NY requires HCWs to get flu shots

Only medical exemptions allowed

Health care workers in New York hospitals are all rolling up their sleeves this fall for the flu vaccine. It's no longer a choice. It's a mandate.

New York is the first state in the country to mandate flu vaccination without allowing health care workers to "opt out" with a declination statement. The State Hospital Research and Planning Council issued an emergency regulation that requires health care workers to receive seasonal flu vaccinations unless they have a medical contraindication.

The rule covers all personnel at health care facilities, including hospitals, outpatient clinics, and home health agencies. (Nursing homes are not covered because of separate legislation that addresses flu vaccines at long-term care facilities.)

Casting a wide net

Everyone with direct contact with patients, or who could potentially expose patients, must receive the vaccine, including medical staff, contractors, students, and volunteers. Employees who work off site or who have "no more than infrequent and/or incidental direct contact with others who might have direct contact with patients," such as those who work in the records department, do not need to be vaccinated.

The council cited studies of hospital-based outbreaks of influenza, the dismal record of voluntary influenza immunization among health care workers, and the pending strain of novel H1N1 on the health care work force. "The sooner that the emergency regulations are in place, the sooner lives will be saved and other complications of influenza disease avoided," the council said in its explanation of the emergency rule.

The mandate for flu vaccination drew a strong response - both praise and criticism. "Kudos to the state of New York for taking a leadership position in protecting patient safety," says Greg Poland, MD, director of the Mayo Vaccine Research Group at the Mayo Clinic in Rochester, MN, and an outspoken advocate for flu vaccination of health care workers.

He predicted that other states and health care institutions will move forward with similar mandates. "In a few years, new health care workers will say, 'Haven't we always done this?'"

However, the New York State Nurses Association in Latham, NY, began to receive calls and emails from nurses who said they would cross the state line into Connecticut or New Jersey to avoid the mandate. The NYSNA supports voluntary flu vaccination, says spokeswoman Nancy Webber, but opposed the mandate. She notes that annual flu vaccines vary in their effectiveness and that infection control precautions will still be the primary way to protect patients and health care workers.

The regulation requires health care employers to administer and document the vaccination of eligible health care personnel by Nov. 30. The council embarked on a rule-making process to create a permanent influenza vaccination rule. It is likely the emergency rule also will be extended to the novel H1N1 vaccine, when it becomes widely available, says Beth Goldberg, public affairs program manager for the New York State Department of Health.

"When it comes to each individual facility, we are going to look closely at how this is implemented," says Webber. "If we feel this is violating our contract agreements, we'll bring this up with employers. There are protections for workers that we're going to be diligent about enforcing."

Meanwhile, as soon as the regulation went into force in mid-August, hospitals began figuring out how to proceed. In some ways, vaccination will be simpler; employee health professionals aren't debating the merits of the vaccine, they're just fulfilling a state mandate. But the logistics of vaccinating not just staff but contractors, students, and volunteers will be daunting.

Winthrop University Hospital in Minneola, NY, began by determining which of the hospital's 6,000 employees fall under the mandate and creating a new database to document the vaccinations. "We are meeting in a committee to decide how to approach this as an organization. We work as a team and we'll get it done," says Carol Cohan, RN, MHA, COHN-S/CM, associate director of employee health and Northeast Regional Director of the Association of Occupational Health Professionals in Health Care.

The hospital plans to provide education to employees, some of whom have never had the flu shot before. And they will still promote the flu vaccine campaign with a catchy slogan and raffled-off prizes, she says. "It doesn't have to be all business. We have fun working together to promote a safer environment for patients and employees," Cohan says.