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Take a strong stand against the flu with declination forms


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APIC officials took a strong position in support of flu vaccinations this season by issuing a statement saying vaccines should be required for healthcare workers and recommending that those healthcare workers who don’t get vaccinated sign a declination form. The form makes healthcare workers acknowledge that they are putting their patients and others at risk, unless they have a medical reason for opting out.

Prior to 2009, APIC’s position statement only reinforced the importance of the flu vaccine for healthcare workers and highly recommended the vaccine along with additional measures to boost compliance. Because other professional societies had issued stronger messages and APIC membership supported a bolder statement, officials revisited the issue in 2009.

“We decided it was time to take a look at our position paper and really put some teeth into it,” says Linda Greene, RN, MPS, CIC, lead author of APIC’s position paper and director of infection prevention and control at Rochester (NY) General Health System.

The response from hospitals has been positive, says Greene.

“We really support the fact that it is the obligation of a healthcare worker to protect their patients, themselves, and their families,” says Terry Burger, BSN, RN, CIC, CNA, BC, IC director at Lehigh Valley Hospital in Allentown, PA.

“However, APIC also wanted to be realistic with its expectations,” Greene says. “One of the things we were sensitive to is the fact that many organizations are unionized.”

Separate barriers might exist at other facilities when it comes to requiring all healthcare workers to get immunized. This is why the APIC decided to include the declination form for hospitals who couldn’t require vaccinations for all healthcare workers.

And officials have strengthened the effect of the declination by using it to educate healthcare workers about the harm they may cause others in the course of making a personal decision.

“Healthcare workers can’t just say they don’t want to get the vaccine because they never get sick,” says Greene. “They have to acknowledge that what they are doing is putting their patients, themselves, and their loved ones at risk. The informed declination certainly makes people stop and think.”

The APIC recommendations apply to healthcare personnel in the following settings:

  • Acute care hospitals
  • Nursing homes
  • Skilled nursing facilities
  • Physician offices
  • Urgent care centers
  • Outpatient settings
  • Home health settings

“All employees with direct patient contact should be immunized annually, examples include, but are not limited to, physicians, nurses, therapists, dietitians, religious workers, housekeeping, and kitchen staff,” states the organization’s press release.

Flu is often spread from person to person before symptoms appear. If healthcare workers become infected, they may spread the infection to patients and others before they’re even aware that they are sick. Or healthcare workers may have a mild case of the flu and go to work and pass it around unknowingly.

Greene says she is hopeful organizations will comply with this new recommendation. “I asked in the Rochester area, and every single organization in our area is following the recommendations,” she says.

Some organizations are taking the recommendations a step further. For example, a change made by one hospital is to include language in its declination indicating that healthcare workers who refuse vaccinations may face reassignment.

Lehigh Valley Hospital required that employees get the vaccine and sign a declination form even before the APIC released its position statement. Information about who has been vaccinated is available to department directors in an electronic tracking system so that they can monitor compliance, says Burger.

This new position statement shouldn’t be viewed as a stand-alone document, says Greene. It should be paired with other strategies that help make shots convenient and free. For example, one strategy would be to use peer immunization. Having nurses and other trained personnel give vaccines to their peers reduces the amount of time people have to devote to getting vaccinated, making them more likely to comply due to the added convenience. It also introduces the element of peer pressure, and that can be a powerful motivator, says Greene.

A mulitpronged approach is important to raising vaccination rates, Burger says. The key is to make the vaccine accessible and get support from administration so you can hold people accountable, she says.

“My prediction is that it’s a matter of time before flu vaccine becomes mandatory like some of the other vaccines,” says Burger. “The main difference between influenza vaccine and others that are mandated, such as hepatitis B or MMR [measles, mumps, and rubella] is that it’s administered annually.”

To obtain additional information on immunization against the flu and a free toolkit, visit the APIC Web site at www.apic.org. Click on Public Policy, and look under Issues and Initiatives for the section on influenza.