Cons of Mandatory Vaccination

1. Cons of Mandatory Vaccination • Patient safety vs. HCW autonomy • Could be considered coercive • Fear of litigation • Fear of union backlash • Fear of negative impact on employee/employer relations

3. Facilities Implementing a Mandatory HCW Influenza Vaccination Program HCA, MSH VMMC

4. 2012-13 • British Columbia mandates influenza vaccination or masking for all HCW’s -disciplinary action not being enforced in first year • Rhode Island first state to mandate influenza vaccination for its direct care givers -challenged by unions

5. VMMC Experience • 7 (0.15%) HCWs left during the first year of the requirement, 2 were terminated and 5 left citing the reason for leaving was the flu mandate • Over the last 4 influenza seasons, only 2 additional HCWs have left • Employee satisfaction scores have improved over the years as judged by an annual external survey • Our culture of safety annual survey has steadily improved • In 2010 we were voted one of the 2 Leapfrog top hospitals of the decade!

6. Unionized Staff • 2005-2006 season: 86% of unionized nurses elected to get immunized • 2010-2011: only 17 (2%) of our 590 inpatient nurses elect not to get vaccinated, these numbers have steadily decreased each year • 2011 masking issue resurfaces • 2012 no current issues

7. Fitness For Duty • Requirement is all inclusive • Includes outside contractors, vendors, volunteers, students and community providers • As a result, > 1000 additional vaccinations provided annually through EH services • Requirement is now reviewed with all new employees • Initial application (online pop up asks if applicant accepts policy) • Reviewed in interview process • Reviewed in job offer letter • Reviewed in orientation

8. VMMC Influenza Vaccination Rates *Preliminary Data

9. Virginia Mason Medical Center 2013 Where are we? • Leaders in patient safety: not waiting for the public to demand it • Aligned with all of the safety and quality work that the organization does • Flu immunization in the fall has just become something we do...part of our organizational culture of safety • Winners of the 2007, & 2011 Healthcare Workers Campaign Award at the NIVS

10. Leapfrog Honors VM

12. Kickoff Event: Making it fun!

13. Seahawks/Sea Gals sign playbooks and photos at Kickoff Party

14. 2012 Kickoff Event

15. 2012 Kickoff Event

16. Other Methods of Vaccine Delivery • Make it convenient • Roving carts • After hours clinics • Vaccinate at regularly scheduled meetings • Drive through clinics • Peer vaccinators • Honor (and pay) for documented vaccination at other locations • Provide multiple vaccine options (IM, ID, Mist)

17. Washington State Hospital Association Board • Board approved a motion asking all hospitals in Washington State to adopt a policy including: • HCW provide annual documentation of influenza immunization; if not immunized wear a mask or follow alternate steps outlined by hospital ID program • All hospitals shall report staff influenza immunization rates to WSHA July 2010

18. WSHA Newsletter 9-11 Editor: Carol Wagner                   September 27, 2011 Washington State Leads the Nation in Hospital Worker Flu Immunizations, Next Year Will Be Even Better Congratulations are in order just as many of you are beginning to plan your next year employee flu campaigns. Last year, 86 percent of Washington hospital workers were immunized against the flu thanks to your hard work! Washington State’s hospital worker flu immunization rate is 15 percent above the national average.The goal for 2011-2012 flu season is 90 percent immunization rate for workforce plus those that you grant privileges to such as physicians, nurse practitioners, etc. Information on best practices will be shared on our October 20, 2011 web conference.Key strategies include: Developing clinical champions Helping staff understand why it is important to them and their patients Making getting the immunization easy Celebrating success We look forward to continuing to achieve great results.  (Carol Wagner,carolw@wsha.org)

19. NHSN: Mandatory Reporting of Healthcare Personnel Influenza Vaccination The Centers for Medicare & Medicaid Services (CMS) published a final rule in August of 2011 adding Healthcare personnel (HCP) influenza vaccination to its Hospital Inpatient Quality Reporting Program • Acute care hospitals that fail to report a designated set of quality measures may be subject to a decrease in their annual payment update from CMS • Hospitals must begin reporting HCP influenza vaccination on January 1, 2013 for the FY 2015 payment determination • Data are to be reported to CMS via the NHSN system

20. NHSN Measure Specifications: Denominator • Report three mutually exclusive groups of HCP: • Employees: Includes all persons who receive a direct paycheck from the reporting facility (i.e. on payroll) • Licensed Independent Practitioners: Includes only physicians (MD, DO) advanced practice nurses, and physician assistants affiliated with the facility but not receiving a direct paycheck from the facility • Adult Students/Trainees and Volunteers: Includes all students, trainees, and volunteers aged 18 and over affiliated with the facility but not receiving a direct paycheck from the facility

21. Measure Specifications: Numerator • Received influenza vaccination at the healthcare facility • Reported in writing (paper or electronic) or provided documentation that vaccination was received elsewhere • Determined to have a medical contraindication or condition of severe allergic reaction to eggs or other vaccine components or history of Guillain-Barre Syndrome less than 6 weeks after prior influenza vaccination • Offered but declined influenza vaccination • Vaccination status unknown or does not meet definitions for any other category

22. General Measurements • Report aggregate data (i.e. facility-level), not vaccination status of individual HCP • Report only HCP working physically in the facility for at least 30 days during the reporting period • Report all HCP meeting denominator definitions, regardless of job duties or level of patient contact • Rates calculated separately for each HCP group • Influenza vaccination reported one time per year, so if any month is selected , all 12 months are included automatically

23. Best Practices for Influenza Prevention • Early identification and droplet isolation of suspect cases (when culture is done and patient is suspect –not when results are received) • Source control / mask patient on entry to facility • Restrict ill visitors/ ill healthcare personnel • Hand hygiene • Vaccination of patients • PPE • Antiviral prophylaxis And of course…….Vaccination of Healthcare Workers!!

25. Save Lives: Immunize “We’re trying to change the culture, such that this becomes not a possible thing to do, not something to give a consideration, but a routine professional obligation every autumn, and it is in the interest of patient safety.” William Schaffner, MD Professor and Chairman, Preventative Medicine Vanderbilt University

26. Contacts and References • Beverly.hagar@vmmc.org Rakita RM, Hagar BA, Crome P, and Lammert JK. Mandatory Influenza Vaccination of Healthcare Workers: A 5-Year Study. Infect Control Hosp Epidemiology 2010; 31:881-888