One in three healthcare workers didn't bother getting immunized against influenza during the 2011–2012 flu season, prompting government and infectious disease organizations to push for more aggressive efforts from healthcare organizations.
Even though last season's overall healthcare worker immunization rates were 3.4% higher than in 2010–11, in hospitals, nearly one in four (23.1%) workers weren't immunized, in physician offices one in three (32.3%) were not immunized, and in long-term care facilities, nearly half (47.6%) of workers failed to get their flu shots. That's according to the Morbidity and Mortality Weekly Report published by Friday by the Centers for Disease Control and Prevention.
The stakes will get higher at least for acute care hospitals starting Jan. 1, when pay-for-reporting rules set by the Centers for Medicare & Medicaid Services require hospitals to submit influenza vaccination rates for their workers for the 2012-13 influenza season. They will be publicly reported starting next July.
Asked during a news conference how healthcare providers expect to motivate their patients to get flu vaccines when so many providers don't set a good example, Litjen Tan, Director, Medicine and Public Health for the American Medical Association, replied that providers are beginning to understand the need for immunization.
"That they need to be good role models and get vaccinated themselves, I think, is something that's beginning to hit them, in terms of their radar, and that's why you're seeing these rates going up," he said.
Recommendations from the National Vaccine Advisory Committee this February say every medical facility needs to have an influenza prevention program in place, and that vaccination "needs to be an important component."
"But if you have all these prevention programs in place and you still can not successfully immunize 90% of your healthcare workers, which is the Healthy People 2020 goal, they strongly recommend that you start looking at other methods to try to get to that rate, which includes things like (making vaccination) a condition of employment," Tan said.
Added William Schaffner, MD, past president of the National Foundation for Infectious Diseases: "We think very strongly about this. I believe that the immunization of the healthcare provider community, writ large, is both an ethical and a professional responsibility of those healthcare workers."
There are two reasons, Schaffner says. "The first and most important is that it's a patient safety issue, so that we do not transmit our influenza infection to our patients. The other reason is that when influenza strikes, we need to be vertical, not horizontal."
A CDC official, responding to an email query, wrote "Hospitals will be asked to report vaccinations received by healthcare personnel at the facility, vaccinations received outside the facility, medical contraindications, and declinations.
"Data must be reported for all payroll employees, licensed independent practitioners (who are physicians, advanced practice nurses, and physician assistants affiliated with the hospital but not on payroll), and students, trainees, and volunteers age 18 or older," for employees who worked at the facility at least 30 days between Oct. 1, 2012 and March 31, 2013.
Nancy Foster, vice president for quality and patient safety policy for the American Hospital Association, says the data will be publicly reported as a batch for all hospitals, but that hospitals will report separately for employees who receive a direct paycheck, licensed independent practitioners including physicians and osteopaths, advanced practice nurses and physicians assistants who do not receive a direct paycheck, and students, trainees and volunteers.
She said the requirement is part of a pay-for-reporting condition in the Hospital Inpatient Quality Reporting Program.
The batch immunization rates will be posted on Hospital Compare in July.
Asked what types of incentives hospitals might employ to provoke their workers to get vaccinated, Foster says that some hospitals have used Starbucks cards, competition among staff, and other methods.
"But the truth is that the data showing the link between improved vaccination rates and reduced problems for patients is the most compelling motivator."
Other statistics gleaned from the MMWR include:
- 33.1% of health care personnel did not get an influenza vaccine last season.
- In hospitals that required influenza immunization among their employees, immunization reached 95.2% but in hospitals that didn't require it, the coverage was only 68.2%.
- Compliance was greatest among physicians, (85.6%); nurses (77.9%) but for other healthcare personnel, it was (62.8%).
- For all healthcare personnel working in hospitals, coverage was 76.9%, 67.7% for all those working in physician offices, and 52.4% for those in long-term care facilities.
- Immunization among healthcare personnel ages 60 or over was higher than for other age groups. And, coverage did not differ more than 5 percentage points among racial/ethnic groups.