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Revealed: Why Health Providers Avoid Vaccines

Cheryl Clark, for HealthLeaders Media, September 1, 2010

The monograph continued: "Health care organization leaders and staff need to mount a concerted effort to improve influenza immunization rates among HCP. Increasing influenza vaccination rates among HCP would reduce the burden of the disease and its associated health care costs."

The CDC's Advisory Committee on Immunization Practices has recommending that all healthcare providers be immunized against influenza since 1984. But obviously, there's a long way to go.

"Vaccination rates of 80% or higher may be needed to provide the 'herd immunity' that prevents healthcare-associated influenza by immunizing those who care for and live with susceptible patients who may not develop an optimal protective response to the influenza immunization.

That may require more healthcare settings, such as hospitals, surgical centers, clinics, and physician practices, to require that its workers get vaccinated, or to encourage vaccination with campaigns or department contests. 

The Joint Commission monograph listed many ways to increase facility compliance and includes case studies from many institutions that were successful.  One obvious technique is to provide vaccination for free. Another is to make it convenient, and a third is to create incentive programs.

CDC officials say they are pleased vaccination rates among providers are increasing, although they acknowledge much more work needs to be done to educate providers who won't or don't.

"Vaccination levels are now known to be much higher in some groups than among others namely physician’s levels are around 70% and allied health and support workers around 40% .  Nurses are in the middle at about 60%," says Gary L. Euler, CDC epidemiologist.

Hospital workers in general have higher levels than do HCP in outpatient facilities such as physician practices with levels the lowest among HCP working in nursing homes CDC is glad to now be able to measure and report levels by occupation and by facility type so that effective interventions can be targeted where they are most needed, he explains.

Many hospitals and clinics have had success with declination programs, in which healthcare employers require workers to actively decline to get vaccinated in writing.  That seems to spur workers to launch discussions about their reasoning, and does away with many providers who don't get vaccinated simply because they forgot to do it or postponed it too long.

Last week, the CDC revised its estimates of influenza mortality, saying that rather than using the 36,000 per year figure that is based on average death rates from the 1990s, each season is more variable, spanning a range of between 3,349 deaths to 48,614 over the last 31 years.

CDC officials say that while Virginia Mason Medical Center in Seattle, WA was the first healthcare institution to mandate influenza vaccination for its workers in 2005, only 66 other hospitals and clinics have followed with such policies nationally, according to an "honor roll" maintained by the Immunization Action Coalition.

I hope the dreaded pandemic flu never comes, of course. But if it does, I hope that my health providers I might depend on for care will not have to stay home because they're sick too.


Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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