Mandatory flu vaccination of healthcare personnel does not lead to worker exodus

(Press-News.org) Fort Lauderdale, Fla., June 7, 2013 – Mandatory influenza (flu) vaccination, as a condition of employment, did not lead to excessive voluntary termination, according to a four-year analysis of vaccination rates at Loyola University Medical Center in Maywood, IL.

Flu infections result in approximately 150,000 hospital admissions and 24,000 deaths annually.1 The Centers for Disease Control and Prevention (CDC) recommends that all healthcare personnel (HCP) receive the annual flu vaccine, yet the national average for HCP vaccination is only 64 percent.

Infection control and prevention specialists at Loyola worked with a multidisciplinary task force to develop a facility-wide policy that made flu vaccination a condition of employment. Their successful approach will be presented on Sunday, June 9, at the 40th Annual Conference of the Association for Professionals in Infection Control and Epidemiology (APIC).

"`First, do no harm' is our mandate as healthcare workers," said Dr. Jorge Parada, MD, MPH, FACP, FIDSA, study author and professor of medicine at Loyola University Chicago Stritch School of Medicine. "We should do all we can to not pass along illness to our patients."

As one of the first medical centers in the country to implement mandatory flu vaccination, Loyola began with the full backing of the hospital's senior leadership. They introduced an active declination system in 2008 – HCPs were no longer allowed to simply not bother to get influenza vaccination, instead they were required by Employee Health to state "yes" or "no" when asked to be vaccinated and to provide reasoning for why they declined the vaccine. This brought the center's overall vaccination rate up to 72 percent, well above the CDC's goal of more than 60 percent of HCPs vaccinated, but the hospital aimed higher.

"This was still well short of what we at Loyola felt we should achieve to maximize patient safety," said Dr. Parada, who led the vaccination program. "After all, this still meant more than one in four staff were not being immunized. In addition, let's not forget that as healthcare workers our staff are at greater risk than the general population for exposure to the flu virus, and we also have a fiduciary responsibility to try and protect our HCP (and by extension, their families) from becoming ill. Vaccination provides that added protection."

In 2009 Loyola chose to mandate flu vaccination as a condition of employment, and extended this mandate to students, volunteers, and contractors. To support and encourage compliance, the center's communications department developed facility-wide reminder emails and created short videos, which were displayed on flat screens throughout the hospital.

In the first year of the mandatory policy (2009-'10 season), 99.2 percent of employees received the vaccine, 0.7 percent were exempted for religious/medical reasons, and 0.1 percent refused vaccination and chose to terminate employment. The results have been sustained: In 2012, 98.7 percent were vaccinated, 1.2 percent were exempted and 0.06 percent refused vaccination.

Dr. Parada explained that in reality, their 2012 numbers were even better than that because, of the five people who refused vaccination in the mandatory period, three were unpaid volunteers, who later reconsidered, received vaccine and returned to Loyola, and the other two were part-time staff, each with only 10 percent time commitment at Loyola, truly reflecting a 0.002 percent vaccine-refusal rate. Over the course of four years, fewer than 15 HCP (including volunteers) out of approximately 8,000 total chose termination over vaccination.

"Near-universal flu immunization is achievable and sustainable with a mandatory vaccination policy," Dr. Parada said. "Our employees and associates now understand that this is the way we do business. Just as construction workers must wear steel-toed boots and hard hats on job sites, healthcare workers should get a flu shot to work in a hospital. We believe that patient and staff safety have been enhanced as a result."

### To assist infection preventionists who are establishing flu vaccination as a condition of employment, APIC has published a position paper with recommendations and rationale for mandatory influenza immunization.

The APIC 2013 Annual Conference, June 8-10 in Fort Lauderdale, is the most comprehensive infection prevention conference in the world, with 90 educational sessions and workshops led by infection prevention experts and attended by more than 4,600 individuals. The conference aims to provide infection preventionists with tools and strategies that are easily adaptable and can be implemented immediately to improve prevention programs. The Twitter hashtag #APIC2013 is being used for the meeting.

Oral Abstract #012 – Four-Year Experience with Mandatory Seasonal Influenza Immunization for All Personnel in a University Medical Center, Sunday, June 9, 10:15- 10:30 a.m.

About APIC
APIC's mission is to create a safer world through prevention of infection. The association's more than 14,000 members direct infection prevention programs that save lives and improve the bottom line for hospitals and other healthcare facilities. APIC advances its mission through patient safety, implementation science, competencies and certification, advocacy and data standardization. Follow APIC on Twitter: http://twitter.com/apic. 1Estimates of Deaths Associated with Seasonal influenza—United States, 1976-2007. JAMA 2010; 304(16):1778-1780.