Screening volunteers? You're on your own
Screening volunteers? You’re on your own
No guidelines exist for employee health services
Question: I am concerned about health screening for new volunteers. Are any guidelines available? What type of standard requirements should I meet? Presently, my hospital requires new volunteers to have a two-step TB screening, the offer of hepatitis B vaccine if they are in an at-risk category, and a signed physician’s note verifying that they are free of communicable disease.
Submitted by Anne Hochstedler, RN, employee health nurse, Howard Community Hospital, Kokomo, IN
Answer: What you already are doing exceeds any existing formal recommendations. In fact, after an extensive search, Hospital Employee Health could find no written guidelines on health screenings for hospital volunteers.
The only published recommendation is included in the federal Centers for Disease Control and Prevention’s guidelines for preventing TB transmission in health care facilities.1 CDC epidemiologist Elizabeth Bolyard, RN, MPH, CIC, says the agency recommends that hospital volunteers be included in the TB screening program the same as employees, with the frequency of such screening based upon the hospital’s TB risk assessment as specified in the guidelines. Two-step testing should be performed for new volunteers.
Presently, the CDC does not have any other recommendations for volunteer screenings or immunizations. New CDC guidelines for infection control in hospital personnel are due out in the spring; that document might contain some recommendations for volunteers, Bolyard says.
"Many hospitals have their own standards and recommendations," she adds. "Some [hospitals] screen volunteers the same as they do employees, and others don’t screen because they don’t allow volunteers to have patient contact."
The American Hospital Association (AHA) in Chicago has no recommendations, either.
"Most hospitals do TB testing but not much beyond that," says AHA spokeswoman Carol Schadelbauer. "They might do hepatitis B [screening and vaccination], but it depends where the volunteer is working. It’s up to the hospitals what they do."
Due to the scarcity of formal recommendations, Hospital Employee Health contacted several experts to obtain some opinions for you.
"Whatever programs you provide to your health care workers should be extended to your volunteers, " says Gina Pugliese, RN, MS, former director of infection control for the AHA and now a vice president with Chicago-based Sullivan Kelly, consultants to health care facilities in the areas of infection control and risk management.
Pugliese advises basing employee and volunteer health services on factors such as a hospital’s patient population, the kinds of diseases for which employees are at risk, the volunteer’s age, the hospital’s services, and the nature of the volunteer’s job.
Hard to define high risk’
While it is not necessary to restrict what volunteers do, "you would tend not to put them in high-risk activities," she adds, "but it’s really hard to define what is high risk."
For example, if a hospital needs laboratory help and can’t afford to hire a full-time employee, a college student interested in entering that field could make a good volunteer.
In that case, washing or handling sharps could be considered high risk, but so could transporting TB patients in a hospital located in a community with a high prevalence of TB. That is why volunteers need to be provided with the same health services that an employee doing the same job would receive.
Jeanne Culver, RN, COHN, director of employee health services at Emory University Hospital in Atlanta, says the lack of government mandates (except for TB screening) means individual hospitals must set their own standards.
"It depends upon how you define the job duties of a volunteer whether they come into direct contact with patients, serve the public, work in offices, or are out on units. I can’t imagine volunteers being put in a place where they would be exposed to blood," Culver says. "That would be an inappropriate use of a volunteer."
Because volunteers are not exposed to blood, they are not offered hepatitis B vaccine, but Emory does offer free annual influenza immunizations. Many hospitals do this as a courtesy to volunteers, she notes. At Emory, volunteers also must have proof of measles-mumps-rubella immunization and/or a positive titer. Baseline and annual TB skin testing also are provided.
Although hospitals generally would not assign volunteers any duties that carry a risk of blood or body fluid exposure, Kathleen VanDoren, RN, BSN, COHN-S, executive president of the Reston, VA-based Association of Occupational Health Professionals in Healthcare, says if there is any chance of exposure, volunteers should be immunized against hepatitis B the same as other HCWs. For example, a volunteer who might help a nursing assistant change a patient’s bed could be stuck by a needle improperly disposed of in the bedding. If volunteers are assigned to assist patients or their families in the emergency room, they could be exposed to blood or body fluids there, she notes.
"Hospitals should look at volunteers’ assigned duties and see if there is any risk of blood or body fluids exposure, and if there is, the volunteers should be offered hepatitis B vaccine," she states.
VanDoren says that for most hospitals, the standard of care is to screen and immunize their volunteers the same as they do their HCWs.
Reference
1. Centers for Disease Control and Prevention. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health care facilities, 1994. MMWR 1994; 43(No. RR-13):1-112.
[Have a question? We’ll get the answer. Jot down your question and mail it to: Editor, Hospital Employee Health, P.O. Box 740056, Atlanta, GA 30374, or fax it to (770) 664-7103. Please include your name, title, hospital, and business phone number. We will publish questions and answers of general interest to hospital employee health practitioners.]
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