Loyola University Medical Center endured its share of objections from healthcare workers who did not want to be vaccinated against influenza. But it has found a way to convince nearly everyone on staff to get the flu shot.
Mandatory flu vaccination programs for healthcare workers have stirred controversy and are especially unpopular among nurses. But Chicago's Loyola University Medical Center—one of the first hospitals mandate that all employees get the flu vaccine—has achieved 98% to 99% compliance among its 8,008 workers, with only 15 involuntary terminations since 2009.
"We do everything we can to minimize any impediment," says Jorge Parada, MD, professor of medicine at Loyola, MD and author of a report on the Loyola effort that he presented Sunday to attendees gathered at the Association for Professionals in Infection Control and Epidemiology's annual conference in Fort Lauderdale. "We make sure it's free and easy to get."
While prior to the policy, vaccination rates at 561-bed Loyola ranged around 65%, last year compliance was 98.7%, and the year before, it was 99%, Parada says.
Last year, the hospital allowed 97 employees an exemption on religious or medical grounds, and only five employees were terminated for refusing vaccination. Three of those five were unpaid volunteers who later reconsidered, got vaccinated and returned to work.
Under Loyola's policy, all employees, medical students, volunteers, and contractors must receive the vaccine, which is offered at no charge to all workers. If individuals choose to receive the vaccine at a drugstore or through another setting, documentation from that provider is accepted, but that is rare, Parada says.
Of the 15 total healthcare workers who were terminated because they refused to get the vaccine since 2009, nine left during the program's first year. That was the biggest year," he says, "but five of those employees had lined up other employment and had the intent to leave independent of this policy."
The idea of universal vaccination within healthcare settings is an increasingly important priority for the federal government. Starting last January 1, the Centers for Medicare & Medicaid Services began requiring acute care hospitals to report healthcare provider vaccination levels as part of the inpatient quality reporting program.
In exchange for reporting that information, hospitals can avoid a 2% reduction in its reimbursement from Medicare, effective Oct. 1, 2014. Hospitals participating in the IQR must report vaccination rates for all employees who worked for at least 30 days from October 2012 through March 2013.
Parada says that like many healthcare systems, Loyola endured its share of objections and "pushback" from its staff. Healthcare workers gave four main reasons:
1. They don't need it because they think they won't get the flu. Perhaps they have never had a symptomatic influenza illness.
2. The vaccine is not 100% effective, so why should they allow an injection of something that might not protect them.
3. The vaccine can cause side-effects or will provoke a disease or condition, like Guillain–Barré syndrome with paralysis. Or they don't want to get a sore arm.
4. They think getting a vaccine they don't want is tantamount to giving up their rights and this violates freedom of choice. Parada says at Loyola, there were some workers who received the flu shot every year, but when the mandate was enforced in 2009, said "You know, I used to get it. But now, if they're going to make me, I don't think I will, just in protest."
But each of those reasons was successfully overcome through town hall meetings and educational initiatives scheduled during all shifts. The most effective argument was the reasoning that the virus can make healthcare workers sick and that they can transmit it to their vulnerable patients. The vaccine is at least 60% effective in preventing the flu. And an infinitesimally small number of those vaccinated have developed side-effects.
"But at the end of the day my number one answer," Parada says, "is that it's not about you, the healthcare worker. It's not about the worker's right to get the vaccine or not get the vaccine. It's about the responsibility to make sure that I don't make my patients sick.
"And if I can reduce the odds that I'm going to catch a vaccine-preventable contagious disease, I should do that because it's going to reduce the odds that I will transmit the disease to all our vulnerable patients that we care for."
Parada also justified Loyola's policy of paying for and distributing the vaccine to all its workers for free.
"There's a fiduciary responsibility on the part of a healthcare organization to try to diminish the risk to healthcare workers. They're at higher risk of catching the flu because when anyone gets (a severe case of influenza), they're going to show up in the hospital. And this vaccine reduces the risk by more than half."
Parada says that while Loyola was one of just a few hospitals in the country to initiate the policy when it did, today many more organizations refuse employment to those who won't get their annual flu shot.
"It's still the minority of hospitals, but it's not nearly as rare as it was. Each year more hospitals adopt these policies."