Category: ASSOCHEALTH
POLICY & PROCEDURE
Subject:
Tetanus-Diphtheria-Pertussis Immunization
Classification: Management Approved
Policy Owner:
Senior Vice President, Human Resources
Approved by:
WFH President and CEO
Associate Health & Wellness Medical Director
Effective: October 26, 2011
POLICY:
It is the policy of Wheaton Franciscan Healthcare (WFH) to maintain a healthy workforce, and
prevent the transmission of communicable diseases. In accordance with Centers for Disease
Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP)
recommendations, Tetanus-diphtheria-pertussis (Tdap) vaccines will be administered to
associates and volunteers. In addition, when indicated, tetanus-diphtheria (Td) or tetanusdiphtheria-pertussis (Tdap) vaccines will be administered to associates post occupational
injury.
RATIONALE:
This policy is designed to be in accordance with WFH’s Mission, Vision and Values:
Value of Respect – Our Value of Respect calls us to ensure that we respect the associate’s
dignity, self worth, and right to privacy of his/her own health information. It also calls us to
ensure we respect our patients’ and residents’ worth by preventing transmission of infection to
them whenever possible.
Value of Integrity – Our Value of Integrity requires us to understand and comply with State and
Federal guidelines regarding the prevention of tetanus, diphtheria, and pertussis in our
associates.
Value of Stewardship – Our Value of Stewardship calls for us to maintain health, safety and
security in the work place and to minimize medical expenses associated with tetanus,
diphtheria, and pertussis disease.
SCOPE:
This policy applies to associates and volunteers in all WFH-owned and managed organizations.
PROCEDURE
A. Adults who have never been vaccinated against tetanus, diphtheria, or pertussis should
receive a series of three vaccinations containing tetanus and diphtheria toxoids. The
preferred schedule is a single dose of Tdap (tetanus toxoid, reduced diphtheria toxoid and
acellular pertussis vaccine), followed by a dose of Td (tetanus and diphtheria toxoids)
greater than or equal to 4 weeks after the Tdap, and another dose of Td 6 to 12 months
later. However, Tdap can be substituted for any one of the doses of Td in the 3-dose
primary series.
1. Adults who received an incomplete vaccination series against tetanus and diphtheria
should be vaccinated with Tdap and/or Td to complete a 3-dose primary series of
tetanus and diphtheria toxoid-containing vaccines.
B. After primary vaccination, one tetanus-diphtheria booster dose is recommended:
1. Every ten (10) years
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2. For clean minor wounds – if more than ten (10) years have elapsed since the time of
the last dose.
3. For all other wounds (i.e., wounds contaminated with dirt, feces, soil, or saliva;
puncture wounds; avulsions, or wounds resulting from crushing, burns, or frostbite) – if
more than five (5) years have elapsed since the last dose was received.
C. All healthcare personnel, regardless of age, should receive a single dose of Tdap as soon
as feasible if they have not previously received Tdap and regardless of the time since the
last Td dose. After receipt of a single dose of Tdap, subsequent doses of tetanus and
diphtheria toxoid-containing vaccines should follow guidelines for the use of Td.
1. Adults should receive a booster with Td 10 years after receipt of Tdap.
D. Associates and volunteers will be screened by Associate Health & Wellness to determine
their tetanus, diphtheria, and pertussis immunization status. If indicated, a Tdap
immunization will be recommended. This vaccine will be given free of charge through
Associate Health & Wellness.
1. Adolescents who did not get all their scheduled doses of DTaP or DTP as children
should complete the series using a combination of Tdap and Td.
2. Pregnant women may receive Tdap, preferably during the third or late second trimester
(after 20 weeks gestation). If not administered during pregnancy, Tdap should be
administered immediately postpartum.
3. Td has been used extensively in pregnant women, and no evidence indicates use of
tetanus and diphtheria toxoids administered during pregnancy are teratogenic.
4. Administering pertussis vaccine to persons with a history of pertussis disease presents
no theoretical safety concern.
E. The Tdap and Td vaccines may be administered simultaneously at separate anatomic sites
with other live or inactivated vaccines.
F. Administration of vaccine:
1. After reading the Tetanus and Diphtheria Vaccine Information Sheet, or the Tetanus
Diphtheria Pertussis Vaccine Information Sheet, a consent form for the vaccine will be
completed by the associate/volunteer.
2. Epinephrine should be available for immediate use at any site where vaccines are
administered in the event symptoms of anaphylaxis occur. See Associate Health &
Wellness Medical Directives policy.
3. Administer the Td or Tdap vaccine (0.5 mL) intramuscularly (I.M.), preferably in the
deltoid muscle.
4. The individual is instructed to apply cold compresses to any local reaction of erythema
or induration and to self administer an over the counter analgesic for inflammation
and/or discomfort. Associate Health & Wellness should be notified of any other
adverse reactions.
5. The vaccine administration date, vaccine manufacturer, vaccine lot number, site of
injection, and signature of vaccine administrator shall be noted on the consent form.
6. The immunization record shall be placed in the appropriate Associate Health &
Wellness file.
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Replaces:
Tetanus and Diphtheria Immunization Program – All Saints, Racine
Tetanus-Diphtheria Immunization – Covenant Healthcare, Milwaukee
Tetanus-Diphtheria Immunization – Marianjoy
Cross reference:
ACIP Provisional Recommendations for Health Care Personnel on use of Tetanus Toxoid,
Reduced Diphtheria Toxoid and Acellular Pertussis vaccine (Tdap) and use of Post exposure
Antimicrobial Prophylaxis, April 4, 2011
MMWR, October 21, 2011, 60(41), 1424-1426,Updated Recommendations for Use of
Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine (Tdap) in
Pregnant Women and Persons Who Have or Anticipate Having Close contact with an Infant
Aged < 12 Months – Advisory Committee on Immunization Practices (ACIP), 2011
Review Period:
Two (2) years
Original Policy Date:
December 1, 2007
Dates Updated:
February 15, 2010; August 30, 2010; September 15, 2010; September 15, 2011; October 26,
2011
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