition, particular attention must be paid to contact precautions and appropriate hand hygiene. If the person is not a health care provider, gauze dressing may be sufficient.