What should be included in a comprehensive questionnaire template to assess an establishment's readiness for hepatitis B (HBV) inclusive employees and applicants?

Comprehensive Questionnaire Template for Hepatitis B Inclusive Workplace Readiness

Establishments must systematically assess vaccination status, immunity documentation, exposure protocols, and infection control infrastructure to ensure safe employment of hepatitis B-infected individuals and protection of all workers.

Section 1: Pre-Employment and Matriculation Screening Protocols

Vaccination Status Documentation

• Does your establishment require documentation of complete hepatitis B vaccination series (≥3 doses) for all employees and applicants at risk for blood or body fluid exposure? 1
• Do you measure anti-HBs levels upon hire or matriculation for healthcare personnel who have documentation of complete vaccination? 1, 2
• Do you use quantitative assays that detect protective anti-HBs concentrations ≥10 mIU/mL? 1, 2

Comprehensive Serologic Testing

• For employees with unknown or incomplete vaccination status, do you order the complete three-marker panel (HBsAg, anti-HBs, and anti-HBc)? 1, 2
• Do you test all applicants born in countries with high or intermediate HBV endemicity (≥2% HBsAg prevalence)? 1
• Do you screen U.S.-born applicants whose parents were born in high-endemicity countries (≥8%)? 1

Section 2: Vaccination and Revaccination Infrastructure

Vaccine Availability and Administration

• Does your establishment provide hepatitis B vaccine at no cost to all employees with occupational blood exposure risk, as mandated by OSHA? 1, 3
• Do you have protocols for administering one booster dose to employees with anti-HBs <10 mIU/mL, followed by retesting 1-2 months later? 1, 3, 2
• For persistent non-responders after one booster, do you administer a complete second 3-dose series with retesting 1-2 months after completion? 1, 3, 2

Non-Responder Management

• After 6 total vaccine doses, do you test non-responders for HBsAg and anti-HBc to rule out chronic HBV infection? 3, 2
• Do you counsel non-responders about their susceptibility and the critical importance of immediate postexposure prophylaxis with HBIG plus vaccine if exposed to HBsAg-positive blood? 3, 2

Section 3: Postexposure Prophylaxis Protocols

Immediate Response Procedures

• Do you have written protocols ensuring exposed employees immediately wash needle-stick sites with soap and water, flush splashes to nose/mouth/skin with water, and irrigate eye exposures with clean water or saline? 1
• Do you require immediate reporting to supervisors and medical treatment within 24 hours of exposure? 1
• Do you document the type of injury, blood involvement, source patient identification, and extent of injury? 1

Source Patient Assessment

• Do you have established policies for determining the HBsAg status of source patients when possible? 1
• Do you use FDA-approved rapid testing methods for source patient serologic status? 1

Prophylaxis Administration Based on Immunity Status

• For unvaccinated exposed employees with HBsAg-positive sources, do you administer HBIG (0.06 mL/kg IM, maximum 5 mL) immediately and begin the vaccine series? 1, 4
• For vaccinated responders (anti-HBs ≥10 mIU/mL), do you provide no treatment regardless of source status? 1
• For vaccinated non-responders with HBsAg-positive sources, do you administer HBIG immediately and either initiate revaccination or give a second HBIG dose in 1 month? 1
• For vaccinated employees with unknown response status and HBsAg-positive sources, do you test for anti-HBs and provide HBIG plus vaccine booster if negative? 1

Section 4: Infection Control and Standard Precautions

Engineering and Work Practice Controls

• Do you prohibit needle resheathing? 1
• Do you provide puncture-resistant needle and sharp object disposal containers? 1
• Do you implement needleless vascular access systems when practical? 1
• Do you mandate double-gloving for procedures with blood exposure risk? 1

Standard Precautions Implementation

• Do you provide appropriate protective equipment (gloves, gowns, masks, eye protection) for all employees with potential blood or body fluid exposure? 1, 5
• Do you have meticulous standards for cleaning and reusing patient care equipment? 1

Section 5: Management of HBV-Infected Employees

Non-Discriminatory Policies

• Do you have written policies ensuring HBV-infected employees are not dismissed, denied employment, or have acceptances rescinded solely based on HBV infection status? 1
• Do you avoid requiring continuous or weekly HBV DNA testing or HBeAg negativity as employment conditions? 1

Monitoring and Oversight

• For HBV-infected healthcare providers performing exposure-prone procedures, do you have reasonable oversight by relevant institutional bodies? 1
• Do you use HBV DNA levels rather than HBeAg status to assess infectivity, recognizing that HBeAg-negative individuals may have high viral loads? 1

Section 6: Education and Training Programs

Infection Prevention Instruction

• Do you provide mandatory infection prevention training to all employees at risk for blood exposure? 6, 7
• Do you offer vaccine counseling to all at-risk employees? 6, 7
• Do you ensure all employees know how to access postexposure prophylaxis policies? 1, 5

Knowledge Assessment

• Do you assess employee knowledge regarding hepatitis B transmission modes (blood, sexual, percutaneous, perinatal)? 7
• Do you verify employee understanding of vaccination as the primary preventive measure? 7

Section 7: Documentation and Follow-Up Systems

Medical Record Maintenance

• Do you maintain confidential records of vaccination status, serologic test results, and exposure incidents for all employees? 1
• Do you ensure follow-up for potentially exposed employees, including anti-HBs testing 1-2 months after vaccine doses? 1, 3

Alternative Institutional Approaches

• If you choose not to measure anti-HBs upon hire for employees with documented complete vaccination, do you ensure timely assessment and postexposure prophylaxis following any exposure? 1, 2
• Is this approach limited to settings with documented low risk for occupational exposures and lower HBV prevalence in the patient population? 1, 2

Section 8: Special Populations and High-Risk Groups

Targeted Screening

• Do you identify and screen employees who are men who have sex with men, injection drug users, or have multiple sexual partners? 1
• Do you screen employees requiring immunosuppressive therapy, including chemotherapy or immunosuppression for organ transplantation? 1
• Do you screen hemodialysis patients and recipients of clotting-factor concentrates? 1

Institutional Settings

• For institutions serving developmentally disabled clients, do you vaccinate both clients and staff who work closely with known HBV carriers? 1

Common Pitfall: Many establishments fail to distinguish between vaccine non-responders and those with waning antibody levels years after childhood vaccination. The CDC specifically addresses this: institutions must either test anti-HBs upon hire for all previously vaccinated personnel or ensure immediate postexposure assessment, recognizing that vaccine-induced protection persists even when antibody titers decline below detectable levels 1, 3, 2. The critical error is dismissing or discriminating against HBV-infected applicants when evidence shows that with proper infection control, standard precautions, and monitoring, these individuals can work safely in healthcare settings 1, 5.