Panel: Include HCW flu shot rates in reporting laws

Declination statements for those who decline

A "tool kit" created by an expert panel on hospital infection reporting laws recommends that health care worker influenza vaccination rates be included as a quality measure and that workers refusing immunization be required to sign declination forms. The importance of the recommendation was underscored by the fact that it was the only "process" measure included in the tool-kit.

"We felt that it was important enough to emphasize, and it puts more of a burden on the institution," said Raymond Chinn, MD, hospital epidemiologist for Sharp Memorial Hospital in San Diego, and a member of the panel that developed the tool kit. "It is one way of ensuring that every person that works in a health care system is approached and they have the opportunity of declining vaccination. This is our way of ensuring that the institution is adhering to [the recommended] guidelines."

The tool kit was created by a working group that includes members from the Association for Professionals in Infection Control and Epidemiology, the Centers for Disease Control and Prevention, the Council of State and Territorial Epidemiologists, and the Society for Healthcare Epidemiology of America. The tool kit provides guidance on the components necessary for a meaningful reporting system in order to assist states and health care facilities facing legislative mandates.

In the guidance for ICPs and state legislatures crafting public reporting laws, the panel particularly emphasized the importance of immunizing workers with patient contact (hands on, face-to-face contact with patients for the purpose of diagnosis, treatment, and monitoring) against influenza. "However, the working group recognizes the importance of vaccinating all health care workers independent of the degree of patient contact and that additional vaccination measurement rates are useful for health care organizations," the tool kit states.

To enable employee health and infection prevention departments to target educational efforts, the panel recommended calculating worker flu vaccination rates within health care delivery groups or high-risk patient care areas. Examples include:

  • Physicians caring for patients in high-risk areas (emergency department, intensive care units, oncology units, and transplant units). This strategy may be helpful in private health care facilities where the majority of physicians are licensed independent practitioners.
  • Health care providers by discipline (nursing, respiratory care practitioners, occupational/physical/ speech therapy) or by unit (transplant, emergency department, intensive care).

The working group recommended legislatures ensure that health care facilities provide influenza vaccination to health care workers at the work site and at no cost during all work shifts of the health care facility. In addition to enhancing education, they should use strategies that have been demonstrated to increase influenza vaccination rates, such as vaccination clinics, mobile carts, vaccination access during all work shifts, and modeling and support by institutional leaders.

"Incorporate a signed declination (from those who decline influenza vaccination for reasons other than medical contraindications) component into a comprehensive health care worker vaccination program when health care worker vaccination rates remain below targeted institutional goals despite implementing evidence-based strategies as outlined [above]," the tool kit guidelines recommend.

(Editor's note: The complete tool kit is available at the APIC web site at