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Mandating flu vaccination leads to few departures

Sunday June 9, 2013
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Mandatory influenza vaccination as a condition of employment did not lead to excessive voluntary termination at a healthcare facility, according to a report.

Flu infections result in approximately 150,000 hospital admissions and 24,000 deaths annually, according to background information for the study, which was scheduled for presentation June 9 at the annual conference of the Association for Professionals in Infection Control and Epidemiology. Although the CDC recommends that all healthcare personnel receive the annual flu vaccine, the national average for HCP vaccination was only 67% in 2011-12.

Infection control and prevention specialists at Loyola University Medical Center in Maywood, Ill., worked with a multidisciplinary task force to develop a facility-wide policy that made flu vaccination a condition of employment. The study results were based on a four-year analysis of vaccination rates at the facility.

" 'First do no harmí is our mandate as healthcare workers," Jorge Parada, MD, MPH, FACP, FIDSA, an author of the study and professor of medicine at Loyola University Chicago Stritch School of Medicine, said in a news release. "We should do all we can to not pass along illness to our patients."

Loyola introduced an active declination system in 2008, according to which healthcare professionals were required by to state "yes" or "no" when asked to be vaccinated and to provide reasoning if they declined the vaccine.

This policy brought the centerís overall vaccination rate up to 72%, but "was still well short of what we felt we should achieve to maximize patient safety," Parada said.

In 2009 Loyola chose to mandate flu vaccination as a condition of employment, and extended this mandate to students, volunteers and contractors. To support and encourage compliance, the centerís communications department developed facility-wide reminder emails and created short videos, which were displayed on flat screens throughout the hospital.

In the first year of the mandatory policy (the 2009-10 flu season), 99.2% of employees received the vaccine, 0.7% were exempted for religious or medical reasons and 0.1% refused vaccination and chose to terminate employment. Those results have been sustained: In 2012, 98.7% were vaccinated, 1.2% were exempted and 0.06% refused vaccination.

Parada said in reality, the 2012 numbers were even better than they appeared because of the five people who refused vaccination in the mandatory period, three were unpaid volunteers who later reconsidered, received the vaccine and returned to Loyola, and the two others were part-time staff, each with only 10% time commitment at Loyola. The true vaccine-refusal rate thus was 0.002%. Over the course of four years, fewer than 15 HCP (including volunteers) out of approximately 8,000 total chose termination over vaccination.

"Near-universal flu immunization is achievable and sustainable with a mandatory vaccination policy," Parada said. "Our employees and associates now understand that this is the way we do business. Just as construction workers must wear steel-toed boots and hard hats on job sites, healthcare workers should get a flu shot to work in a hospital. We believe that patient and staff safety have been enhanced as a result."

Parada also noted that "as healthcare workers, our staff are at greater risk than the general population for exposure to the flu virus, and we also have a fiduciary responsibility to try and protect our HCP (and by extension, their families) from becoming ill. Vaccination provides that added protection."


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