FAQ: Current situation in the U.S. regarding mandated or required seasonal influenza vaccination programs for HCP?

What is the current situation in the U.S. regarding mandated or required seasonal influenza vaccination programs for HCP? [FAQ Date: April 1, 2013]

Three recent journal articles provide a good perspective. In a March 2013 article in the American Journal of Infection Control, Nowalk et al [citation and abstract below] surveyed 964 hospitals across the U.S. to study the incidence and impact of mandated policies around HCP seasonal influenza vaccination and the impact of “consequences” for non-compliance.  Danziger et al, writing in Human Vaccines, surveys children’s hospital in the U.S.  In a November 2011 article in Vaccine, Miller et al [citation and abstract below] surveyed  almost 1,000 acute care hospitals for similar parameters.

We urge a careful reading of the abstracts below and the full articles, but refer the reader to the “Results” section of the Nowalk et al  abstract which notes that of the surveyed institutions, “One hundred fifty hospitals required influenza vaccination, 84 with consequences (wear a mask, termination, education, restriction from patient care duties, unpaid leave) and 66 without consequences for noncompliance. Hospitals whose mandates have consequences for noncompliance included a broader range of personnel, were less likely to allow personal belief exemptions, or to require formal declination. The change in vaccination rates in hospitals with mandates with consequences (19.5%) was nearly double that of the hospitals with mandates without consequences (11%; P=.002). Presence of a state law regulating HCW influenza vaccination was associated with an increase in rates for mandates with consequences nearly 3 times the increase for mandates without consequences.”

While these surveys are indicative, it obviously does not capture data from the 5,700+ hospitals in the American Hospital Association’s annual registry, and does not capture data from other healthcare institutions types such as long-term care facilities, nursing homes, etc.

.

Impact of hospital policies on health care workers’ influenza vaccination rates
Mary Patricia Nowalk, PhD, RD; Chyongchiou Jeng Lin, PhD; Mahlon Raymund, PhD; Jamie Bialor, MPH, CHES, Richard K. Zimmerman, MD, MPH
American Journal of Infection Control
Vol 41 | No. 3 | March 2013 | Pages 189-284
Article in Press -published online 18 February 2013.
Abstract
Background
Overall annual influenza vaccination rate has slowly increased among health care workers but still remains below the national goal of 90%.
Methods
To compare hospitals that mandate annual health care worker (HCW) influenza vaccination with and without consequences for noncompliance, a 34-item survey was mailed to an infection control professional in 964 hospitals across the United States in 4 waves. Respondents were grouped by presence of a hospital policy that required annual influenza vaccination of HCWs with and without consequences for noncompliance. Combined with hospital characteristics from the American Hospital Association, data were analyzed using χ2 or Fisher exact tests for categorical variables and t tests for continuous variables.
Results
One hundred fifty hospitals required influenza vaccination, 84 with consequences (wear a mask, termination, education, restriction from patient care duties, unpaid leave) and 66 without consequences for noncompliance. Hospitals whose mandates have consequences for noncompliance included a broader range of personnel, were less likely to allow personal belief exemptions, or to require formal declination. The change in vaccination rates in hospitals with mandates with consequences (19.5%) was nearly double that of the hospitals with mandates without consequences (11%; P=.002). Presence of a state law regulating HCW influenza vaccination was associated with an increase in rates for mandates with consequences nearly 3 times the increase for mandates without consequences.
Conclusion
Hospital mandates for HCW influenza vaccination with consequences for noncompliance are associated with larger increases in HCW influenza vaccination rates than mandates without such consequences.

Mandatory influenza vaccination programs for healthcare personnel in NACHRI-associated children’s hospitals vs. non-children’s hospitals
Phoebe Danziger and Matthew M. Davis
Human Vaccines and Immunotherapeutics (formerly Human Vaccines)
Volume 8, Issue 6  June 2012
http://www.landesbioscience.com/journals/vaccines/toc/volume/8/issue/6/
RECENTLY ACCEPTED AND COMING SOON
RESEARCH PAPERS
Abstract:
We conducted a national study of children’s hospitals and neighboring general medical-surgical hospitals to examine their employee vaccination policies. Survey questions addressed healthcare personnel (HCP) influenza vaccination policies for the 2009–2010 (seasonal, H1N1) and 2010–2011 (H1N1+seasonal = combined) influenza seasons at each hospital, assessment of primary objectives behind hospitals’ influenza vaccination policies, and information about influenza vaccination policies for inpatient children. We conducted standard univariate and bivariate statistical analyses. The study sample included 136 hospitals: 71 children’s hospitals (response rate = 59%) and 65 matched non-children’s hospitals (39%). Children’s hospitals were significantly more likely than non-children’s institutions to have mandatory H1N1 influenza vaccination policies for their HCP in 2009–10 (27% vs. 13%, p = 0.03). There were no differences in HCP influenza vaccination policies otherwise: 25% in both groups with mandatory seasonal vaccination programs in 2009–10, and 19% in both groups with mandatory combined influenza programs in 2010–11. Children’s hospitals were significantly more likely to have policies in place strongly encouraging inpatient children to have influenza vaccination than were non-children’s hospitals (47% vs 5%; p < 0.001). Among children’s and non-children’s hospitals alike, the primary intentions of HCP influenza vaccination policies were to reduce transmission of influenza from employees to patients (89% overall) and to reduce transmission of influenza from patients to employees (70%). This study—the first known national assessment of hospitals’ policies regarding influenza—suggests that HCP mandatory vaccination is uncommon, even in child-focused hospitals where the patient population is known to be at disproportionately high risk for complications from the illness.

Increases in vaccination coverage of healthcare personnel following institutional requirements for influenza vaccination: A national survey of US hospitals
Brady L. Miller, Faruque Ahmed, Megan C. Lindley, Pascale M. Wortley
Vaccine
Volume 29, Issue 50 pp. 9289-9410 (Nov. 21, 2011)
http://www.sciencedirect.com/science/journal/0264410X
Regular Papers  Pages 9398-9403
Abstract
Background
Institutional requirements for influenza vaccination, ranging from policies that mandate declinations to those terminating unvaccinated healthcare personnel (HCP), are increasingly common in the US. Our objective was to determine HCP vaccine uptake following requirements for influenza vaccination at US hospitals.
Methods
Survey mailed in 2011 to a nationally representative sample of 998 acute care hospitals. An institutional requirement was defined as an institutional policy that requires receipt or declination of influenza vaccination, with or without consequences for vaccine refusal. Respondents reported institutional-level, seasonal influenza vaccination coverage, if known, during two consecutive influenza seasons: the season prior to (i.e., pre-requirement), and the first season of requirement (i.e., post-requirement). Weighted univariate and multivariate analyses accounted for sampling design and non-response.
Results
808 (81.0%) hospitals responded. Of hospitals with institutional requirements for influenza vaccination (n = 440), 228 hospitals met analytic inclusion criteria. Overall, mean reported institutional-level influenza vaccination coverage among HCP rose from 62.0% in the pre-requirement season to 76.6% in the post-requirement season, representing a single-season increase of 14.7 (95% CI: 12.6–16.7) percentage points. After adjusting for potential confounders, single-season increases in influenza vaccination uptake remained greater among hospitals that imposed consequences for vaccine refusal, and among hospitals with lower pre-requirement vaccination coverage. Institutional characteristics were not associated with vaccination increases of differential magnitude.
Conclusion
Hospitals that are unable to improve suboptimal influenza vaccination coverage through multi-faceted, voluntary vaccination campaigns may consider institutional requirements for influenza vaccination. Rapid and measurable increases in vaccination coverage followed institutional requirements at hospitals of varying demographic characteristics.

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