Protecting Healthcare Personnel in Outpatient Settings: The Influence of Mandatory Versus Nonmandatory Influenza Vaccination Policies on Workplace Absenteeism During Multiple Respiratory Virus Seasons

2018 ◽  
Vol 39 (4) ◽  
pp. 452-461 ◽  
Author(s):  
John Frederick ◽  
Alexandria C. Brown ◽  
Derek A. Cummings ◽  
Charlotte A. Gaydos ◽  
Cynthia L. Gibert ◽  
...  
Keyword(s):  
Influenza Vaccination ◽  
Respiratory Illness ◽  
Healthcare Personnel ◽  
Respiratory Protection ◽  
Vaccination Rates ◽  
Medical Centers ◽  
Observational Cohort ◽  
Mandatory Vaccination ◽  
Outpatient Settings ◽  
Multivariable Regression Models

OBJECTIVETo determine the effect of mandatory and nonmandatory influenza vaccination policies on vaccination rates and symptomatic absenteeism among healthcare personnel (HCP).DESIGNRetrospective observational cohort study.SETTINGThis study took place at 3 university medical centers with mandatory influenza vaccination policies and 4 Veterans Affairs (VA) healthcare systems with nonmandatory influenza vaccination policies.PARTICIPANTSThe study included 2,304 outpatient HCP at mandatory vaccination sites and 1,759 outpatient HCP at nonmandatory vaccination sites.METHODSTo determine the incidence and duration of absenteeism in outpatient settings, HCP participating in the Respiratory Protection Effectiveness Clinical Trial at both mandatory and nonmandatory vaccination sites over 3 viral respiratory illness (VRI) seasons (2012–2015) reported their influenza vaccination status and symptomatic days absent from work weekly throughout a 12-week period during the peak VRI season each year. The adjusted effects of vaccination and other modulating factors on absenteeism rates were estimated using multivariable regression models.RESULTSThe proportion of participants who received influenza vaccination was lower each year at nonmandatory than at mandatory vaccination sites (odds ratio [OR], 0.09; 95% confidence interval [CI], 0.07–0.11). Among HCP who reported at least 1 sick day, vaccinated HCP had lower symptomatic days absent compared to unvaccinated HCP (OR for 2012–2013 and 2013–2014, 0.82; 95% CI, 0.72–0.93; OR for 2014–2015, 0.81; 95% CI, 0.69–0.95).CONCLUSIONSThese data suggest that mandatory HCP influenza vaccination policies increase influenza vaccination rates and that HCP symptomatic absenteeism diminishes as rates of influenza vaccination increase. These findings should be considered in formulating HCP influenza vaccination policies.Infect Control Hosp Epidemiol 2018;39:452–461

Voluntary to Mandatory: Evolution of Strategies and Attitudes toward Influenza Vaccination of Healthcare Personnel

2012 ◽  
Vol 33 (1) ◽  
pp. 63-70 ◽  
Author(s):  
Kathleen Quan ◽  
David M. Tehrani ◽  
Linda Dickey ◽  
Eugene Spiritus ◽  
Denise Hizon ◽  
...  
Keyword(s):  
Influenza Vaccination ◽  
Vaccination Campaign ◽  
Vaccine Uptake ◽  
Healthcare Personnel ◽  
Vaccination Policy ◽  
Vaccination Rates ◽  
Hospital Policies ◽  
Mandatory Vaccination ◽  
Vaccination Campaigns ◽  
The Impact

Background.Assessing the relative success of serial strategies for increasing healthcare personnel (HCP) influenza vaccination rates is important to guide hospital policies to increase vaccine uptake.Objective.To evaluate serial campaigns that include a mandatory HCP vaccination policy and to describe HCP attitudes toward vaccination and reasons for declination.Design.Retrospective cohort study.Methods.We assessed the impact of serial vaccination campaigns on the proportions of HCP who received influenza vaccination during die 2006–2011 influenza seasons. In addition, declination data over these 5 seasons and a 2007 survey of HCP attitudes toward vaccination were collected.Results.HCP influenza vaccination rates increased from 44.0% (2,863 of 6,510 HCP) to 62.9% (4,037 of 6,414 HCP) after institution of mobile carts, mandatory declination, and peer-to-peer vaccination efforts. Despite maximal attempts to improve accessibility and convenience, 27.2% (66 of 243) of die surveyed HCP were unwilling to wait more than 10 minutes for a free influenza vaccination, and 23.3% (55 of 236) would be indifferent if they were unable to be vaccinated. In this context, institution of a mandatory vaccination campaign requiring unvaccinated HCP to mask during the influenza season increased rates of compliance to over 90% and markedly reduced the proportion of HCP who declined vaccination as a result of preference.Conclusions.A mandatory influenza vaccination program for HCP was essential to achieving high vaccination rates, despite years of intensive vaccination campaigns focused on increasing accessibility and convenience. Mandatory vaccination policies appear to successfully capture a large portion of HCP who are not opposed to receipt of die vaccine but who have not made vaccination a priority.Infect Control Hosp Epidemiol 2012;33(1):63-70

Barriers and Facilitators of Implementation of a Mandate for Influenza Vaccination among Healthcare Personnel

2014 ◽  
Vol 35 (6) ◽  
pp. 724-727 ◽  
Author(s):  
Lauren Block ◽  
Samantha Pitts ◽  
Trish M. Perl
Keyword(s):  
Influenza Vaccination ◽  
National Sample ◽  
Infect Control Hosp ◽  
Barriers And Facilitators ◽  
Healthcare Personnel ◽  
Institutional Barriers ◽  
Hospital Administrators ◽  
Vaccination Rates ◽  
Barriers To Implementation ◽  
Mandatory Vaccination

Mandatory influenza vaccination is associated with improved healthcare personnel vaccination rates, but institutional barriers to implementation and enforcement are reported. We explored barriers and facilitators to mandatory vaccination among a national sample of hospital administrators. Support from employees and administration were cited as key to the success of a mandate.Infect Control Hosp Epidemiol 2014;35(6):724-727

Correlates of Improved Influenza Vaccination of Healthcare Personnel: A Survey of Hospitals in Louisiana

2013 ◽  
Vol 34 (7) ◽  
pp. 723-729 ◽  
Author(s):  
Kayla L. Fricke ◽  
Mariella M. Gastañaduy ◽  
Renee Klos ◽  
Rodolfo E. Bégué
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Influenza Vaccination ◽  
Vaccination Campaign ◽  
Vaccination Rate ◽  
Healthcare Personnel ◽  
Patient Contact ◽  
Hospital Type ◽  
Vaccination Rates ◽  
Item Questionnaire

Objective.To describe practices for influenza vaccination of healthcare personnel (HCP) with emphasis on correlates of increased vaccination rates.Design.Survey.Participants.Volunteer sample of hospitals in Louisiana.Methods.All hospitals in Louisiana were invited to participate. A 17-item questionnaire inquired about the hospital type, patients served, characteristics of the vaccination campaign, and the resulting vaccination rate.Results.Of 254 hospitals, 153 (60%) participated and were included in the 124 responses that were received. Most programs (64%) required that HCP either receive the vaccine or sign a declination form, and the rest were exclusively voluntary (36%); no program made vaccination a condition of employment. The median vaccination rate was 67%, and the vaccination rate was higher among hospitals that were accredited by the Joint Commission; provided acute care; served children, pregnant women, oncology patients, or intensive care unit patients; required a signed declination form; or imposed consequences for unvaccinated HCP (the most common of which was to require that a mask be worn on patient contact). Hospitals that provided free vaccine, made vaccine widely available, advertised the program extensively, required a declination form, and imposed consequences had the highest vaccination rates (median, 86%; range, 81%–91%).Conclusions.The rate of influenza vaccination of HCP remains low among the hospitals surveyed. Recommended practices may not be enough to reach 90% vaccination rates unless a signed declination requirement and consequences are implemented. Wearing a mask is a strong consequence. Demanding influenza vaccination as a condition of employment was not reported as a practice by the participating hospitals.

scholarly journals 1716. Results of the Respiratory Protection Effectiveness Clinical Trial (ResPECT)

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S51-S51
Author(s):  
Lewis Radonovich ◽  
Michael S Simberkoff ◽  
Mary Bessesen ◽  
Alexandria C Brown ◽  
Derek Cummings ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Respiratory Infections ◽  
Controlled Trial ◽  
Respiratory Illness ◽  
Healthcare Personnel ◽  
Respiratory Protection ◽  
Protective Effects ◽  
Becton Dickinson ◽  
High Exposure ◽  
Cluster Randomized

Abstract Results of the Respiratory Protection Effectiveness Clinical Trial (ResPECT) Background Respiratory protection (RP) for healthcare personnel (HCP) is controversial and clinical studies are inconclusive about the effectiveness of N95 respirators (N95) and medical masks (MM) for protecting HCP from workplace viral respiratory infections and illnesses (VRII). Methods We conducted a cluster-randomized, investigator-blinded, multisite effectiveness study comparing N95 to MM in geographically diverse, high exposure outpatient settings between 2011 and 2016. Each year during VRII season, participants wore assigned devices when within 6 feet of patients with known or suspected respiratory illness. Respiratory swabs were collected from symptomatic and asymptomatic participants. Diaries detailed VRII exposures, influenza vaccination, adherence to RP and hand hygiene, and manifestations of illness. The primary and secondary outcomes were the incidence of laboratory-confirmed influenza (LCI) using polymerase chain reaction (PCR) and hemagglutinin inhibition assays (HAI), and acute respiratory illness (ARI), influenza-like illness (ILI), laboratory-confirmed respiratory illness (LCRI), and laboratory-detected respiratory infection (LDRI) (figure). Intervention protective effects were estimated using unadjusted odds and incidence rate ratios. Results 5,180 HCP seasons enrolled and randomized (2,243 to N95 and 2,446 to MM), with 4,689 (91%) completing the study. In the intention-to-treat cohort (ITT), among participants in the N95 and MM groups, respectively, 207 (8.2%) and 193 (7.2%) were diagnosed with LCI (odds ratio [OR] 1.14, 95% confidence interval [CI] 0.93–1.40); 1,556 (61.9%) and 1711 (64.1%) were diagnosed with ARI (relative risk (RR) 0.99, CI 0.92–1.06); 128 (5.1%) and 166 (6.2%) were diagnosed with ILI (RR 0.87, CI 0.68–1.10), 371 (14.8%) and 417 (15.6%) were diagnosed with LCRI (RR 0.97, CI 0.84–1.12); and 679 (27.0%) and 745 (27.9%) were diagnosed with LDRI (RR 0.99, CI 0.89–1.09). The adjusted ITT and per-protocol analyses yielded similar results. Conclusion In this outpatient-based, cluster-randomized, controlled trial, neither N95 nor MM resulted in superior protection from LCI or VRII. Disclosures C. Gaydos, BioFire: Consultant, Consulting fee. Cepheid: Speaker’s Bureau, Speaker honorarium. Becton Dickinson: Speaker’s Bureau, Speaker honorarium.

scholarly journals Impact of an influenza vaccine educational programme on healthcare personnel

2016 ◽  
Vol 144 (11) ◽  
pp. 2290-2294 ◽  
Author(s):  
R. RODRÍGUEZ-FERNÁNDEZ ◽  
A. B. MARTÍNEZ-LÓPEZ ◽  
J. PÉREZ-MORENO ◽  
M. I. GONZÁLEZ-SÁNCHEZ ◽  
F. GONZÁLEZ-MARTÍNEZ ◽  
...  
Keyword(s):  
High Risk ◽  
Influenza Vaccination ◽  
Risk Groups ◽  
Educational Programme ◽  
Healthcare Personnel ◽  
Preventive Strategy ◽  
Paediatric Hospital ◽  
Vaccination Rates ◽  
Question Survey ◽  
Effective Preventive Strategy

SUMMARYInfluenza vaccination has been shown to be the most effective preventive strategy to reduce influenza-related morbidity and mortality in high-risk groups. Despite healthcare personnel (HCP) being considered part of such high-risk groups, their vaccination coverage is low in Europe. In January 2012, we distributed an 18-question survey regarding influenza vaccination to HCP at Gregorio Marañon Paediatric Hospital, in Madrid, Spain. After we documented that only ~30% of HCP were vaccinated an educational programme was implemented in October 2012 before the next influenza season. In January 2013, the same survey delivered again to all HCP documented a significant increase in vaccination rates (from 30% to 40%, P = 0·007) mainly among physicians and for patients' protection. In summary we found that a simple and inexpensive educational programme significantly improved the uptake of influenza vaccination in HCP in our centre. Nevertheless, vaccination rates remained low, and broader and updated campaigns are needed to overcome perception barriers.

scholarly journals Revised SHEA Position Paper: Influenza Vaccination of Healthcare Personnel

2010 ◽  
Vol 31 (10) ◽  
pp. 987-995 ◽  
Author(s):  
Thomas R. Talbot ◽  
Hilary Babcock ◽  
Arthur L. Caplan ◽  
Deborah Cotton ◽  
Lisa L. Maragakis ◽  
...  
Keyword(s):  
Influenza Vaccination ◽  
Healthcare Workers ◽  
Position Paper ◽  
Healthcare Personnel ◽  
Executive Summary ◽  
Vaccination Rates ◽  
Official Statement ◽  
Healthcare Epidemiology ◽  
Vaccine Shortages ◽  
New Evidence

Executive SummaryThis document serves as an update and companion piece to the 2005 Society for Healthcare Epidemiology of America (SHEA) Position Paper entitled “Influenza Vaccination of Healthcare Workers and Vaccine Allocation for Healthcare Workers During Vaccine Shortages.” In large part, the discussion about the rationale for influenza vaccination of healthcare personnel (HCP), the strategies designed to improve influenza vaccination rates in this population, and the recommendations made in the 2005 paper still stand. This position paper notes new evidence released since publication of the 2005 paper and strengthens SHEA's position on the importance of influenza vaccination of HCP. This document does not discuss vaccine allocation during times of vaccine shortage, because the 2005 SHEA Position Paper still serves as the Society's official statement on that issue.

scholarly journals Improving immunization practices in United States hospitals and health systems

2017 ◽  
Vol 22 (3) ◽  
pp. 199-211
Author(s):  
Wesley D. Kufel ◽  
Dennis M. Williams ◽  
David Jay Weber
Keyword(s):  
Health System ◽  
Health Systems ◽  
Healthcare Services ◽  
Healthcare Personnel ◽  
Fee For Service ◽  
Content Type ◽  
Vaccination Rates ◽  
Immunization Rates ◽  
The Usa ◽  
Mandatory Vaccination

Purpose Payment for healthcare services in the USA has shifted from fee for service to compensation based on value and quality. The indicators used for payments are a variety of clinical measures, including administration of vaccines to patients. The purpose of this paper is to describe the implementation of programs in health systems to improve vaccination rates and patient outcomes. Design/methodology/approach A search of the literature was conducted to find examples of vaccine programs in US health systems, and also to identify policies to improve immunization rates. Findings Successful programs for improving vaccination rates require advocacy and support of leadership, a systematic and multidisciplinary approach, and an evaluation of local resources and capacity. Numerous examples exist of medical, nursing, and pharmacy led programs that improve vaccination rates. The department in charge has relied on the support of other groups to ensure the success. Social implications Mandatory vaccination of healthcare personnel (HCP) in the health system has been a growing trend in the USA. Although there has been some resistance to mandatory vaccinations for HCP, the standards and requirements have resulted in improved rates in health systems, which ultimately improve efficiency and protects patients. Originality/value This review describes considerations for implementing a successful vaccination program in a health system and provides examples of specific strategies. An overview of mandatory vaccinations for HCP is also described.

Factorial Design for Improving Influenza Vaccination Among Employees of a Large Health System

2009 ◽  
Vol 30 (7) ◽  
pp. 691-697 ◽  
Author(s):  
Richard Kent Zimmerman ◽  
Mary Patricia Nowalk ◽  
Chyongchiou J. Lin ◽  
Mahlon Raymund ◽  
Dwight E. Fox ◽  
...  
Keyword(s):  
Influenza Vaccination ◽  
Health System ◽  
Factorial Design ◽  
Healthcare Personnel ◽  
Patient Contact ◽  
Administrative Positions ◽  
Healthcare Facilities ◽  
Vaccination Rates ◽  
Contact Rates ◽  
Acute Care Facilities

Objective.As healthcare personnel (HCP) influenza vaccination becomes a quality indicator for healthcare facilities, effective inter¬ventions are needed. This study was designed to test a factorial design to improve HCP vaccination rates.Design.A before-after trial with education, publicity, and free and easily accessible influenza vaccines used a factorial design to determine the effect of mobile vaccination carts and incentives on vaccination rates of HCP, who were divided into groups on the basis of their level of patient contact (ie, business and/or administrative role, indirect patient contact, and direct patient contact).Setting.Eleven acute care facilities in a large health system.Participants.More than 26,000 nonphysician employees.Results.Influenza vaccination rates increased significantly in most facilities and increased system-wide from 32.4% to 39.6% (P < .001). In the baseline year, business unit employee vaccination rates were significantly higher than among HCP with patient contact; rates did not differ significantly across groups in the intervention year. In logistic regression that accounted for demographic characteristics, intervention year, and other factors, the use of incentives and/or mobile carts that provided access to vaccine at the work unit significantly increased the likelihood of vaccination among HCP with direct and indirect patient contact, compared with control sites.Conclusions.Interventions to improve vaccination rates are differentially effective among HCP with varying levels of patient contact. Mobile carts appear to remove access barriers, whereas incentives may motivate HCP to be vaccinated. Education and publicity may be sufficient for workers in business or administrative positions. Interventions tailored by worker type are likely to be most successful for improving HCP vaccination rates.

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