JCAHO: Hospitals should track HCW flu vaccines, improve vaccination rates

Proposed standard doesn't include declinations

For many hospitals, encouraging health care workers (HCWs) to receive the flu vaccine is an annual exercise in futility. Yet soon it may be a standard from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

The Oakbrook Terrace, IL-based Joint Commission has proposed a standard that would require hospitals to provide influenza-related education and free access to influenza vaccine to all staff, students, volunteers, and licensed independent practitioners. Hospitals would be required to document who receives the vaccine, track immunization rates, and implement efforts to improve those rates. (See standard.)

"It's one of our many ongoing efforts to try to help our organizations get on top of infection-related issues," says Nancy Kupka, DNSc, MPH, RN, project director, division of standards and survey methods.

An influenza immunization standard could become effective as early as January 2007, she says.

"Reducing the risk of influenza and pneumococcal disease in institutionalized older adults" is JCAHO's National Patient Safety Goal. The Joint Commission also is responding to efforts by the Centers for Disease Control and Prevention (CDC) in Atlanta and several professional societies to improve influenza vaccination rates of health care workers, Kupka says.

Only about 36% of HCWs receive the vaccine each year, according to the CDC's national health interview survey. The CDC advocates educating HCWs on the benefits of the vaccine for themselves and patients as well as free access to the vaccines.

Yet some contend that those voluntary efforts are not enough. Two CDC advisory panels, infection control professional societies, and quality improvement organizations have called for mandatory declinations, or policies that require health care workers to sign a declination statement if they refuse to be vaccinated.

The Joint Commission is treading lightly in this area. In its field review, which closed Feb. 12, JCAHO asked, "Should the Joint Commission require mandatory staff immunizations and require organizations to provide access to immunizations at the work site? How difficult would it be for your organization to collect and analyze data for staff in your organization who declined to be immunized?"

"We try to develop standards using the best science available," says Kupka. "We also have to survey the field to [determine] the barriers for implementation."

JCAHO gauges options

In its background statement, JCAHO explained: "Through this field review, the Joint Commission is interested in learning your thoughts about whether influenza vaccination should be made mandatory among caregivers in various health care settings, what categories of individuals should be vaccinated, whether the option to decline vaccination for legitimate or other reasons should be provided, and whether and how organizations can track declination rates."

Kupka noted that the standard would apply to health care workers who have contact with patients at high risk of complications from influenza; it would not apply to all employees of a hospital.

She acknowledged that some health care organizations might face administrative difficulties in tracking immunizations of staff, volunteers, independent practitioners, and students. "We want something that's complete and achievable," she says.

Setting a reasonable standard

The Joint Commission's proposed standard is reasonable, says William Buchta, MD, MPH, medical director of the Employee Occupational Health Service at the Mayo Clinic in Rochester, MN. "Everything they're recommending, we're doing here at Mayo and more."

Buchta was co-author of a position statement from the American College of Occupational and Environmental Medicine opposing mandatory declination statements. Requiring hospitals to collect the statements from employees would be unnecessary and an "administrative mess," he says.

This year, Mayo put its efforts into an "enhanced flu vaccine program" for units that care for high-risk patients, such as intensive care, transplant, and hematology. Employees in those units who have not been vaccinated receive repeated reminders. Some units have achieved 100% compliance, but others hover closer to 50%, Buchta says. Overall, as of December, Mayo's vaccination rate was 67%.

Greg Poland, MD, director of the Mayo Vaccine Research Group and president of the International Society for Vaccines, has been a strong proponent of mandatory influenza vaccination programs, with the option of declination. He says he's disappointed with the Joint Commission's proposed standard.

"It's an incremental step in the right direction," says Poland. "It continues the model of a voluntary program. There are no instances published of voluntary programs with sustained high rates of influenza immunization."

But by issuing a standard, the Joint Commission is putting hospitals on alert that influenza immunization of health care workers is important. That alone will have significant impact, says Poland.