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Hospital committed to mandatory policy
Over time, tracking vaccinations gets easier
At Virginia Mason Medical Center in Seattle, every health care worker, contractor, vendor, and volunteer needs to be tracked for the hospital's strict mandatory influenza vaccination policy. That is possible thanks to an up-to-date occupational health database and a hospital-wide commitment, as managers and other departments assist in supporting the vaccination program, says Joyce Lammert, MD, PhD, chief of the Department of Medicine.
Virginia Mason vaccinates 5,000 employees annually, as well as about 1,300 physicians, students, volunteers, and contract workers. The effort requires more than 500 hours of time by nurses, medical assistants, or other vaccinators. The hospital hires agency nurses to assist, in addition to using peer vaccinators on the floors, nursing and pharmacy students, and nurses who are on light duty due to temporary work restrictions.1
The policy requires the flu vaccine as a "fitness for duty" condition, much the way tuberculosis screening is required, although in a shorter timeframe. But the hospital still tries to create enthusiasm about the flu vaccine campaign.
Each fall, the vaccination campaign begins with a kick-off event, in which Virginia Mason seeks to vaccinate about 20% of its staff. About 12 to 15 vaccinators provide the flu shots to 800 to 1,000 employees within a three-hour period.
The hospital also brings the vaccine to all units and shifts with a rolling cart, and employees may obtain the vaccine from their private physician or a community provider if they bring in proof of vaccination. Managers follow up with employees who haven't been vaccinated before the deadline.
"You need to have a strong database because you have to provide good information back to those managers," says Beverly Hagar, BSN, COHN-S, supervisor of Employee Health.
The mandatory policy was especially challenging the first year it was adopted in 2005. "It's hard to be the first," says Hagar, noting that some employees asked, "'Nobody else is doing this, why are you making us do this?'
"We had to go through a lot of education and training for the staff," she says. As more hospitals adopt similar polices, "it's certainly easier," she says.
Over time, "there's just an assumption that everyone will get flu shots. It's just not really a big deal anymore," says Lammert.
Various departments in the hospital must help enforce the policy among non-employees. The medical staff office tracks credentialed physicians to make sure they have received their flu shot. When vendors apply for a temporary badge for access to the hospital, they must show proof of vaccination or be vaccinated. Human resources requires contractors to maintain the fitness for duty requirement among the contracted staff. Volunteers and students are similarly tracked when they receive hospital access badges.
Having strong support from hospital leadership is critical, says Hagar. "This isn't an employee health project. This is an organizational project," says Lammert. "We had a very strong cohesive core team that believed in everything we're doing."
Medicaid incentive for vaccine rate
Mandatory policies don't have to result in termination in order to be effective. In 2005, the Washington State Nurses Association filed a grievance, stating that a new mandate needed to be part of the collective bargaining agreement. The union prevailed, but the hospital requires non-vaccinated employees to wear masks while they work during the flu season. In 2009-2010, 95.8% of unionized inpatient nurses received the vaccine.
Mandatory flu vaccination has since become commonplace in Washington. The Washington State Hospital Association supported mandatory vaccination and asked its members to adopt a policy. Currently, 95 hospitals have a mandatory policy, although the consequences for failing to be vaccinated vary. Some hospitals allow unvaccinated workers the option to wear a mask or take other infection control precautions, says WSHA spokesperson Beth Zborowski.
"There was a lot of enthusiasm from our membership around having a mandatory immunization policy as a way to protect patients and employees," she says.
A mandatory policy also will help Washington hospitals attain a Medicaid quality incentive. Health care influenza immunization is one of five measures that will be used to enable hospitals to receive an extra 1% in Medicaid payment. To get a perfect score of 10, hospitals must immunize 80% of their employees. (Non-employees, including credentialed physicians, are not included because of the difficulty in tracking their immunization status, according to the measure definition.)
An employee vaccination rate of 70% would earn 5 quality points, which would be enough to qualify for the incentive payment.
1. Rakita RM, Hagar BA, Crome P, and Lammert JK. Mandatory influenza vaccination of healthcare workers: A 5-year study. Infect Control Hosp Epidemiol 2010;31:881-888.