Major employers support flu shot requirement for health professionals

The national immunization rate for health care workers is 63.5%. Facilities with mandatory policies have an average 98.1% vaccination rate.

By — Posted Feb. 14, 2012

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Many of the country's largest companies are telling hospitals to send a message to physicians and other health professionals who refuse influenza immunization: "You're fired."

"Transmission of seasonal influenza between health care workers and patients is a significant patient and worker safety issue. Failure to prevent the transmission of seasonal flu between health care workers and patients also increases health costs," said Helen Darling, president and CEO of the National Business Group on Health, at a Feb. 2 news conference. The organization represents 340 U.S. companies, 68 of which are listed on the Fortune 500.

Most hospitals that have adopted mandatory policies require all employees to receive the flu vaccination as a condition of employment unless they present evidence of a medical contraindication. If the employees do not get immunized, they are typically required to wear face masks whenever they interact with patients or risk getting a pink slip.

"Requiring flu vaccinations for hospital personnel is the right thing to do," Darling said. "Hospitals have an obligation to prevent the spread of infection to patients in their care. It's a fitness-for-duty issue. At the same time, patients have the right to assume that health care personnel and the organizations that employ them will take all reasonable measures to reduce and avoid transmission of preventable diseases, including the flu."

The push for mandatory flu-vaccination policies for health professionals and other employees at health care organizations has picked up steam in the last two years. In September 2010, the American Academy of Pediatrics backed the idea, and the Society for Healthcare Epidemiology of America followed suit a month later. Last year, the American Hospital Assn. also approved the mandatory vaccination.

On Feb. 8, the Dept. of Health and Human Services' National Vaccine Advisory Committee voted 12-2 to recommend that health facilities failing to achieve a 90% flu-vaccination rate using voluntary approaches "strongly consider a policy of employer requirement for influenza vaccination."

The American Medical Association has policy supporting universal influenza vaccination of health care workers. The policy says hospitals and skilled nursing facilities should have a way to measure and maximize their flu vaccination rate but stops short of endorsing or opposing a mandatory approach.

Flu shot rate on the rise

The flu immunization rate among health workers hovered around 50% for about a decade before rising to 61.9% during the 2009-10 flu season and increasing to 63.5% during the 2010-11 flu season, said Don Wright, MD, MPH, deputy assistant secretary for health for health care quality in the Dept. of Health and Human Services. A survey conducted by the Centers for Disease Control and Prevention in November 2011 found that 63.4% of health workers had already received their immunization for this season, compared with a 55% rate in November 2010.

Thirteen percent of health workers now are employed in a facility that mandates flu immunization, Dr. Wright said. Health care organizations that require flu immunization have achieved an average vaccination rate of 98.1%, he added. Starting in 2013, hospitals could see their Medicare pay cut for not reporting the flu immunization rate among their employees.

Despite the mandate push, voluntary approaches can achieve excellent immunization rates, said Jeanette Clough, who also spoke at the news conference and is president and CEO of Mount Auburn Hospital in Cambridge, Mass. The hospital improved its rate from 70.3% during the last flu season to 90.2% this season by making it easy for workers to get immunized on site or off site at many times on different days, noting employees' vaccination status on their badges and sending a strong message through clinical department leaders about expectations regarding immunization.

Health workers should see it as a duty to get vaccinated, said John Santa, MD, MPH, director of the Consumer Reports Health Ratings Center.

"Health care workers are a key factor in the process of getting the flu in our country," he said. "They're what we call a vector. Choosing not to be vaccinated is choosing to do harm. That's a choice that has no place in health care."

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What health care workers are getting flu shots?

The nationwide flu immunization rate among people working in health facilities during the 2010-11 season was 63.5%, according to the Centers for Disease Control and Prevention. Physicians and dentists, who were not separated in the CDC data, had the highest rate but still fell short of the target 90% vaccination rate. Immunization rates by type of health worker are shown below.

Type of health worker 2010-11 immunization rate
Physician or dentist 84.2%
Nurse practitioner or physician assistant 82.6%
Nurse 69.8%
Allied health professional 64.4%
Technician 64.0%
Nonclinical support 66.2%
Administrative 57.2%
Assistant or aide 55.9%

Source: "Influenza Vaccination Coverage Among Health-Care Personnel -- United States, 2010-11 Influenza Season," Morbidity and Mortality Weekly Report, Aug. 19, 2011 (link)

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