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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

An inconvenient truth about mandated flu shots

Everyone wants to have high rates of health care worker influenza immunization, but just who gets counted in their numbers? Not everyone.

About half of hospitals face major barriers in tracking the immunizations of credentialed or other non-employees, according to a survey by the Centers for Disease Control and Prevention. The difficulty in tracking and documenting immunization is a reality that has to be faced as discussions begin about national mandates to immunize health care workers.

The CDC is working to validate a National Quality Forum measure for influenza immunization of health care personnel, but first the agency must show that health care institutions can calculate the rates in a standardized way.

Currently, hospitals use different methods of counting their employees and non-employees who are vaccinated or who decline vaccination, says Megan C. Lindley, MPH, epidemiologist with the CDC’s National Center for Immunization and Respiratory Diseases.

“We know that things are being counted different ways and the rates are not necessarily comparable,” she says. “It makes it difficult to formally evaluate different policies for increasing influenza immunization rates when it’s not certain who’s being measured in those rates.”

The ongoing CDC study involves three online surveys conducted during and at the end of the 2010-2011 influenza season at 216 health care institutions, including 80 hospitals, in four states. (One survey is still pending as of this post.) The institutions were asked to rate the ease of counting the vaccinated employees on a scale of 1 to 5. Hospitals responded that counting employees was relatively easy, with a score of 4.1. But counting credentialed non-employees, such as physicians, and other non-employees, such as contract workers or volunteers, was more difficult, with scores of 2.8 and 2.5.

About half of the hospitals said their ability to determine the vaccination status of those non-employees was a major barrier. About a third said the time involved in collecting that information was a major barrier. The hospitals ranged in size from fewer than 75 beds to more than 500 beds.

That mirrors a more informal survey conducted by Melanie Swift, MD, medical director of the Vanderbilt Occupational Health Clinic at Vanderbilt University in Nashville, TN.

“By and large, people are able to provide vaccination to their direct employees and to track it,” she says. But the ability to track other non-employee groups – contractors, vendors, students, volunteers, credentialed professionals – varied widely, she says.

A workgroup of the National Vaccine Advisory Committee, an expert panel that advises the U.S. Department of Health and Human Services, is considering the issue of mandatory influenza vaccination. If that becomes a federal recommendation, Swift predicts: “Everyone would comply in some fashion with that, but there would be large inconsistencies in the populations covered and in the ability to enforce that.”

Special update from our sister publication, Hospital Employee Health

Michele Marrill