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TJC proposes 90% flu shot goal
Standard modeled after HHS plan
Proposed changes in a Joint Commission infection control standard may accelerate the trend toward mandatory influenza vaccination policies.
The Joint Commission accrediting body, based in Oakbrook Terrace, IL, requested comments on changes that would set a goal of 90% for influenza vaccination of staff and licensed independent practitioners, such as physicians, by 2020.1
While the Joint Commission is not specifically advocating mandatory influenza vaccination, hospitals that have rates above 90% often have such a policy.
"We think we can get there [with voluntary programs] through education," says Bill Borwegen, MPH, health and safety director with the Service Employees International Union (SEIU). "But if this is a de facto mandatory requirement, we think it's a massive overreach that isn't demonstrated by scientific evidence."
In fact, the Joint Commission is recommending a goal, not a policy, says Robert Wise, MD, vice president of the division of standards and survey methods.
"We are not suggesting it be a mandatory requirement. This [decision] is really at the level of the hospital," says Wise, who notes that the target date is in nine years.
The Joint Commission cites the 90% goal in the U.S. Health and Human Services Action Plan to Prevent Healthcare-Associated Infections.2 However, the action plan simply notes the Healthy People 2020 goal of 90% vaccination of health care personnel. It also points out the variation in vaccination rates among different health care settings and differences in measurement among different facilities.
"Coverage among health care personnel working in hospitals was over 60%, while for those health care personnel in long term care facilities coverage is well below 50%," the action plan says. "Healthcare settings should tailor their strategies to their setting, workforce, and region."
The Joint Commission plans to issue a final standard before the start of the 2012 flu season, Wise says. The accrediting agency aims to raise the dialogue and emphasize the importance of increasing vaccination rates, he says. Hospitals may choose to avoid the pushback that can occur with mandatory policies, including potential legal issues if employees are unionized, by opting for voluntary programs, he says.
"There is more attention now than ever before about this issue and there's more debate than ever before. We'll find out what's successful and what's not, and people will learn from each other and how to achieve [the goal],"he says.
The Mayo Clinic in Rochester, MN, has achieved a vaccination rate of about 80% with a voluntary program. William Buchta, MD, MPH, medical director of the Employee Occupational Health Service, notes that the Joint Commission will judge hospitals on their compliance with their own policies and program aimed at meeting the goal, not on the attainment of the goal itself.
"I think you can stay within the Joint Commission standards without making it mandatory, you just have to be very careful in how you word your policy," he says. "They're very forgiving about not meeting goals as long as you have a plan."
For example, Buchta says he could envision a policy that sets a mandate in units with especially vulnerable patients, such as bone marrow transplant or neonatal intensive care.
Employees in those units who did not want to be vaccinated could transfer to other positions in the hospital but would not lose their jobs, he says.
A policy also would have to account for years in which there are vaccine supply disruptions, leading to lower vaccination rates.
Meanwhile, as the years go by, technology changes.
"Hopefully, we'll have a better vaccine by 2020," he says, noting that a mandatory vaccine policy would be easier to implement and more acceptable if it was a one-time vaccine. "Hopefully in five to ten years this argument will be a moot point. That's what I would love to see."