Flu shot mandate yields results without scaring off health workers

Mandating annual influenza vaccinations as a condition of employment results in a nearly 100% success rate without significant numbers losing their jobs, said researchers at Loyola University Medical Center in Maywood, Ill., after a four-year analysis.

Loyola was among the first hospitals to mandate the annual vaccine for all health care workers when it initiated the policy in 2009, with exemptions for religious and medical reasons. In the first year, 99.2% of employees received the vaccine; 0.7% were exempted; and 0.1% (nine employees of about 8,000) were terminated. Those numbers have been sustained. In 2012, 98.7% were vaccinated. Over four years, fewer than 15 workers, including volunteers, were terminated.

Loyola’s success was reported at the Assn. for Professionals in Infection Control and Epidemiology meeting June 9 in Fort Lauderdale, Fla.

Jorge Parada, MD, MPH, study author and professor at Loyola University Chicago Stritch School of Medicine, said those results would not have been achieved without a mandate. The Centers for Disease Control and Prevention reports that only 63% of U.S. health care workers get a flu vaccination. Reasons for not getting the shot and degree of compliance vary by category of worker and health care setting. Meanwhile, flu infections result in about 150,000 hospital admissions and 24,000 deaths every year.

“I would like to believe you can just invite all health care personnel to get the flu shot and they would come running, but the data show otherwise,” he said. “I think we have a very important responsibility to first cause no harm to our patients. If we can reduce the risk of health care providers catching the flu, we are then going to reduce the risk of transmitting the flu.”

Loyola had introduced a policy with more choice in 2008 that required all employees to sign a form stating “yes” or “no” when asked to be vaccinated rather than letting employees simply not get the vaccine. That brought the center’s vaccination rate to 72%, which was well above the CDC’s goal of 60% for health care workers but below what the hospital wanted to see.

Roll up sleeve or don a mask

Hospital Corp. of America, the nation’s largest for-profit hospital chain, increased compliance to 90% when it took a slightly different approach in 2008. It mandated that clinical personnel either get immunized or wear a mask. HCA went from a 58% vaccination rate in 2008 to more than 90% three years later. Results are posted online in the March 7 Journal for Healthcare Quality.

Medical organizations differ on their vaccination policies.

American Medical Association policy supports mandated immunization for physicians and other workers in direct contact with patients in long-term-care settings, unless a medical contraindication or religious objection exists. Outside of those settings, it supports universal influenza vaccination of health care workers but stops short of making it a condition of employment.

APIC recommends that acute-care hospitals, long-term care, and other facilities that employ health care personnel require annual influenza immunization as a condition of employment unless there are compelling medical contraindications.

National Nurses United recommends vaccination but does not support making it a condition of employment.

Loyola saw very little pushback, said Dr. Parada, who added that the key to buy-in was that the mandate came from the top administrators.

“I am sure that there were some VPs who were not quite as supportive, but when they understood that the No. 1 and No. 2, the president and CEO, were really strongly in favor of this, they all lined up.”

In some states with mandated flu shots for health care workers, employees have rebelled. In Rhode Island, more than 1,000 workers signed a petition against mandatory flu shots in October 2012.

“The real question to me is, ‘Does one believe that flu poses a real risk to health care workers and, perhaps more importantly, … the patients?’ If the answer to that question is yes, then to me the only logical solution is then we should reduce that risk,” Dr. Parada said.

When voluntary percentages are in the low 60s and mandatory numbers are nearly 100%, “it’s quite evident why one would want to go to mandatory,” he said.