Review Article
Occupational Health & Infection Control

Health Care Workers Safety Screening and Immunization: A Review

Summary

Healthcare workers (HCWs) constitute a population at elevated risk for occupational exposure to infectious diseases. Through daily contact with patients, bodily fluids, and contaminated materials, HCWs may acquire and subsequently transmit vaccine-preventable diseases, endangering both their own health and the safety of vulnerable patients. This review article, published in the Malaysian Journal of Public Health Medicine, examines the evidence base and recommendations for safety screening and immunization of healthcare personnel.

Occupational Infection Risks in Healthcare

The healthcare workplace presents unique infection transmission dynamics. HCWs may be exposed to pathogens through direct patient contact, airborne transmission in clinical areas, percutaneous injury from contaminated sharps, and contact with infectious body fluids during procedures. The World Health Organization has emphasised that protection of health workers through vaccination is an important part of patient safety, infection prevention and control programmes, and occupational health and safety.

Key vaccine-preventable diseases of concern for HCWs include hepatitis B, influenza, measles, mumps, rubella, varicella, pertussis, and tuberculosis. The risk of exposure varies by healthcare setting, with emergency departments, intensive care units, and surgical theatres typically presenting higher risk environments. Additionally, the emergence of novel pathogens—as demonstrated during the COVID-19 pandemic—has further highlighted the importance of robust occupational health screening and immunization programmes.

Pre-Employment Health Screening

Pre-employment screening serves as the foundation of occupational health protection for HCWs. This process typically encompasses review of immunization history and documentation of immunity, baseline health assessment including tuberculosis screening, identification of conditions that may increase susceptibility to occupational infections, and establishment of baseline serological status for key vaccine-preventable diseases.

International guidelines, including those from the Advisory Committee on Immunization Practices (ACIP) and the Healthcare Infection Control Practices Advisory Committee (HICPAC), recommend that all HCWs, regardless of whether they have direct patient care duties, should receive appropriate vaccinations. The rationale extends beyond individual protection to encompass the broader goal of preventing nosocomial transmission to patients who may be immunocompromised or otherwise vulnerable.

Immunization Recommendations for Healthcare Workers

The review summarises key vaccination recommendations for HCWs. Hepatitis B vaccination is paramount given the occupational risk of needlestick injuries, with post-vaccination serology recommended to confirm adequate antibody response. Annual influenza vaccination is recommended to reduce the risk of healthcare-associated influenza transmission, particularly in settings caring for elderly or immunocompromised patients. Two doses of measles-mumps-rubella (MMR) vaccine are recommended for HCWs without documented immunity, as nosocomial measles outbreaks have resulted in substantial institutional costs and patient harm.

Varicella vaccination or documented immunity is essential to prevent healthcare-associated varicella-zoster virus transmission. Pertussis boosters (Tdap) are increasingly recommended for HCWs caring for neonates and infants. The review also discusses emerging considerations around COVID-19 vaccination and the evolving landscape of respiratory pathogen prevention in healthcare settings.

Challenges in the Malaysian Context

In Malaysia, as in many countries, HCW vaccination coverage remains suboptimal for several vaccine-preventable diseases. Barriers include inconsistent institutional policies, limited awareness among HCWs about occupational vaccination recommendations, cost considerations, and concerns about vaccine side effects. The review identifies the need for standardised national guidelines for HCW immunization that are consistently implemented across public and private healthcare facilities.

Implications for Policy

The evidence reviewed supports the implementation of comprehensive, mandatory HCW immunization programmes as a core component of healthcare facility accreditation and quality standards. Such programmes should include clear documentation requirements, regular compliance monitoring, and mechanisms to address HCWs who decline vaccination. The protection of HCWs through vaccination represents a critical investment in healthcare system resilience and patient safety.

Limitations

As a review article, this paper synthesises existing evidence rather than presenting original data. The generalisability of international recommendations to the Malaysian context requires consideration of local epidemiological patterns, healthcare infrastructure, and cultural factors. The review may not capture the most recent developments in HCW vaccination policy that have evolved in response to the COVID-19 pandemic.

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