PUB­LIC HEALTH:

More hos­pi­tals man­date flu shots for work­ers

Modern Healthcare - - MODERN HEALTHCARE - Ashok Sel­vam

More hos­pi­tals man­dat­ing flu vac­ci­na­tions for staff

Seattle’s Vir­ginia Ma­son Med­i­cal Cen­ter stood alone seven years ago when the hospi­tal first re­quired its staff to re­ceive in­fluenza vac­ci­na­tions. But these days, the start of the flu sea­son means Vir­ginia Ma­son’s phones ring off the hook with calls from other providers ask­ing for tips on how to start their own im­mu­niza­tion pro­grams.

Ban­ner Health, a 21-hospi­tal sys­tem based in Phoenix and with hos­pi­tals in seven states, called for ad­vice, as Vir­ginia Ma­son is widely ac­knowl­edged as the first ma­jor hospi­tal that has im­ple­mented such a pro­gram. Ban­ner started its pi­lot pro­gram last year called “No Flu for You.” This year, they’re rolling out the pro­gram full scale for its 36,000 work­ers.

“This pro­gram is around to make our pa­tients as healthy as pos­si­ble when we are tak­ing care of them,” said Dr. Mar­jorie Bessel, chief med­i­cal of­fi­cer for Ban­ner’s Ari­zona East re­gion.

Ban­ner used the Im­mu­niza­tion Ac­tion Coali­tion’s web­site as a re­source. The St. Paul, Minn.-based IAC works with the Cen­ters for Dis­ease Con­trol and Preven­tion to de­velop im­mu­niza­tion rec­om­men­da­tions.

Con­tra Costa County, Calif., last week also an­nounced its own em­ployee vac­ci­na­tion re­quire­ment. The or­der was sent to hos­pi­tals, emer­gency med­i­cal ser­vice providers, am­bu­la­tory health clin­ics, skilled-nurs­ing fa­cil­i­ties and other health­care fa­cil­i­ties in the county, and got the back­ing of Kaiser Per­ma­nente.

Ear­lier this year, the Na­tional Busi­ness Group on Health joined the Amer­i­can Hospi­tal As­so­ci­a­tion, the Amer­i­can Col­lege of Physi­cians and oth­ers in sup­port­ing manda­tory flu shots.

Vir­ginia Ma­son planned to be­gin the sea­son’s vac­ci­na­tion process Sept. 18, and they’ve seen suc­cess since 2005, im­mu­niz­ing nearly all of its 5,000 work­ers. There are a few out­liers— those with med­i­cal con­di­tions, union af­fil­i­a­tions or reli­gious be­liefs that ex­empt them from the vac­ci­na­tions.

BJC Health Care in St. Louis fol­lowed with its own re­quire­ment in 2007. The sys­tem vac­ci­nated 98.4% of its 25,980 ac­tive em­ploy­ees in 2008, ac­cord­ing to a Wash­ing­ton Univer­sity School of Medicine re­port re­leased in 2010. About 0.3%, or 90, gained reli­gious ex­emp­tions, while 321, or 1.2%, re­ceived a med­i­cal ex­emp­tion. Eight em­ploy­ees, or .03% of the work­force, were ter­mi­nated af­ter fail­ing to re­ceive a vac­ci­na­tion in time.

HHS re­ported that for the 2006 flu sea­son, 42% of health­care work­ers were im­mu­nized. The rate for the 2010 sea­son was 63.5%. How­ever, at places where vac­ci­na­tions were man­dated, 98.1% of work­ers were im­mu­nized. The 2009 out­break of H1N1 in­creased those rates by forc­ing more hos­pi­tals to de­velop a pro­gram. It also af­fected Vir­ginia Ma­son’s ex­ist­ing pro­gram. The staff at the 248-bed hospi­tal needed sec­ond im­mu­niza­tions that sea­son, this time to pro­tect them from swine flu.

Start­ing in 2013, the CMS will re­quire acute-care hos­pi­tals to re­port health­care flu vac­ci­na­tions as part of the agency’s hospi­tal in­pa­tient qual­ity re­port­ing pro­gram. The gov­ern­ment al­ready of­fers bonus pay­ments to hos­pi­tals that vol­un­tar­ily re­port im­mu­niza­tion rates. Some providers, where im­mu­niza­tions aren’t manda­tory, of­fer raf­fle prizes and other in­cen­tives for em­ployee vac­ci­na­tion.

A Na­tional Vac­cine Ad­vi­sory Com­mit­tee re­port from this year rec­om­mended manda­tory poli­cies for providers strug­gling to hit tar­geted em­ployee vac­ci­na­tion rates. How­ever, the group noted that reli­gious be­liefs, al­ler­gies to vac­cines, and union ob­jec­tions can pose ob­sta­cles. The coun­try’s largest nurses’ union, Na­tional Nurses United, has op­posed NVAC’s rec­om­men­da­tion, say­ing it shouldn’t be a con­di­tion of em­ploy­ment.

The ex­emp­tion pol­icy at Vir­ginia Ma­son was the re­sult of a 2006 U.S. Dis­trict Court rul­ing in fa­vor of the Wash­ing­ton Nurses As­so­ci­a­tion. The union claimed the manda­tory vac­ci­na­tion pol­icy should have been ne­go­ti­ated as part of its col­lec­tive bar­gain­ing agree­ment.

Lam­mert said the ben­e­fits are worth the pro­gram’s costs, which in­clude the vac­ci­na­tions and per­son­nel: “It’s re­ally helped change our cul­ture and how we look at our obli­ga­tion to the pa­tient.”

Richard Watts of Ban­ner Good Sa­mar­i­tan Med­i­cal Cen­ter re­ceives a flu shot.

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