Patient safety push boosts flu shots among hospital workers

About two in three U.S. health care workers get vaccinated annually against influenza, even though the Centers for Disease Control and Prevention recommends that all such workers be immunized.

At the Hospital Corp. of America, about nine in 10 of the hospital network's clinical personnel have been vaccinated since participation in a patient safety program became mandatory.

The Journal for Healthcare Quality detailed the Nashville, Tenn.-based network's vaccine compliance in an article posted online March 7. HCA went from a 58% vaccination rate among workers in 2008 to more than 90% three years later.

“In 2008, we were at or above the industry average, but we weren't where we wanted to be,” said lead report author Jonathan B. Perlin, MD, HCA's chief medical officer. “A healthy woman should not come in to deliver a baby and leave with the flu, and a critically ill patient should not bear the risk.”

A flu shot or a mask?

The HCA's mandatory Influenza Patient Safety Program began in August 2009 with a joint letter from hospital leaders introducing goals and expectations. A webcast emphasized seasonal influenza vaccination as a major patient safety initiative.

The vaccination component featured the choice of getting a free seasonal flu shot or wearing a mask. The mask provision was presented as an option rather than as a punitive measure.

“Making it mandatory and signing declination forms is insufficient,” Dr. Perlin said. “It's about understanding the issue as patient safety and respect for colleagues.”

When possible, work flows were revised to eliminate patient contact for nonvaccinated employees unable to wear a mask for extended periods. Resistance was countered by an emphasis on education.

“A lot of education and discussion helped people understand how harmful the flu is,” Dr. Perlin said. “I have had employees call me and say, 'Infection from patients is an acceptable and unavoidable occupational hazard, but infection from colleagues is an avoidable, unacceptable hazard.' ”

American Medical Association policy supports universal influenza vaccination of health care workers but not does support mandatory vaccination.

Some hospitals have faced opposition for mandatory vaccination among health workers, even though other mandatory shots like hepatitis B are accepted practice. Barriers include fear of vaccine side effects and perceived ineffectiveness of the vaccine.

HCA employees were aware that refusing the vaccination or mask without reason could result in termination. “I believe there may have been a couple of employees who left because they could not embrace this,” Dr. Perlin said.