February 27, 2013 – Hospitals with flu vaccination mandates for health care workers that include consequences for noncompliance saw greater increases in vaccination rates than hospitals that had mandates without consequences or no mandates at all, according to a study published online in the American Journal of Infection Control.
In fact, the change in the vaccination rates in hospitals with mandates that included consequences was almost double the rate for hospitals that had mandates without consequences.
States have started passing legislation regulating health care worker flu vaccination, and an increasing number of hospitals have started implementing policies in attempt to reach the Healthy People 2020 goal of having 90 percent of health care workers vaccinated. Only two-thirds of health care workers were vaccinated against the flu last year. This can leave patients at risk and hospitals short-staffed because of absenteeism.
The study, conducted by Mary Patricia Nowalk, PhD, RD and Richard Zimmerman, MD, MPH and their colleagues at the University of Pittsburgh, offers insight into the impact hospital policies and state laws have on health care worker vaccination rates.
The study surveyed 150 hospitals that require employees to receive a vaccination against the seasonal flu. Of those hospitals, there were 84 with policies that include consequences for workers who did not comply and 66 hospitals that had policies without consequences.
The researchers found that among those hospitals with consequences, 66.7 percent required workers who did not comply to wear a mask, 28.5 percent terminated the position of those who did not comply, 14.3 percent required workers to take classes or receive additional education, 6 percent restricted those workers from patient care duties, and 3.6 percent required temporary suspension or unpaid leave.
When the researchers asked which factors led to the implementation of a mandate, hospitals most frequently cited the previous year’s vaccination rates. Those hospitals without consequences attached to their mandate more often cited the state law or statues and the Joint Commission recommendations, while those hospitals with consequences more often cited experience with similar policies at other facilities.
The article is available online: http://bit.ly/13XjHHR
An interview with study PI Richard Zimmerman, MD, MPH, can be viewed at: http://youtu.be/r0CNxLbS-TI
The grantee description page can be found here: http://bit.ly/TsMy0z
Bethany Swanson, PHLR Communications Director
In the United States, vaccinations against certain diseases are accepted as an important step in leading a healthy life and helping to keep other people from getting sick. It is not unusual to be required to show proof that you have had certain vaccinations before you are allowed to register for school or college, for example. But these common requirements for vaccination do not always extend to influenza—commonly known as flu—even for hospital workers who are at the most risk of exposure to the flu virus and who are likely to come into contact with people who are at a high risk of serious health complications if they were to become infected with the flu virus. This study will take a state-by-state inventory of laws that regulate influenza immunization among people who work in hospitals. Investigators will also review policies that individual hospitals and health systems might have to require their employees to receive a flu vaccination. The study will then match these findings with data on rates of vaccination among hospital workers to determine what, if any, effect such laws and policies have on vaccination rates.
Grant Number: 68394
Funding Date: Mon, 11/15/2010
Researching Institution: University of Pittsburgh Graduate School of Public Health, Center for Public Health Practice
Researcher: Patricia Sweeney, J.D., M.P.H., R.N.; Richard Zimmerman, M.D., M.P.H., M.A.
ORIGIN: Community Guide systematic review
Publication Date: 12/07/2009
Vaccine coverage for preventable disease is an essential public health goal. Low vaccine coverage rates enable otherwise avoidable outbreaks of harmful diseases. CDC: Vaccines and Immunizations.
State vaccination laws require children to be immunized prior to entering school. National Vaccine Program Office: Immunization Laws. Subject to instances where exemptions apply, these laws require written proof of a child’s immunization status provided from a health provider. For examples of state vaccination laws, see Colorado (6 CCR 1009-2), Iowa (Iowa Administrative Code), Nebraska (173 NAC 3) and Massachusetts (105 CMR 220.000).
In a systematic review, a Community Guide expert panel reviewed the evidence concerning the effectiveness of requiring vaccinations as a condition of matriculation into child care, secondary school or college. Briss PA, Rodewald LE, Hinman AR, et al. Reviews of evidence regarding interventions to improve vaccination coverage in children, adolescents, and adults. Am J Prev Med 2000;18(1S):97-140. The review identified nine studies in the U.S. and Canada that measure the impact of these requirements. Of the nine studies, seven examined the impact of school laws; one examined vaccination mandates for child care, and one looked at requirements for college attendance. Six studies measuring the effect of vaccination requirements on the incidence of specific diseases (e.g., measles) found an inverse relationship suggesting that laws reduce rates of the targeted diseases. Three studies also observed a positive relationship between mandated immunization programs and rates of vaccination among the target populations. On the basis of this evidence, the reviewers concluded that there is sufficient evidence that school vaccination requirements are an effective public health intervention aimed at increasing vaccination coverage and decreasing the incidence of certain diseases.
The Centers for Disease Control and Prevention has compiled and provided online access to all state vaccination laws.
The Immunization Action Coalition also has online maps showing specific legal requirements for the fifty states.
This project will explore the relationship between non-medical exemption laws and variability in those state laws and disease rates. The project will employ mixed-effects hierarchical models at 3 levels (year, state, and region) of analysis for 5 vaccine-targeted diseases (measles, mumps, pertussis, varicella, andhepatitis B). We will use a longitudinal research design to examine state-level data from 51 jurisdictions over 8 years (2001-2008). Deliverables for this project include at least two publications for highly visible law and health journals, an Issue Brief to be distributed in the NCLS newsletter, the Forum for State Health Policy and to State Health Commissioners. The project staff also aims to present findings to the Institute for Medicine and in other legislative venues.
Grant Number: 67143
Funding Date: Tue, 12/01/2009
Researching Institution: George Mason University
Researcher: Y. Tony Yang, Sc.D., M.P.H., Vicky Debold, Ph.D. R.N.