Saturday, October 06, 2012

Rhode Island Adopts New Flu Vaccination Requirements For HCPs


HCW Flu Vaccine Survey – Credit MMWR


# 6611


Last week (Sept 28th) the CDC’s MMWR carried a report on the level of seasonal flu vaccination among Health Care Personnel (HCPs) based on a pair of relatively small Internet Surveys.


Influenza Vaccination Coverage Among Health-Care Personnel — 2011–12 Influenza Season, United States


. . .  overall, 66.9% of HCP reported having had an influenza vaccination for the 2011–12 season. By occupation, vaccination coverage was 85.6% among physicians, 77.9% among nurses, and 62.8% among all other HCP participating in the survey. Vaccination coverage was 76.9% among HCP working in hospitals, 67.7% among those in physician offices, and 52.4% among those in long-term care facilities (LTCFs). Among HCP working in hospitals that required influenza vaccination, coverage was 95.2%; among HCP in hospitals not requiring vaccination, coverage was 68.2%.



While the numbers are considerably higher than we’ve seen in previous years, this survey was subject to a number of limitations and may overstate the percentage of HCPs who actually accepted the flu shot last year.


It recruited its small sampling (n=2348) via emails and pop up ads from two websites (Medscape & SurveySpot) – so this was not a random sampling.


Additionally, the responses were based on self-reporting, and were not verified by employee records.


Still, this survey indicated fully 1/3rd of health care workers refused the flu shot last year.  According to this survey, the top three reasons for doing so were:


1) a belief that they did not need it (28.1%)

2) concern about vaccination effectiveness (26.4%)

3) concern about side effects (25.1%).


Regardless of the exact percentage, millions of health care workers in the U.S. choose not to be vaccinated against influenza each year, a number that worries many infectious disease specialists.


While strongly advocating influenza vaccination for HCPs, the CDC has stopped short of mandating them. I blogged on this back in June of 2010 (see CDC: Proposed Influenza Infection Control Guidance).


Many professional medical organizations have taken a stronger stance, adopting policies calling for mandatory vaccination of health care workers (HCWs).  A few earlier blogs on this include:


APIC Calls For Mandatory Flu Vaccination For HCWs
AAP: Recommends Mandatory Flu Vaccinations For HCWs
SHEA: Mandatory Vaccination Of Health Care Workers
IDSA Urges Mandatory Flu Vaccinations For Healthcare Workers



Given that hospitalized patients are often at increased risk of serious illness or death from influenza, reasonable measures that can reduce the spread of the flu virus – such as improved vaccination rates and better infection control measures - are vital areas that many healthcare facilities need to review and improve.


Some facilities are offering employees an alternative to taking the vaccine. This from a July 2011 edition of Infection Control and Hospital Epidemiology.


An Alternate Approach To Improving Healthcare Worker Influenza Vaccination Rates

Lisa M. Esolen, Kimberly Kilheeney, Richard E. Merkle


Essentially, this approach allows HCWs with medical or ethical objections to flu vaccination to opt out and elect to wear a surgical facemask during flu season when in close contact with patients.





Which brings us to a press release from Rhode Island’s Department of Health, announcing the mandating (with some exemptions) seasonal flu vaccinations for all health care workers, students, trainees and volunteers who are likely to have direct contact with patients in a healthcare facility.



HEALTH Adopts Regulations to Require Flu Shots for Healthcare Workers in Rhode Island

Release date: 10-05-2012

PROVIDENCE – The Rhode Island Department of Health (HEALTH) has announced that it has adopted new amendments to its Rules and Regulations for Immunization and Testing For Healthcare Workers that will make flu immunizations mandatory for all workers, students, trainees and volunteers who may have routinely anticipated face-to-face interaction, also known as "direct contact," with patients at a healthcare facility.


"HEALTH listened closely to all stakeholders and used that feedback to craft amendments that addressed the concerns of healthcare workers and volunteers, while protecting patients from the threat of influenza," said Michael Fine, MD, director of HEALTH.


Healthcare workers and volunteers who have a medical reason for not getting a flu shot may obtain a medical exemption from their doctor, licensed physician's assistant or licensed nurse practitioner. This exemption must be renewed annually and submitted to the employing facility by December 15 each year.


Healthcare workers and volunteers who are opposed to having a flu shot but are not medically exempt must submit a form annually by December 15 that states their refusal to be immunized against influenza and indicates their understanding that they are obligated to wear a surgical face mask during each routinely anticipated direct patient contact during any declared period in which the flu is widespread. That determination will be made by the Director of Health, and healthcare facilities will notify all workers that "a period in which flu is widespread" has been declared for the facility.


"Those who care for and interact with patients in a healthcare setting have a duty to protect the health and safety of those for whom they care," said Michael Fine, MD, director of HEALTH. "A flu shot for all those who interact with patients as part of their employment or volunteer efforts at a healthcare facility is the best way to prevent the spread of influenza to some of our state's most vulnerable populations."


These regulations do not apply to patient family members or to friends who visit or otherwise assist in the care of that patient in a healthcare facility.


To read the newly-amended rules and regulations, visit



While this move will likely be applauded by many infectious disease specialists, many HCP will be less than pleased.  Mandatory flu shots have evoked a contentious debate among health care workers for years.


According to an AP article RI health workers now required to get flu shots by Erika Niedowski last night, union officials opposed to mandatory vaccination are already considering how they will respond to this requirement.


New York State, you may recall, attempted to require vaccination as a requirement to work as a HCW in 2009, but legal challenges and vaccine shortages forced them to abandon – at least temporarily – that mandate  (see New York Rescinds Mandatory Flu Shots For HCWs).


In recent years an increasing number of hospitals have moved aggressively towards implementing mandatory flu vaccinations, including Seattle’s Virginia Mason Medical Center and BJC Heathcare of St. Louis, Missouri  (see here and here).


The Immunization Action Coalition (IAC) maintains a terrific website with extensive information on vaccines, and includes a growing `Honor Roll’ of organizations and practices that have adopted a mandatory flu shot policy (some exemptions may apply).


Of course, legal challenges still lie ahead.

Hospitals increasingly are looking at this as both a liability and an economic issue, on top of their concerns over patient welfare.


Love the idea or hate it – short of an overturn in the courts – the requirement for annual flu vaccinations in HCPs appears to be gaining traction across the country.

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