Flu shot requirement adopted by JCAHO

JCAHO will require shots to be given on-site

Does your ED offer influenza vaccine to staff? This will be a requirement from the Joint Commission on Accreditation of Healthcare Organizations, effective Jan. 1, 2007.

The Joint Commission developed the standard in response to recommendations by the Centers for Disease Control and Prevention (CDC) making the reduction of influenza transmission from health care professionals to patients a top priority in the United States.

Currently, less than 40% of health care workers are immunized each year, according to the CDC. Health care-associated transmission of influenza has been documented among many patient populations in a variety of clinical settings, and infections have been linked to unvaccinated health care workers.

The standard requires you to establish an annual influenza vaccination program for staff with flu vaccine given on-site. In addition, staff must be educated about the flu vaccination; nonvaccine control measures such as the use of appropriate precautions; and diagnosis, transmission, and potential impact of influenza.

At Clarian Health Partners in Indianapolis, "we currently have a vaccination program in place for all employees," reports Kathy Hendershot, RN, director of clinical operations for the ED. "When vaccines are in short demand, the ED direct caregivers are identified as high risk and get priority vaccine." Last year, 64% of staff received the vaccine in the ED, she reports.

All ED staff are inserviced every year about the vaccine and the illness, and they have to sign a refusal if they are unwilling or unable to take the vaccine. "Once the season hits us, we have guidelines as to when you cannot work, vaccinated or not," says Hendershot. "Of course, we educate all our staff about cough etiquette, hand washing, and mode of transmission."

A new system is needed to track which staff have been vaccinated, she says. "Right now, I only track how many I vaccinate," she says. "This does not account for those who are unable to receive the vaccine or receive the vaccine elsewhere. We will have to add this to our database." A system to track vaccination of employees can help you predict possible vacancy rates during flu season and determine availability of staff for certain infectious disease outbreaks such as avian flu or smallpox, says Hendershot.

In addition, knowing who is not vaccinated can help you to protect staff most at risk of being exposed during a flu outbreak, she adds. "We should have a process to place this person somewhere other than triage to decrease the likelihood of exposure."

About 50% of ED nurses receive the flu vaccine at Southern Ohio Medical Center in Portsmouth. "I don't expect the number to increase much," says Betsy Marsh, RN, assistant ED nurse manager. "Employees either want it or they don't, based on their past experience."

At Gwinnett Medical Center in Lawrenceville, GA, ED nurses have been offered the flu vaccine in the ED for the past four years, says Sandy Vecellio, RN, BSN, clinical manager for emergency services.

They have nurses schedule times in the ED so that staff can get the vaccine, she says. "Everyone is offered it, and we have about 60% that take it," says Vecellio. Someone is scheduled to give the vaccines on all shifts, she says. "It works well."


For more information about the flu vaccine, contact:

  • Kathy Hendershot, RN, MSN, CS, Director of Clinical Operations, Emergency Medicine and Trauma Center, Methodist Hospital, I-65 at 21st St., P.O. Box 1367, Indianapolis, IN 46206-1367. Telephone: (317) 962-8939. Fax: (317) 962-2306. E-mail: KHendershot@clarian.org.
  • Betsy Marsh, RN, Assistant Nurse Manager, Emergency Department, Southern Ohio Medical Center, 1805 27th St., Portsmouth, OH 45662. Telephone: (740) 356-5000. E-mail: MarshB@somc.org.
  • Sandy Vecellio, RN, BSN, Clinical Manager, Emergency Services, Gwinnett Medical Center, 1000 Medical Center Blvd., Lawrenceville, GA 30046. Telephone: (678) 442-3243. Fax: (678) 442-4531. E-mail: SVecellio@ghsnet.org.