SHEA: Improving HCW Flu Vaccine Uptake

 

 

# 5635

 

 

Hospital acquired infections are the bane of modern health care, with MRSA, C. Diff, garden variety staph, various pneumonias, and other infections estimated to cost tens of thousands of lives and add billions of dollars to healthcare costs each year. 

 

And while we tend to think of bacterial infections in this context most of the time, every year there are legitimate concerns over the spread of influenza in healthcare facilities as well.

 

These concerns have sparked repeated calls for mandatory yearly vaccination of HCWs (Health Care Workers) against the flu.

 

A few recent blogs on that contentious subject include:

 

APIC Calls For Mandatory Flu Vaccination For HCWs

AAP: Recommends Mandatory Flu Vaccinations For HCWs

SHEA: Mandatory Vaccination Of Health Care Workers

IDSA Urges Mandatory Flu Vaccinations For Healthcare Workers

 

While strongly advocating HCW influenza vaccination, the CDC has stopped short of mandating them. I blogged on this back on June 23rd, 2010  in  CDC: Proposed Influenza Infection Control Guidance.

 

While many infection control experts see this as a long overdue step in patient and co-worker protection, the obstacles that lay before these sorts of policies are substantial.

 

This is a hugely divisive issue, with many HCWs believing that it is an infringement of their rights to decide what will be injected into their bodies.

 

I’ve covered HCW’s objections to forced flu shots in the past, including:

 

HCWs: Refusing To Bare Arms

HCWs: Developing a Different Kind Of Resistance

 

 

Given that hospitalized patients are often at increased risk of serious illness or death from influenza, reasonable measures that can reduce the spread of the virus – such as improved vaccination rates and better infection control measures - are vital areas that many healthcare facilities need to review and improve.

 

In recent years a few large hospitals have managed to implement mandatory flu vaccinations, including Seattle’s Virginia Mason Medical Center and BJC Heathcare of St. Louis, Missouri  (see here and here).

 

However, it is possible to achieve high vaccination rates without mandating vaccination, as the following article published in the current edition of Infection Control and Hospital Epidemiology points out.

 

An Alternate Approach To Improving Healthcare Worker Influenza Vaccination Rates

Lisa M. Esolen, Kimberly Kilheeney, Richard E. Merkle

Essentially, this approach allows HCWs with medical or ethical objections to flu vaccination to opt out and elect to wear a surgical facemask during flu season when in close contact with patients.

 

 

Although full access to the article is available only to SHEA members (the first page is available to all), the Society for Healthcare Epidemiology in America has published a press release with the details.

 

Society for Healthcare Epidemiology of America

Health system achieves high flu vaccination rates by mandating masking

CHICAGO (June 15, 2011) – Geisinger Health System vaccinated more than 92% of all employees against influenza this season, with a modification of a mandatory program. On average, fewer than half of all healthcare workers receive flu vaccinations.

 

In an article published in July's Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America, Dr. Lisa Esolen demonstrated the effectiveness of Geisinger's influenza vaccination that helped achieve high rates of vaccine compliance for two consecutive years. This past season, 2010-2011, Geisinger had vaccinated 95% of clinical employees and 92% of all employees by mid-December. Since hospitals continue to release vaccine until the end of March, final vaccination rates were not known at that the time of this publication.

 

"Influenza vaccination rates among hospital employees has received extensive attention in recent years," said Lisa Esolen, MD, Systems Director, Infection Control Geisinger Health System "Healthcare workers are critical to limiting the spread of influenza since they are exposed to numerous sick patients and can readily spread the infection from patient to patient."

 

To increase vaccination rates among staff, some hospitals have embraced a mandatory approach – get vaccinated or lose your job. However, Geisinger Health System chose a slightly different approach. The 14,000-employee system decided to allow staff members to opt out of receiving the flu vaccine for ethical or medical reasons, but required that those who did opt out would need to wear a facemask for the entire flu season, extending from November 1 to March 31. All vaccinated employees were known by a campaign sticker placed on their identification badge – no sticker meant the employee needed to wear a mask whenever they were within five or six feet of any other person throughout the entire day.

 

"We're proud of the success we had and the team building it inspired, encouraging each unit to act as a team to achieve full vaccination." said Dr. Esolen.

 

 

This idea is one I actually wrote about (and advocated) during the pandemic as being a reasonable compromise to mandatory vaccination (see Public Support For Mandatory HCW Vaccination).

 

Although some HCWs may consider wearing a mask as onerous, they should help reduce in-hospital influenza transmission, while being a considerably less draconian solution than mandating employees either accept the flu vaccine or risk losing their jobs.

 

It’s not a perfect solution (neither are vaccines, btw), but compromises rarely are. 

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APIC Calls For Mandatory Flu Vaccination For HCWs

 

 

# 5282

 

 

APIC (the Association for Professionals in Infection Control and Epidemiology, Inc.) has joined the chorus of other professional infection control and medical organizations (including SHEA, IDSA, & AAP) who are calling for mandatory yearly flu vaccinations for healthcare workers (HCWs).

 

If this story sounds a bit like Deja Flu, you probably recall that in October of 2008 APIC released a similar statement (see APIC Seeking Mandatory Flu Shot For HCWs), but in that case provided for an informed `opt out clause’ if HCWs signed a declination form saying they understood the risks to patients.

 

The new statement eliminates that escape clause, recommending that that hospitals, nursing homes, and other facilities employing HCWs:

 

“require influenza immunization as a condition of employment unless there are compelling medical contraindications."

 

You can read the entire 4-page position paper, outlining their recommendations and rationale behind them, on the APIC home page.

 

APIC Position Paper:  Influenza Vaccination Should Be a Condition of Employment for Healthcare Personnel, Unless Medically Contraindicated

 

The paper also calls for those who are exempted for medical reasons to:

 

“. . .  be educated on the importance of careful adherence to all of the non-vaccine related HICPAC prevention strategies, including hand hygiene and cough etiquette.

Further, they may be  required to wear a surgical mask when contact with patients or susceptible employees is likely. “ 

 

Over the past year several other professional medical organizations have made similar calls for mandatory vaccinations.

 

AAP: Recommends Mandatory Flu Vaccinations For HCWs

SHEA: Mandatory Vaccination Of Health Care Workers

IDSA Urges Mandatory Flu Vaccinations For Healthcare Workers

 

While strongly advocating HCW influenza vaccination, the CDC has stopped short of mandating them. I blogged on this back on June 23rd, 2010  in  CDC: Proposed Influenza Infection Control Guidance.

 

Similarly, a UK Department of Health report issued in June 2010 called Learning The Lessons From the H1N1 Vaccination Campaign For Healthcare Workers  – while not mandating vaccination – stresses the `professional duty’ of all HCWs to get the vaccine.

 

New York State attempted to require vaccination as a requirement to work as a HCW in 2009, but legal challenges and vaccine shortages forced them to abandon – at least temporarily – that mandate  (see New York Rescinds Mandatory Flu Shots For HCWs).

 

While many infection control experts see this as a long overdue step in patient and co-worker protection, the obstacles that lay before these sorts of policies are substantial.

 

This is a hugely divisive issue, with many HCWs believing that it is an infringement of their rights to decide what will be injected into their bodies.

 

There will almost certainly be legal challenges, and possibly labor disputes as well. I’ve covered HCW’s objections to forced flu shots in the past, including:

 

HCWs: Refusing To Bare Arms

HCWs: Developing a Different Kind Of Resistance

 

 

Only a few large hospitals have thus far managed to implement mandatory flu vaccinations, including Seattle’s Virginia Mason Medical Center and BJC Heathcare of St. Louis, Missouri  which I blogged about here

.

Details on how Virginia Mason Medical Center implemented mandatory HCW vaccinations can be read in the following  PDF.

 

 

Over the past 5 years Virginia Mason MC has maintained a 98% vaccination rate, and has vigorously promoted the uptake of flu shots not only in the workplace, but the greater community as well.

 

An abstract from a study that appeared in the August 2010 Infection Control and Hospital Epidemiology journal concludes that a policy of mandatory HCW vaccination is feasible, sustainable, and effective.

 

DOI: 10.1086/656210

Mandatory Influenza Vaccination of Healthcare Workers: A 5‐Year Study

Robert M. Rakita, MD; Beverly A. Hagar, BSN, COHNS; Patricia Crome, MN; Joyce K. Lammert, MD, PhD

(EXCERPT)

Results.

In the first year of the program, there were a total of 4,703 HCWs, of whom 4,588 (97.6%) were vaccinated, and influenza vaccination rates of more than 98% were sustained over the subsequent 4 years of our study. Less than 0.7% of HCWs were granted an accommodation for medical or religious reasons and were required to wear a mask at work during influenza season, and less than 0.2% of HCWs refused vaccination and left Virginia Mason Medical Center.

 

Impressive results. 

 

And, when combined with increased calls from infection control organizations to adopt similar practices, likely to inspire other facilities to follow suit.

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AAP: Recommends Mandatory Flu Vaccinations For HCWs

 

 

# 4887

 

The American Academy of Pediatrics is the latest professional medical organization to embrace the idea of making yearly influenza vaccinations a requirement for HCWs (Health Care Workers).

 

The AAP – which boasts a membership of roughly 60,000 pediatricians – released the following statement yesterday (slightly reparagraphed for readability).

  

 

AAP Recommends Mandatory Flu Vaccine for All Health Care Workers

---

For Immediate Release:

Health-care associated influenza outbreaks are a common and serious public health problem that contribute significantly to patient morbidity and mortality and create a financial burden on health care systems.

 

In a new policy statement, the American Academy of Pediatrics (AAP) recommends that all health care personnel should be required to receive an annual influenza vaccine. The policy, "Recommendation for Mandatory Influenza Immunization of All Health Care Personnel," published in the October 2010 print issue of Pediatrics (published online Sept. 13), states that "despite the efforts of many organizations to improve influenza immunization rates with the use of voluntary campaigns, influenza coverage among health care personnel remains unacceptably low."

(Continue . . . )

 

While there remains a good deal of opposition among the rank and file of HCWs to mandatory flu vaccinations, over the past year or two the idea has gained increasing support among professional organizations such as SHEA, IDSA, and APIC.

 

Earlier this summer the CDC released their proposed infection control guidelines, where they strongly urged – but did not mandate – flu vaccinations for HCWs.

 

In response to what many felt was a tepid policy, Richard Whitley, MD president of the Infectious Diseases Society of America (IDSA), wrote an open letter to CDC  director Thomas Frieden urging that these guidelines include mandatory influenza vaccination.

 

Less than two-weeks ago SHEA (Society for Healthcare Epidemiology of America) released a similar position paper (see SHEA: Mandatory Vaccination Of Health Care Workers).

 

While many infection control experts see this as a long overdue step in patient and co-worker protection, the obstacles that lay before these sorts of policies are substantial.

This is a hugely divisive issue, with many HCWs believing that it is an infringement of their rights to decide what will be injected into their bodies.

 

There will almost certainly be legal challenges, and possibly labor disputes as well.

 

Last year New York State attempted to require vaccination as a requirement to work as a HCW, but lawsuits and vaccine shortages forced them to abandon – at least temporarily – that mandate  (see New York Rescinds Mandatory Flu Shots For HCWs). 

 

I’ve covered HCW’s objections to forced flu shots in the past, including:

 

HCWs: Refusing To Bare Arms

HCWs: Developing a Different Kind Of Resistance

 

Only a handful of large hospitals have managed to implement mandatory flu vaccinations, including Seattle’s Virginia Mason Medical Center and BJC Heathcare of St. Louis, Missouri  which I blogged about here.

 

Details on how Virginia Mason Medical Center implemented mandatory HCW vaccinations can be read in the following  PDF.

 

 

 

The backing of AAP, IDSA, SHEA and APIC most certainly adds gravitas to the movement - but without government regulatory backing – it remains to be seen just how many health care facilities are going to be willing to pioneer these sorts of policies on their own.

 

But love the idea or hate it, this is an issue that isn’t going to be going away anytime soon.

»» Read More

SHEA: Mandatory Vaccination Of Health Care Workers

 

 

 

# 4855

 

 

The vaccination rate among health care workers (HCWs) against seasonal influenza runs abysmally under 50%, and in recent years there have been multiple calls to make yearly vaccination a requirement of employment.

 

For infection control professionals, the advantages are obvious.  Influenza exacts a heavy burden on patients, their families, and co-workers.  Requiring vaccination would undoubtedly save lives, and reduce costs.

 

But for many HCWs, the issues are more about personal rights to decide what they will inject into their bodies. And that has left this hot-potato issue in the wings.

 

Earlier this summer the CDC released their proposed infection control guidelines, where they strongly urged – but did not mandate – flu vaccinations for HCWs.

 

Here is the passage from the proposed guidance:

 

Strategies to improve HCP vaccination rates include providing incentives, providing vaccine at no cost to HCP, improving access (e.g., offering vaccination at work and during work hours), and requiring personnel to sign declination forms to acknowledge that they have been educated about the benefits and risks of vaccination.

 

While some have mandated influenza vaccination for all HCP who do not have a Contraindication, it should be noted that mandatory vaccination of HCP remains a controversial issue.

 

In response to what many felt was a tepid policy, Richard Whitley, MD president of the Infectious Diseases Society of America (IDSA), wrote an open letter to CDC  director Thomas Frieden urging that these guidelines include mandatory influenza vaccination.

 

You can read the letter off the IDSA website from the link below.  

 

IDSA Letter to CDC Director Tom Frieden on Draft Guidance “Prevention Strategies for Seasonal Influenza in Healthcare Settings”  07/15/2010

 

 

As you can imagine, this is a hot button issue.
 

Last year New York State attempted to require vaccination as a requirement to work as a HCW, but legal challenges and vaccine shortages forced them to abandon – at least temporarily – that mandate  (see New York Rescinds Mandatory Flu Shots For HCWs).

 

• Some hospitals around the nation have adopted mandatory vaccination – or require the wearing of masks by unvaccinated workers during flu season.
• APIC (Association for Professionals in Infection Control and Epidemiology) has been promoting the idea of mandatory flu shots for HCWs for two years (see APIC Seeking Mandatory Flu Shot For HCWs)
• In the UK, the Department of Health  – while not mandating vaccination – stresses the `professional duty’ of all HCWs to get the vaccine.

 

 

Which brings us to a press release and a positions paper from SHEA (Society for Healthcare Epidemiology of America), – endorsed by the IDSA -  that calls for the mandatory vaccination of all HCWs against seasonal flu each year.

 

First an excerpt from the press release, followed by a link to the position paper.

 

NATION’S LEADING INFECTIOUS DISEASES EXPERTS CALL FOR MANDATORY FLU VACCINE FOR ALL HEALTHCARE PERSONNEL

Vaccination Should Be Requirement for Continued Employment for Healthcare Personnel, Epidemiologists and Infectious Disease Physicians Say

(Arlington, VA)— Influenza vaccination of healthcare personnel is a professional and ethical responsibility and non-compliance with healthcare facility policies regarding vaccination should not be tolerated, according to a position paper released today by the Society for Healthcare Epidemiology of America (SHEA). The paper, published in this month’s Infection Control and Healthcare Epidemiology journal and endorsed by the Infectious Diseases Society of America (IDSA), stresses influenza vaccination of healthcare personnel as a core patient safety practice that should be a condition of both initial and continued employment in healthcare facilities.

 

According to SHEA, their recommendations apply to all healthcare professionals in all healthcare settings, regardless of whether the professional has direct patient contact or whether he or she is directly employed by the facility. The policy also applies to students, volunteers, and contract workers. The only exemptions, say the epidemiologists and infectious disease physicians, should be in cases of medical contraindications.

(Continue . . . )

 

 

SHEA Position Paper: Influenza Vaccination of Healthcare Personnel

An update of an original SHEA statement issued in 2005, this paper states that influenza vaccination is the professional and ethical responsibility of healthcare professionals and that non-compliance with healthcare facility policies regarding vaccination should not be tolerated. It is endorsed by IDSA.

 

SHEA Position Paper

 

 

 

Hospitals are looking at this as both a liability and an economic issue, on top of their concerns for patient welfare.  So this movement has `legs’.

 

Of course, legal challenges still lie ahead, but the momentum is clearly moving in the direction of mandatory vaccinations for Health Care Workers.

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