• An education program at the beginning of the “flu season” promoting awareness of influenza and the importance of vaccination as well as a resource list which highlights the risks and side effects.
• Posting of a notice in accessible locations of the facility, e.g. staff lounge and bulletin boards, at least a month in advance of the vaccination clinic dates. The notice will include the clinic dates, hours and location.
• Obtaining worker individual consent

1. Workers must provide influenza immunization status by the first Monday of December of each year or earlier in time if widespread influenza activity or unit/facility outbreak to OH&S. This documentation will be maintained by OH&S. Documentation will be shared with the Infection Prevention and Control department, Human Resources and manager/responsible person to enable appropriate management of staff, assignments and patients with identified influenza, during widespread influenza activity in the community or during unit/facility outbreak.
2. New workers will be informed about this policy prior to being hired/placed/or given privileges and that it is a condition of service. Those that initiate service between November 1st and April 30th will be required to comply within 7 days of being on site. For students training at RVH, the hospital must inform the supplying school that the school is responsible for the appropriate education, vaccination of their students, and maintenance of immunization records (OHA, 2010).
3. Documentation will be by means of one of the following or an acceptable alternative where indicated:
• An appropriately completed annual Influenza Vaccine Consent/Decline form;
• Employees who do not provide documentation of receipt of vaccine should be managed as unimmunized (OHA, 2010);
• Those who are not vaccinated due to documented medical contraindications*(see definitions) will provide documentation of reason for medical exemption signed by an approved health care professional. This medical exemption will be maintained in the health file, in the OH&S department.

1. Immunized Workers: Those immunized, with documented vaccination at least 2 weeks prior to the declaration of widespread influenza activity by the Simcoe Muskoka District Health Unit (SMDHU) may continue to work without disruption of their work pattern.
2. Non immunized Workers: Those workers that are not immunized must choose from the following options during widespread influenza activity:
   1. Vaccination
      The worker can receive vaccination at RVH or provide proof of vaccination. In order to resume work:
      • After a waiting period of two weeks after vaccination to allow sufficient time to develop immunity to the influenza virus; or
      • If prophylactic antiviral medication is taken in the interim (for 14 days after immunization) or;
      • Wear a mask until at least 14 days after receipt of vaccination

      If one of these options is chosen then an earlier return to work would be allowed. Documentation of prescribed antiviral medication or wearing a mask is required, as well as signing of a Confirmation of Taking Antiviral form.

   2. Taking daily prophylactic antiviral medication

   Non-vaccinated workers may take antiviral medication until such time as the widespread influenza activity is declared over. Documentation of prescribed antiviral medication is required. RVH will not provide antiviral medication to workers; they will be responsible for making these arrangements on their own. The hospital benefit plan may cover the cost of prescribed antiviral medication. It is advisable for workers to discuss this with their healthcare provider, in advance of the influenza season, so that arrangements are in place for prompt administration of the antiviral, if required to be at work or on RVH premises (obtain a prescription in advance, to be used if needed to work). Workers will be required to sign a Confirmation of the taking of Antiviral Medication. Those that are non-vaccinated may take antiviral medication until such time as the widespread influenza activity is declared over by the MOH of the SMDHU, in consultation with Infection Prevention and Control and OH&S.

   3. Mask use

   Non-vaccinated workers may choose to wear a mask until such time as the widespread activity is declared over but this is not an option during a unit/facility outbreak. There is a requirement for worker to sign that they will wear a mask at all times while on RVH premises, except during meals breaks.

   4. Work exclusion

   Non-vaccinated workers, not on prophylactic antiviral medication or agreeing to wear a mask, will be excluded from the RVH premises for the duration of the widespread community influenza activity.

1. Immunized workers – if immunized for 14 days or more they can continue to work on the affected unit
2. Workers not immunized taking antivirals may continue to work on the affected unit
3. Workers under immunized – those that received the vaccine less than 14 days can take antivirals and continue to work. The can stop antivirals after 14 days of immunization.

For those not taking immunization or antivirals during a unit/facility outbreak the following options are available and work is not available in non-outbreak areas:

• Use of stat holidays, vacation and/or owed overtime
• Unpaid leave of absence
• Paid leave of absence (this option is only available to staff with medical contraindications to the influenza vaccine that has been documented and are on file). This option also requires that the staff member is unable to take antiviral medication and has provided documentation to this affect to the OH& S/ from their medical provider.
• Medical staff restrictions will be in place for physicians, as per the direction of the Chief of Staff.