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

Flu and consequences: HCW policies getting tougher

Mandatory influenza vaccination programs continue to gain traction at hospitals around the country. Though outright termination policies are still rare, more and more facilities are invoking some level of consequences for health care workers who refuse shots.

A survey of 808 hospitals found that 56% had a requirement for influenza vaccination of employees in the 2010-2011 influenza season. By the study’s definition, a hospital’s vaccination requirement could include declination statements or personal belief exemptions. Yet one in four (24.8%) had consequences for declining vaccination – a dramatic increase from the 2007-2008 season, when just 37 (5%) had such policies.1

Just 29 hospitals reported having a policy that involved terminating employees who refused vaccination and didn’t have a medical or religious exemption, or 3.6% of the total. Three-quarters of hospitals with consequences for declining vaccination required health care workers to wear masks

“[Hospitals] definitely want to achieve the highest rates of vaccination possible,” says lead author Brady Miller, MPH, who was a post-graduate fellow working with the Centers for Disease Control and Prevention and is now a medical student at the University of Michigan in Ann Arbor.

But hospitals increase the requirements incrementally, he says. “If it doesn’t have to [involve] terminating non-vaccinated people, they don’t want to go that far,” he says.

Hospitals were less likely to include non-employees in their requirements, such as medical staff, volunteers, students or contractors.

Hospitals also were liberal in the use of exemptions. More than half (55%) of the hospitals with consequences for failing to be vaccinated allow personal belief exemptions, the study found. “Hospitals may titrate up their vaccination programs and incrementally increase the stringency,” says Miller.

How successful were the mandatory policies at raising vaccination rates? Not surprisingly, hospitals that terminated employees for failing to get the vaccine had the greatest increase in their rates, with an increase of about 24%, according to a complementary study by the same authors. Hospitals that used other consequences had an increase of about 18%, and hospitals without mandates had an increase of about 10%.2

Interestingly, the authors reported that hospitals that allowed non-medical exemptions had increases in their vaccination rates that were similar to those that did not allow non-medical exemptions.

Overall, the H1N1 pandemic led to an increase in health care worker vaccination rates. Increases were greatest for hospitals that had lower rates before adding vaccination requirements.