More Hospitals Requiring Influenza Vaccine for Workers

Marcia Frellick

June 01, 2018

The percentage of hospitals that require healthcare personnel (HCPs) to have annual influenza vaccinations has jumped dramatically in 4 years, according to national survey data.

M. Todd Greene, PhD, MPH, from the Patient Safety Enhancement Program at the University of Michigan and the Veterans Affairs (VA) Ann Arbor Healthcare System and colleagues found that among all responding hospitals, the percentage that require annual influenza vaccinations for workers went from 37.1% in 2013 to 61.4% in 2017 (difference, 24.3%; 95% confidence interval [CI], 18.4%-30.2%; P < .001).

The findings were published online today in JAMA Network Open.

Most of the increase came from non-VA hospitals. Among those hospitals, requirement policies increased from 44.3% (171 of 386) in 2013 to 69.4% (365 of 526) in 2017 (difference, 25.1%; 95% CI, 18.8%-31.4%; P < .001). In contrast, there was no significant change among VA hospitals (1.3% [1 of 77] to 4.1% [3 of 73]; difference, 2.8%; 95% CI, −2.4% to 8.0%; P = .29).

"While HCP influenza vaccination in VA hospitals is strongly encouraged, as of summer 2017, less than 5% of VA hospitals mandated influenza vaccination for HCP providing care for veterans," the authors write.

However, after the study period, the authors note, the VA announced in September 2017 that all personnel were expected to receive the annual vaccine, and if they are unwilling or unable to get it, they must wear masks throughout the influenza season.

The survey was part of an ongoing project in which the authors surveyed hospital preventionists every 4 years. The overall response rate from hospitals' infection preventionists for the 2013 survey was 69.3%, and in 2017 was 59.1%.

In an accompanying commentary, Hilary Babcock, MD, MPH, an infectious disease specialist at Washington University School of Medicine in St. Louis, Missouri, noted that the survey has many limitations. Among them, the surveys in 2013 and 2017 included different facilities and the 2017 survey included smaller hospitals, eliminating direct comparison. Also, the survey question was worded slightly differently in the 2 years.

Most important, Babcock said, the term "mandate" seems ill-defined among the hospitals.

"Among respondents who reported having a vaccination mandate, only 74% reported having penalties for noncompliance and 13% allowed declination without a specified reason. Of those reporting no mandate, 21% reported penalties for noncompliance with hospital policy on influenza vaccination and 41% reported requirements for wearing masks if unvaccinated," she explained.

Still, an increase seems likely, Babcock said. For example, in the 2013 survey, 4% of respondents reported discussing mandates, about 10% said they would have one the next season, and 21% endorsed having an option to decline (signed form and/or mask requirement).

She notes that the Centers for Disease Control and Prevention Healthy People 2020 initiative pushes for an HCP vaccination rate above 90% and she says it is becoming clear that the best way to reach that bar is with an institutional requirement.

Greene and colleagues note that "over the past several years, HCP influenza vaccination coverage rates have continuously been greater than 95% among HCP required by their employer to be vaccinated."

However, mandating vaccines is controversial, and the authors acknowledge that although they encourage healthcare organizations to consider requiring HCPs to have annual influenza vaccinations, they should also consider the ethical, moral, and legal implications.

Babcock says the announcement by the VA holds promise for studying the relationship between vaccinating workers and better outcomes for patients. Because the system has large numbers of hospitals with a wide range of locations and sizes, and because patients often receive all of their inpatient and outpatient care within the VA system, it provides new opportunities for research, she writes.

Greene reports receiving grants from Blue Cross Blue Shield of Michigan Foundation and the US Department of Veterans Affairs Patient Safety Center of Inquiry during the conduct of the study. Coauthors report grants from the US Department of Veterans Affairs National Center for Patient Safety and Blue Cross Blue Shield of Michigan Foundation during the conduct of the study, and personal fees from Jvion and from Doximity outside the submitted work. The study was supported by Blue Cross Blue Shield of Michigan Foundation, the US Department of Veterans Affairs, and the Veterans Affairs National Center for Patient Safety. Babcock has disclosed no relevant financial relationships.

JAMA Network Open. Published online June 1, 2018.

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