JCAHO: Patient contact? Flu vaccine mandated

Vaccines must be provided; employees can say no

As expected, the Joint Commission for Accreditation of Healthcare Organizations (JCAHO) has issued an infection control standard that requires accredited critical access hospitals, hospitals, and long-term care facilities to offer influenza vaccinations to staff, including volunteers and licensed independent practitioners with close patient contact.

The standard becomes an accreditation requirement January 1, 2007, and addresses a concern shared by health care professionals across the board — the low (less than 40%) influenza vaccination rate among providers. It stops short of mandating that health care providers with close patient contact be vaccinated, a move that would have met stiff resistance.

"This is an important first step toward improving influenza vaccination rates within the health care community, which will enhance the health and safety of patients in their care and health care workers themselves," according to William Schaffner, MD, vice president of the National Foundation for Infectious Diseases and chair of Vanderbilt University School of Medicine's department of preventive medicine.

"We hope in the future this standard will be expanded to encompass various strategies to increase health care worker vaccine uptake, such as signed declination," Shaffner adds.

While nursing organizations and other groups had clearly stated opposition to mandatory vaccines for health care workers, the JCAHO standard fell short of what other groups, including hospital pharmacists represented by the American Society of Health System Pharmacists, who wanted flu vaccines to be mandatory for everyone except those in whom the vaccine is contraindicated, abhorrent on religious grounds, and employees who signed declination forms.

Influenza causes approximately 36,000 deaths and more than 200,000 hospitalizations annually in the United States. The JCAHO standard, suggested in early 2007 and open to comment before the final standard was announced in June, follows closely the Centers for Disease Control and Prevention (CDC) recommendations for flu vaccination in health care workers in close contact with patients.

Will convenience boost compliance?

JCAHO issued the standard in response to recommendations by the CDC making the reduction of influenza transmission from health care professionals to patients a top priority in the United States. While the CDC has urged annual influenza vaccination for health care workers since 1981, the CDC's "Morbidity and Mortality Weekly Report" published earlier in 2006 calls for stronger steps to increase influenza vaccination of health care workers.

"Preventing the spread of the flu protects patients and saves lives. Encouraging health care workers to be vaccinated can play a vital role in stopping the transmission of this potentially fatal infection," says Robert Wise, MD, vice president of JCAHO's division of standards and survey methods.

According to JCAHO, health care–associated transmission of influenza has been documented among many patient populations in a variety of clinical settings, and infections have been linked epidemiologically to unvaccinated health care workers. Typically, fewer than 40% of health care workers are immunized each year.

Aiming to increase awareness and education efforts, as well as to boost vaccination numbers by simply making the vaccine free and convenient to health care workers, the new Joint Commission standard requires organizations to:

  • Establish an annual influenza vaccination program that includes at least staff and licensed independent practitioners;
  • Provide access to flu vaccinations on site;
  • Educate staff and licensed independent practitioners about flu vaccination; non-vaccine control measures (such as the use of appropriate precautions); and diagnosis, transmission, and potential impact of influenza;
  • Annually evaluate vaccination rates and reasons for non-participation in the organization's immunization program; and
  • Implement enhancements to the program to increase participation.