IDSA, SHEA, NPSF, AAP push for Mandatory Vaccination of Healthcare Workers

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Richard Whitley, MD, FIDSA, president of the Infectious Diseases Society of America (IDSA), has written a letter to CDC director Thomas Frieden relating to the draft guidance, "Prevention Strategies for Seasonal Influenza in Healthcare Settings." The IDSA says it supports the CDC?s draft guidance concerning infection prevention and control measures that should be implemented in response to seasonal and H1N1 influenza, but notes the guidance should also support mandatory influenza immunization of healthcare workers.

In the letter Whitley notes, "IDSA welcomes the proposed update, which replaces the previous seasonal influenza guidance and the Interim Guidance on Infection Control Measures for 2009 H1N1 Influenza in Healthcare Settings, to recommend that healthcare workers (HCWs) wear face masks around patients with confirmed or suspected influenza, wear respirator devices during aerosol-generating procedures and utilize negative pressure rooms, when available, during higher-risk procedures. While IDSA took issue with the 2009 federal guidance on the use of N95 respirator devices, we appreciate the remedial action that CDC is proposing, which responds in large part to our concerns and the concerns of other experts. The proposed revisions on personal protective equipment (PPE) for HCWs are more closely aligned with the safety precautions supported by IDSA members and others?precautions that are evidence-based and supported by the best available science. IDSA welcomes future opportunities to work closely with the U.S. Department of Health and Human Services (HHS), CDC, and Occupational Safety and Health Administration (OSHA) to ensure that all decisions affecting HCWs? and patient safety are science-based. In July and November 2009 joint letters, IDSA, the Society for Healthcare Epidemiology of America (SHEA) and the Association for Professionals in Infection Control and Epidemiology (APIC) outlined control measures for use in healthcare facilities during care of patients with suspected or confirmed novel H1N1 influenza infection and expressed concern with the federal PPE guidance issued last year. Our primary goal continues to be the effective delivery of patient care while protecting both HCWs and patients from acquiring influenza in healthcare settings."

In the letter, the IDSA says it endorses the following principles: "Early recognition and identification of suspected seasonal and novel H1N1 influenza-infected patients upon presentation to a healthcare setting; Placing surgical masks on patients with suspected or confirmed seasonal or pandemic H1N1 influenza infection at the point of entry into any healthcare setting; Using surgical masks to cover the HCWs? nose and mouth to prevent acquisition of influenza virus by droplets or hand contact during routine patient care activities; Placing patients with suspected or confirmed seasonal or pandemic H1N1 influenza infection in a single room, if available, or cohorting them with other patients infected with the same influenza virus; Strict adherence to hand hygiene, respiratory hygiene and cough etiquette; and Restricting visitors and HCWs with acute respiratory illnesses."

The IDSA adds that it believes it is crucial that guidance keeps pace with science and, as such, supports the CDC?s current efforts: "It is in one area, however, that IDSA feels the guidance does not go far enough. We feel the CDC should provide a definitive recommendation for mandatory influenza vaccination of healthcare providers. IDSA supports universal immunization of HCWs against seasonal influenza by healthcare institutions (inpatient and outpatient) through mandatory vaccination programs, as these programs are likely to be the most effective means to protect patients against the transmission of seasonal influenza by HCWs. Employees who cannot be vaccinated due to medical contraindications, or because of vaccine supply shortages, or who sign a written declination choosing not to be vaccinated for religious reasons, should be required to wear masks or be re-assigned away from direct patient care. IDSA also is supportive of comprehensive educational efforts that inform HCWs about the benefits and risks of influenza immunization to both patients and HCWs. The rationale for this policy is as follows: The most recent data, including the CDC?s April 2, 2010 Morbidity and Mortality Weekly Report, 59(12); 357-362 (enclosed), shows that organizations with a mandatory vaccination policy in place have a much higher immunization rate than those who have a voluntary program or no program at all. Several studies demonstrate that immunizing HCWs against influenza protects patients against acquiring the virus from HCWs, reducing both morbidity and mortality. Thus, universal immunization of HCWs against seasonal influenza is a critical patient safety issue. Immunizing HCWs against influenza also protects the individual HCW from falling ill, thus both protecting the HCW from potentially serious illness while maintaining an adequate workforce, which further protects patients. Decades of scientific data demonstrate Food and Drug Administration-approved influenza vaccines to be safe, effective, and cost-saving. Educational programs, declination policies and easy access to influenza immunization have resulted in modest improvements in coverage in many healthcare systems in recent years, but generally have not achieved acceptable levels of coverage. Despite extensive and sophisticated efforts, most successful educational programs still average only 40 percent to 70 percent rates of influenza vaccine coverage."



http://www.infectioncontroltoday.co...lthcare-workers-in-cdc-flu-guidance.aspx?pg=2

http://www.idsociety.org/

 

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Re: IDSA Pushes for Mandatory Vaccination of Healthcare Workers in CDC Flu Guidance

Re: IDSA Pushes for Mandatory Vaccination of Healthcare Workers in CDC Flu Guidance

Mandatory influenza vaccination for healthcare personnel needed


Vaccination should be requirement for continued employment for health-care personnel, epidemiologists and infectious disease physicians say

Influenza vaccination of healthcare personnel is a professional and ethical responsibility and non-compliance with healthcare facility policies regarding vaccination should not be tolerated, according to a position paper released today by the Society for Healthcare Epidemiology of America (SHEA). The paper, published in this month's Infection Control and Healthcare Epidemiology journal and endorsed by the Infectious Diseases Society of America (IDSA), stresses influenza vaccination of healthcare personnel as a core patient safety practice that should be a condition of both initial and continued employment in healthcare facilities.

According to SHEA, their recommendations apply to all healthcare professionals in all healthcare settings, regardless of whether the professional has direct patient contact or whether he or she is directly employed by the facility. The policy also applies to students, volunteers, and contract workers. The only exemptions, say the epidemiologists and infectious disease physicians, should be in cases of medical contraindications.

"The transmission of influenza in healthcare settings is a substantial safety concern for both patients and healthcare personnel and deserves our attention and action," said Neil Fishman, MD, president of SHEA. "Healthcare providers are ethically obligated to take measures proven to keep patients from acquiring influenza in healthcare settings. Mandatory vaccination is the cornerstone to a comprehensive program designed to prevent the spread of influenza which also includes identification and isolation of infected patients, adherence to hand hygiene and cough etiquette, the appropriate use of protective equipment, and restriction of ill healthcare personnel and visitors in the facility."

The position paper, an update of an original statement issued in 2005, comes as healthcare personnel and facilities prepare for the upcoming 2010 flu season, and on the heels of one of the worst flu seasons in our nation's history, the result of the H1N1 strain. Last year's flu season highlighted the necessity for stronger policies for healthcare personnel influenza vaccination, especially in light of the low vaccination rates in many voluntary influenza vaccination programs.

"Given the debate that surrounded mandatory healthcare personnel vaccination during the last influenza season, we support and applaud SHEA for issuing a strong and unequivocal statement about the critical importance of healthcare personnel vaccination," said Richard Whitley, MD, president of IDSA.

According to a 2009 RAND Corporation survey, 39 percent of healthcare professionals stated they had no intention of getting vaccinated despite the heightened concern surrounding influenza with the H1N1 pandemic.

"The scientific evidence shows significant reductions in the risk of influenza in both acute and long-term care settings as a result of strong immunization policies and programs," Dr. Whitley said. "Vaccination of healthcare personnel saves patients' lives and reduces illness. It also protects the individual worker from falling ill during influenza outbreaks and from missing work, which further impacts patient care." IDSA also supports SHEA's recommendation that a mandatory vaccination program be part of a multi-faceted, comprehensive infection control program.

Fishman added that he believes that this position paper, coupled with full and visible support of mandatory influenza vaccination by healthcare facility leadership, will dramatically improve the rates of vaccination.

http://www.news-medical.net/news/20...cination-for-healthcare-personnel-needed.aspx

 

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Re: IDSA Pushes for Mandatory Vaccination of Healthcare Workers in CDC Flu Guidance

Re: IDSA Pushes for Mandatory Vaccination of Healthcare Workers in CDC Flu Guidance

Pediatricians will join call for mandatory flu shots


The American Academy of Pediatrics plans to call for all health workers to get flu vaccinations, saying unvaccinated doctors, nurses and other medical staffers pose a threat to patients.

The academy, which represents 60,000 pediatricians, is the latest of several organizations that now back mandatory flu shots for health workers. The groups include the National Patient Safety Foundation, the Infectious Diseases Society of America and the Society of Healthcare Epidemiologists.

FLU VACCINE: Available free to many this year

"They're all unanimously saying this is a patient-safety issue," says Gregory Poland, director of the Mayo Clinic's vaccine research group, who helped draft the position adopted jointly by the infectious-disease experts and health care epidemiologists.

The new push to make flu shots compulsory for health workers was prompted by low vaccination rates during last year's swine flu pandemic, Poland says. It probably will bring to a head a debate that has festered for more than a decade, he says.

More than 23,600 people die of flu each year and roughly 200,000 are hospitalized, the U.S. Centers for Disease Control and Prevention reports. Flu typically takes its greatest toll among children younger than 2 and people 65 and older. Pregnant women and patients with chronic diseases are especially vulnerable, doctors say.

Last January, a CDC survey found that just 37% of health care workers received swine flu vaccine and 35% received both seasonal and swine flu shots. On average, flu vaccination rates hover under 50%. "Nurses have the lowest rates of all, and they're the ones who have the most contact with patients," says Poland, who says he based his conclusion on a comprehensive survey of medical literature.

The pediatrics academy statement, to be released Monday, cites a study published in 2000 of a flu outbreak in a newborn intensive care unit in which 19 of 54 infants were infected with flu by "health-care-associated transmission." Six infants got sick and one died. A survey found that only 15% of health workers who responded got their flu shots. An outbreak in a bone marrow transplant unit cost two patients their lives, the statement says. Only 12% of the staff were vaccinated.

The authority to require vaccination lies with hospitals and health plans, says Thomas Talbot, chief of epidemiology at Vanderbilt. "I can't get re-credentialed without showing I'm immune to measles, mumps, rubella and chickenpox," Talbot says. Yet Vanderbilt does not yet require flu shots. "We've looked at flu and pertussis and have not added them as a requirement. But I'm hopeful."

Nancy Hughes of the American Nurses Association says her organization also believes all registered nurses should get flu shots. But the nursing organization has steadfastly opposed mandatory vaccine, a policy to be reviewed today by its board of directors. "There may be a change of policy, there may not be," Hughes says. "We're very concerned about seasonal influenza. We don't want to see a nurse infected either."


http://www.usatoday.com/yourlife/health/medical/coldflu/2010-09-08-1Aflu08_ST_N.htm

 

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Re: IDSA, SHEA, NPSF, AAP push for Mandatory Vaccination of Healthcare Workers

Mandatory Flu Vaccination of Healthcare Workers: A Patient Safety Imperative


By Kelly M. Pyrek

Despite knowing that vaccination is a patient-safety imperative, many healthcare professionals are not immunized against influenza. Healthcare institutions are trying to change that by mandating vaccination for its workers, and one of the biggest success stories has been unfolding for the last five years at Virginia Mason Medical Center (VMMC), a tertiary-care, multi-specialty medical center in Seattle with 5,000 employees.

Virginia Mason achieved and sustained influenza vaccination of more than 98 percent of its healthcare workers, a feat written up in the September issue of the journal Infection Control and Hospital Epidemiology by Robert Rakita, MD; Beverly Hagar, BSN, COHNS; Patricia Crome, MN; and Joyce Lammert, MD, PhD. Rakita, et al. (2010) report on their five ‐ year study (from 2005 to 2010) at VMMC, in which all healthcare workers were required to receive influenza vaccination; those who were accommodated for medical or religious reasons were required to wear a mask at work during influenza season.

In the first year of the program, 4,588 of 4,703 healthcare workers (97.6 percent) were vaccinated, and influenza vaccination rates of more than 98 percent were sustained over the subsequent four years of the study. Not only were all employees of the medical center required to receive the influenza vaccine, in addition, other individuals such as students, vendors, volunteers, contractors and outside physicians, were also required to be vaccinated. Less than 0.7 percent of healthcare workers were granted the aforementioned accommodation and less than 0.2 percent refused vaccination and left the medical center.

Although this vaccination rate seems extraordinary, Lammert, chief of medicine and also the main physician sponsor of the VMMC?s vaccination program, says nothing less would have sufficed. ?Once we decided that we were going to require mandatory vaccination, we weren?t aiming for anything other than as close to 100 percent as possible,? Lammert emphasizes.

The impetus for the vaccination mandate evolved from conversations during a workshop that was held to increase influenza vaccination rates at VMMC. ?One of our healthcare workers had been reading the literature and said she didn?t understand why we don?t require immunization for influenza,? Lammert says. ?As we started to think about it, we said, ?We don?t understand it either.? So we brought the issue before our community board, comprised of non-medical members of the community ? and they were surprised that the national immunization rates were so low. They supported mandatory vaccination from the beginning because they felt it was the right thing to do to protect our patients.? Strong support of the mandatory vaccination program also came from the medical center?s senior leadership, and so a multi-disciplinary task force ? including representatives from infection prevention and control -- was assembled to lead the influenza vaccination campaign during the first year of implementation

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http://www.infectioncontroltoday.co...care-workers-a-patient-safety-imperative.aspx

 

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Re: IDSA, SHEA, NPSF, AAP push for Mandatory Vaccination of Healthcare Workers

Loyola continues mandatory employee flu-vaccination policy for second straight year

The best way to prevent the spread of the flu to patients in a medical setting would be to require all health-care workers to get an annual flu shot, says the American Academy of Pediatrics.

Joining the academy's recent call for mandatory flu shots for all health workers is the National Patient Safety Foundation, the Infectious Diseases Society of America and the Society of Healthcare Epidemiologists.

Yet, despite the known health risks the flu poses - particularly to patients with chronic illnesses or weakened immune systems - only 61.9 percent of all medical workers in the United States voluntarily got flu shots in 2009, according to the Centers for Disease Control. Predictably, there are numerous instances in which medical workers have infected their patients with the flu.

Loyola University Health System (LUHS) has adopted a policy to lessen the flu risk to its patients. For the second straight year, the health system is requiring all of its 7,825 employees to get flu shots. Last year, 99.3 percent of its employees were vaccinated against the seasonal flu, among the highest percentage of any medical center in the nation.

Loyola was among the first medical centers in the nation to make the regular seasonal flu shots mandatory as a condition of employment. Exceptions were made for religious or medical reasons. Though it wasn't mandated last year, due to tight supplies, employees were strongly encouraged to also get shots for H1N1, also known as "swine flu."

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http://www.news-medical.net/news/20...cination-policy-for-second-straight-year.aspx

 

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Re: IDSA, SHEA, NPSF, AAP push for Mandatory Vaccination of Healthcare Workers

Flu vaccine mandates for medical workers


Should medical professionals be required to get a flu shot?

Flu season has officially arrived, and with it the quick prick to the upper arm or a spritz up the nose that comes with the annual vaccine. A few minutes of minor discomfort and you'll be protected against the three influenza strains most likely to fell you this season. More important, you'll be preventing the flu's spread to others for whom the flu is far more dangerous.

So it's surprising that healthcare workers ? the doctors and nurses you trust ? have pitiful immunization rates. The Centers for Disease Control and Prevention estimated that only 62% of healthcare professionals received the seasonal flu vaccine between August 2009 and January 2010, and only 35% also received the H1N1 swine flu vaccine. Published scientific studies have suggested that unvaccinated healthcare workers were at least partly responsible for flu outbreaks in a neonatal intensive care unit in Ontario, Canada, in 1998 and a bone marrow transplant unit at Memorial Sloan-Kettering in New York City the same year.

Professional organizations such as the Society for Healthcare Epidemiology of America and the American Academy of Pediatrics support mandatory vaccinations for healthcare workers, including doctors, nurses, students and other hospital employees. The American Nurses Assn., a professional association for registered nurses, rejects such mandates because they vary from hospital to hospital and typically do not allow religious exemptions.


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http://www.latimes.com/health/la-he-pro-con-flu-shots-20101115,0,5406111.story

 

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Re: IDSA, SHEA, NPSF, AAP push for Mandatory Vaccination of Healthcare Workers

Lancet: Time to mandate influenza vaccination in health-care workers

The Lancet, Volume 378, Issue 9788, Pages 310 - 311, 23 July 2011
<Previous Article|Next Article>
doi:10.1016/S0140-6736(11)61156-2Cite or Link Using DOI
Time to mandate influenza vaccination in health-care workers
Arthur Caplan aEmail Address
Earlier this year, I had the opportunity to chat with David Salisbury, National Director for Immunisation at the UK's Department of Health. He told me how proud he was of the success that had been achieved in getting people living in the UK to get their influenza shots. I mentioned that one group that had proven very tough to vaccinate in the USA was health-care workers. He rolled his eyes and confided that doctors in the UK were a hard lot to get vaccinated as well.
Why is it that health-care workers around the world prove so hard to vaccinate against influenza or other communicable diseases? Rates of influenza vaccination in health-care workers have averaged well under 50% for the past decade in many hospitals and long-term care facilities in the USA and in other nations. What should be done about this dismal state of affairs? Will redoubling efforts at voluntary vaccination work? That seems unlikely. This low uptake of vaccination in health-care workers does not seem to be the result of a failure to push from administrators and government authorities. Nor are the culprits a lack of vaccines or money to pay for them. The call for those who care for others to get vaccinated both for their own protection and that of their patients has been issued year after year. All manner of efforts have been made to make vaccination in the workplace easy to do, ranging from bringing carts with vaccine directly on to hospital floors, posters, webcasts, jamborees, and various incentive schemes. None of these approaches have succeeded in getting rates up to where they need to be to protect the workforce and patients.

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http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61156-2/fulltext

 

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Re: IDSA, SHEA, NPSF, AAP push for Mandatory Vaccination of Healthcare Workers

APHA: Hospitals May Have to Mandate Flu Shot, Panel Says


WASHINGTON -- Hospitals and clinics where fewer than 90% of healthcare workers get an annual flu shot should consider mandating vaccination, according to draft recommendations by a federal advisory committee.

In recent years, only about 40% of healthcare workers received a seasonal flu shot, despite many public health and medical groups calling on every healthcare worker to get one. During the 2009 H1N1 pandemic, that rate bumped up to 62%, according to data from the CDC.

The vaccination should be mandated at hospitals and other healthcare facilities with rates under 90%, according to draft recommendations from the Health Care Personal Influenza Vaccination subcommittee of the National Vaccine Advisory Committee. The committee is tasked with making recommendations to the Department of Health and Human Services (HHS) on how to achieve 90% coverage for healthcare workers.

The subcommittee's draft recommendations were presented by Hilary Babcock, MD, MPH, of Washington University School of Medicine's Division of Infectious Diseases, during a panel presentation at the American Public Health Association's annual meeting. The subcommittee will present its final recommendations to the full National Vaccine Advisory Committee in February 2012.

Healthy People 2020, HHS's detailed plan to reduce health risk factors and disparities, listed getting 90% of all healthcare workers to receive regular flu shots as a goal by 2020.

In February, the Association for Professionals in Infection Control and Epidemiology released a position paper supporting making annual influenza vaccination mandatory as a condition of employment for all healthcare workers.

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http://www.medpagetoday.com/MeetingCoverage/APHA/29430

 

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Re: IDSA, SHEA, NPSF, AAP push for Mandatory Vaccination of Healthcare Workers

Flu vaccine could be mandatory for New Jersey health care workers

A bill making its way through the New Jersey legislature would require health care facilities to give their workers flu vaccines.

The bill, approved by the Assembly Health and Senior Services Committee last week, could be voted on in the full assembly as early as next week.

The bill calls for each health care facility to establish and implement an annual influenza vaccination program.

Health care facilities, such as a general or special hospital, nursing home, or home health care agency, would fall under the mandate.

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http://www.lehighvalleylive.com/war...f/2012/02/flu_vaccine_could_be_mandatory.html

 

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Re: IDSA, SHEA, NPSF, AAP push for Mandatory Vaccination of Healthcare Workers

Monday, April 30, 2012
California Senate Panel Approves Bill on Health Care Worker Flu Vaccination

Late Thursday, the Senate Labor and Industrial Relations Committee approved a bill (SB 1318), by Sen. Lois Wolk (D-Davis), that would require all California health care workers to either receive an influenza vaccination or wear a mask while in patient areas during the flu season, the Woodland Daily Democrat reports.
The legislation now goes to the Senate Appropriations Committee.
Bill Details
The bill aims to help prevent the spread of influenza among patients at high risk of developing serious flu complications.
Wolk said, "According to CDC, vaccination is especially important for health care personnel who regularly come in contact with these vulnerable individuals, who are at higher risk of flu complications and death." She added that the bill "is an essential step toward preventing the outbreak of influenza in California's health care facilities."
Sponsors of the legislation include the Health Officers Association of California, the California Medical Association and the California Association of Nurse Practitioners (Woodland Daily Democrat, 4/28). . . .


Read more: http://www.californiahealthline.org...are-worker-flu-vaccination.aspx#ixzz1taOE05ZK


excerpt from SB1318

BILL NUMBER: SB 1318 AMENDED BILL TEXT AMENDED IN SENATE APRIL 11, 2012 INTRODUCED BY Senator Wolk FEBRUARY 23, 2012 An act to amend , repeal, and add Section 1288.7 of , and to add Section 1228.5 to, the Health and Safety Code, relating to infectious diseases. LEGISLATIVE COUNSEL'S DIGEST SB 1318, as amended, Wolk. Health facilities: influenza vaccinations. Existing law imposes on the State Department of Public Health various duties and responsibilities regarding the regulation of clinics and health facilities, including general acute care hospitals, as defined. Existing law requires a general acute care hospital to annually offer onsite influenza vaccinations, if available, to all hospital employees. Existing law requires a general acute care hospital to require its employees to be vaccinated, or if the employee elects not to be vaccinated, to declare in writing that he or she declined the vaccination. A violation of these provisions is punishable as a misdemeanor. This bill would <strike> extend these vaccination provisions to </strike> require, commencing July 1, 2013, each clinic and health facility to annually offer onsite influenza vaccinations to its employees and to require its employees, contractors, students, volunteers, persons with privileges on the medical staff, and other onsite health care workers affiliated with the <strike> hospital, </strike> clinic or health facility, as defined , to be vaccinated. This bill would require each of the above-listed persons who has received a vaccination from another health facility to present verification to the clinic or he alth facility . This bill would require <strike> one of these parties </strike> each of the above-listed persons who elects not to be vaccinated or does not provide proof of vaccination to wear a <strike> hospital-provided </strike> clinic- or health facility-provided protective mask, as specified, while serving his or her duties at the <strike> hospital </strike> clinic or health facility during the influenza season . By expanding the definition of a crime, this bill would impose a state-mandated local program. . . .