Northside Hospital's Immunization Requirements

NORTHSIDE REQUIRED PROOF OF IMMUNIZATION

           **Student/Clinical Instructor credentialing will not be complete UNLESS all questions are answered on Northside Health History Form and proof of immunization is provided.**

Northside Employees are exempt from providing proof of immunization or completing the Health History From.
All supporting documents, with the exception of GRITS and School Immunization Records, must include official/authorized healthcare provider’s signature.

INFLUENZA VACCINE

• Student/Clinical Instructor MUST provide proof of vaccine administration if clinical experience starts or ends during Northside Flu Season (October through March).
• Proof of vaccine administration must include the date of vaccination, the location where vaccine was administered. (i.e. Left deltoid), and the signature of the person who administered.
• If student/clinical instructor answers No on the Health History form, a reason must be selected from those listed on the form supported by a note from Primary Care Physician.

TDAP VACCINE

• Student/Clinical Instructor MUST provide proof of vaccine administration if assigned to High Risk Areas*.
• If student/Clinical Instructor answers No, a reason must be selected from those listed on the Northside Health History form supported by a note from Primary Care Physician.

MMR IMMUNIZATION

• Student/Clinical Instructor BORN BEFORE 1957 MUST provide one of the following as proof of immunity to MMR:

1. A positive titer for Rubella (German Measles) OR
2. A Rubella vaccine OR
3. One dose of MMR vaccine

• Student/Clinical Instructor BORN AFTER 1957 MUST provide one of the following as proof of immunity to MMR:

1. Proof of 2 MMR vaccines OR
2. Proof of 1 MMR vaccine and one Rubeola (Red Measles) vaccine OR
3. Proof of 1 MMR Vaccine and positive titer for Ruebola OR
4. Proof of positive titers for Rubeola and Rubella

HEPATITIS B IMMUNIZATION

• Student/Clinical Instructor MUST provide one of the following as proof of immunization for Hepatitis B:

1. Proof of at least 2 vaccination and scheduled to receive the 3rd dose OR
2. Proof of Positive titer for Hepatitis B antibody OR
3. If student chooses not to be vaccinated due to allergy or other reasons, he/she must provide a completed HEP B Declination form which may be obtained from any Physician’s office or Public Health Department. The form must be signed by the student/clinical instructor and authorized healthcare provider.

VARICELLA IMMUNIZATION

• Student/Clinical Instructor MUST provide one of the following proof of immunization for Varicella (Chicken Pox):

1. Childhood Immunization Record showing 2 doses of vaccine OR
2. Proof of Positive titer for Varicella
   • If the titer is negative, student must provide proof of booster vaccine

TUBERCULINE VACCINE

(Northside REQUIRES Annual QuantiFeron-Gold/T-Spot Blood Test)

• Student/Clinical Instructor MUST provide proof of current negative QuantiFERON-Gold or T-Spot blood test result to attend clinical experience at Northside Hospital. The test result must be valid for the duration of the clinical experience.

• Student/Clinical Instructor with previous proof of positive TST, must provide current QuantiFeron-Gold or T- Spot blood test result

• NEW Positive Results

  Student/Clinical Instructor assigned to work in High Risk Areas* MUST provide the following for clearance:

1. Proof of NEW POSITIVE QuantiFERON–Gold or T-Spot blood test result which must be valid for the duration of clinical experience at Northside Hospital AND

2. A current negative/normal Chest X-Ray which must be valid for the duration of clinical experience (one year from clinical experience End Date) AND

3. Evidence of INH or RIFAMPIN TREATMENT which includes the following:
   a) Copy of the New prescription AND
   b) Picture of first filled bottle showing the student name, medicine name and date prescription was filled

   Student/Clinical Instructor assigned to Other Areas of the hospital MUST provide the following for clearance:

4. Proof of NEW POSITIVE QuantiFERON–Gold or T-Spot blood test result which must be valid for the duration of clinical experience at Northside Hospital AND

5. A current negative/normal Chest X-Ray which must be valid for the duration of clinical experience (one year from clinical experience End Date) AND

6. Negative screening for symptoms of TB (see Northside Health History form)

• PAST Positive Results

  Student/Clinical Instructor assigned to work in High Risk Areas* MUST provide the following for clearance:

1. Documentation of first positive reading/result - To confirm true positive results, student must provide proof of POSITIVE QuantiFERON–Gold or T-Spot blood test result AND

2. A current negative/normal Chest X-ray which must be valid for the duration of clinical experience (one year from the clinical experience End Date) AND

3. Evidence of INH or RIFAMPIN TREATMENT
   a) On-going Treatment – Student to provide prescription refill log from either treating physician or County Public Health Department. Either documents must be signed. OR
   b) Completed Treatment – Medical screening and clearance is required from the treating physician or County Public Health Department. The clearance must include the start and end date of treatment.

   Student/Clinical Instructor assigned to Other Areas of the hospital MUST provide the following for clearance:

4. Documentation of first positive reading/result - To confirm true positive results, student must provide proof of POSITIVE QuantiFERON–Gold or T-Spot blood test result AND

5. A current negative/normal Chest X-ray which must be valid for the duration of clinical experience.(one year from the clinical experience End Date) AND

6. Negative screening for symptoms of TB (see Northside Health History form)

   * High Risk areas are Women’s Services, Bone Marrow Transplant Unit, Oncology/Infusion Center, ICU, Respiratory Therapy and Child Development Center