Hospitals make employee flu vaccinations a patient safety issue

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The emergence of the H1N1 flu put a spotlight in early 2009 on a question: Should healthcare organizations do more in terms of policies and approaches to increase flu vaccinations among hospital personnel?

In one presentation this week at the 5th Decennial International Conference on Healthcare Associated Infections 2010 in Atlanta, the Hospital Corporation of America (HCA) discussed worker immunizations. In 2009, the H1N1 pandemic "reminded us that inadequate healthcare worker vaccination is an often overlooked patient safety issue," said Jonathan Perlin, MD, HCA's president of clinical services and chief medical officer. Perlin spoke about his findings in a teleconference prior to the meeting.

"Influenza remains the number one cause of vaccine-preventable death in the United States. But sadly, only 29% of U.S. healthcare workers receive the influenza vaccine," Perlin said.

Earlier studies have shown that infected workers may have few or no flu symptoms—even when there may be serologic evidence of having it. Also, studies have shown that an individual can transmit the flu 24 hours before showing symptoms, he said. "This means that simply having healthcare workers stay home when they feel sick is not sufficient to protect patients."

After media focus on the spread of H1N1 last year, a RAND study of healthcare worker vaccination showed it only increased by 10%, Perlin said. Part of this is because of some workers' resistance to vaccinations as was seen last year in two lawsuits filed against HCA. While HCA "successfully defended" itself, "it nevertheless shows that not everyone was supportive of our policy."

As part of an influenza prevention strategy, the 163-hospital HCA implemented a policy that required employees who could infect—or become infected—by a patient to receive the seasonal influenza vaccine, wear a surgical mask in patient care areas, or be reassigned to non-patient contact roles.

A core group representing emergency preparedness, infection prevention, human resources, legal, pharmacy, communications, and supply was formed. Non-vaccine strategies, such as cough and sneeze etiquette, proper hand hygiene, proper cleaning techniques, and the "hazards of presenteeism" (or coming to work when sick) were introduced. And human resources policies were changed to accommodate time off needed by employees who were sick with the flu.

Prior to the policy, seasonal influenza vaccine rates among HCA employees for the 2008 2009 influenza season varied from a low of 20% to a high of 74%, Perlin said.

As of November 1, 2009 (after implementation), 140,599 employees were offered the seasonal influenza vaccination, with 135,584 accepting, or 96%. Among clinical employees, 98,067 were offered, with 94,530 accepting, or a 98% rate.

Overall, the program resulted in a 65% increase in employee vaccine rates. A total of 5,015 employees declined the seasonal influenza vaccine. Reasons for declination were allergy (12%), contraindicated (7%), fear (4%), pregnant (1%),religion (3%), and no reason given (73%).

"The response from our employees was overwhelmingly positive. Our employees have embraced it as a patient safety issue," Perlin said.

In terms of why HCA made the highly publicized decision on immunization, he said, "In the future, I believe the question to hospitals won't be 'Why are you focused on immunizing healthcare workers?', but 'Why aren't all hospitals doing this?'"