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Title: Pennsylvania Health Care Worker Flu Immunization Campaign A Patient Safety & Employee Health Initiative Training Resources: Policy Module Version 1.4 June 2011


1
Pennsylvania Health Care Worker Flu Immunization
CampaignA Patient Safety Employee Health
InitiativeTraining ResourcesPolicy
ModuleVersion 1.4June 2011
2
Pennsylvania Health Care Worker Flu Immunization
Campaign
  • Using Healthy People 2020 benchmark as anchor for
    program
  • This presentation reviews current public health
    policy recommendations around mandatory HCW
    seasonal influenza vaccination
  • Brief look at PA Patient Safety Authority data on
    impact of mandatory programs in PA NHs
  • Case Study Module addresses Best Practices, and
    recognizes promising practices as important
    interim strategies

3
  • Healthy People 2020
  • Vision
  • A society in which all people live long, healthy
    lives.
  • Mission
  • Healthy People 2020 strives to
  • - Identify nationwide health improvement
    priorities.
  • Increase public awareness and understanding of
    the determinants of health, disease,
  • and disability and the opportunities for
    progress.
  • Provide measurable objectives and goals that are
    applicable at the national, state, and
  • local levels.
  • Engage multiple sectors to take actions to
    strengthen policies and improve practices
  • that are driven by the best available
    evidence and knowledge.
  • - Identify critical research, evaluation, and
    data collection needs.
  • Overarching Goals
  • Attain high-quality, longer lives free of
    preventable disease, disability, injury, and
  • premature death.
  • - Achieve health equity, eliminate disparities,
    and improve the health of all groups.
  • - Create social and physical environments that
    promote good health for all.
  • Promote quality of life, healthy development,
    and healthy behaviors across all life

4
(No Transcript)
5
Public Health Policy and HCW Flu Vaccination
  • Number and strength of evidence-based
    recommendations for mandatory HCW seasonal flu
    vaccination are building
  • Common theme mandatory HCW seasonal flu
    vaccination is the ethical, effective and
    indicated program model
  • Specific language from key recommendations from

6
2010 National Vaccine Plan
The National Vaccine Plan is the nations roadmap
for a 21st century vaccine and immunization
enterprise and the 10-year strategy to ensure
that all Americans can access the preventive
benefits of vaccines. It includes strategies for
advancing vaccine research and development,
financing, supply, distribution, safety, global
cooperation, and informed decision-making among
consumers and health care providers.  National
Vaccine Program Office/HHS
http//www.hhs.gov/nvpo/vacc_plan/index.html
See Beauchamp, TL, Childress, JF Principles of
Biomedical Ethics
7
2010 National Vaccine Plan Health Care
Providers Objective
Objective 4.6 Educate and support health care
providers in vaccination counseling and vaccine
delivery for their patients and themselves.
Strategies 4.6.8 Develop, implement, and
evaluate comprehensive programs to ensure health
care professionals are appropriately immunized
with recommended vaccines.
http//aappolicy.aappublications.org/cgi/content/f
ull/pediatrics126/4/809
See Beauchamp, TL, Childress, JF Principles of
Biomedical Ethics
8
Recommendation for Mandatory Influenza
Immunization of All Health Care PersonnelHenry
H. Bernstein, DO, Jeffrey R. Starke, MD and
Committee on Infectious DiseasesOctober 2010
  • Abstract
  • The purpose of this statement is to recommend
    implementation of a mandatory influenza
    immunization policy for all health care
    personnel. Immunization of health care personnel
    is a critically important step to substantially
    reduce health careassociated influenza
    infections. Despite the efforts of many
    organizations to improve influenza immunization
    rates with the use of voluntary campaigns,
    influenza coverage among health care personnel
    remains unacceptably low. Mandatory influenza
    immunization for all health care personnel is
    ethically justified, necessary, and long overdue
    to ensure patient safety.

PEDIATRICS Vol. 126 No. 4 October 2010, pp.
809-815 (doi10.1542/peds.2010-2376)
http//aappolicy.aappublications.org/cgi/content/f
ull/pediatrics126/4/809
See Beauchamp, TL, Childress, JF Principles of
Biomedical Ethics
9
Recommendation for Mandatory Influenza
Immunization of All Health Care PersonnelHenry
H. Bernstein, DO, Jeffrey R. Starke, MD and
Committee on Infectious DiseasesOctober 2010
  • Mandatory programs for all HCP should be
    implemented nationwide Medical and religious
    exemptions to required influenza immunization can
    be granted on an individual basis. Individual
    organizations and practices must decide at a
    local level (how to address) the additional
    objections to vaccination, (those) which may be
    required by state law (eg, philosophical),
    (those) that are reasonable and the ones they are
    willing to accept for an individual to be granted
    an exception and be allowed to continue to work.
    Policies should be developed for management of
    exempted HCP during influenza season, including
    efforts to ensure patient and staff safety and to
    identify ill HCP.

PEDIATRICS Vol. 126 No. 4 October 2010, pp.
809-815 (doi10.1542/peds.2010-2376)
http//aappolicy.aappublications.org/cgi/content/f
ull/pediatrics126/4/809
See Beauchamp, TL, Childress, JF Principles of
Biomedical Ethics
10
ACP Policy on Influenza Vaccination of Health
Care Workers
The recommendation of the Adult Immunization
Advisory Board is that a series of educational
activities be centered on this message An
annual influenza vaccine should be required for
every health care worker with direct patient care
activities, unless a medical contraindication to
influenza immunization exists or a religious
objection to immunization exists. If, however,
health care workers invoke those exceptions, they
must still fulfill their ethical obligations to
patients and colleagues by not engaging in direct
patient care activities if flu-like symptoms are
present. In addition, those health care workers
who cannot receive flu vaccines due to medical or
religious contraindications should either be
re-assigned to non-patient care areas during
influenza season or wear a mask at all times
during influenza season in the context of patient
care.
11
Revised SHEA Position Paper Influenza
Vaccination of Healthcare Personnel Author
SHEADate Published 9/2/2010 101600
AMAbstract In large part, the discussion about
the rationale for influenza vaccination of
healthcare personnel, the strategies designed to
improve influenza vaccination rates in this
population, and the recommendations made in the
2005 paper still stand. This position paper notes
new evidence released since publication of the
2005 paper and strengthens SHEAs position on the
importance of influenza vaccination of HCP. This
document does not discuss vaccine allocation
during times of vaccine shortage, because the
2005 SHEA Position Paper still serves as the
societys official statement on that issue. SHEA
views influenza vaccination of HCP as a core
patient and HCP safety practice with which
noncompliance should not be tolerated.
Therefore, for the safety of both patients and
HCP, SHEA endorses a policy in which annual
influenza vaccination is a condition of both
initial and continued HCP employment and/or
professional privileges.
http//www.shea-online.org/View/smid/428/ArticleID
/5.aspx
12
National Patient Safety Foundation Supports
Mandatory Flu Vaccinations for Healthcare
Workers
The National Patient Safety Foundation
recognizes vaccine-preventable diseases as a
matter of patient safety and supports mandatory
influenza vaccination of health care workers to
protect the health of patients, health care
workers, and the community. NPSF appreciates
that where vaccination is not possible for any
reason, due to unavailability or medical
contraindications of potential vaccine
recipients, hospitals and healthcare
professionals must use all available alternatives
to avoid transmission to patients and coworkers
including masks and adjusting job
responsibilities.
http//www.npsf.org/pr/pressrel/2009-11-18.php
13
2010-11 Influenza Prevention Control
Recommendations Additional Information about
Vaccination of Specific Populations
  • All HCP and persons in training for health-care
    professions should be vaccinated annually against
    influenza. Persons working in health-care
    settings who should be vaccinated include
    physicians, nurses, and other workers in both
    hospital and outpatient-care settings, medical
    emergencyresponse workers (e.g., paramedics and
    emergency medical technicians), employees of
    nursing home and long-termcare facilities who
    have contact with patients or residents, and
    students in these professions who will have
    contact with patients

http//www.cdc.gov/flu/professionals/acip/specific
populations.htm
14
2010-11 Influenza Prevention Control
Recommendations Additional Information about
Vaccination of Specific Populations
  • Facilities that employ HCP should provide vaccine
    to workers by using approaches that have been
    demonstrated to be effective in increasing
    vaccination coverage. The HCP influenza coverage
    goal should be vaccination of 100 of employees
    who do not have medical contraindications.
    Health-care administrators should consider the
    level of vaccination coverage among HCP to be one
    measure of a patient safety quality program and
    consider obtaining signed declinations from
    personnel who decline influenza vaccination for
    reasons other than medical contraindications.
    Influenza vaccination rates among HCP within
    facilities should be measured regularly and
    reported, and ward-, unit-, and
    specialty-specific coverage rates should be
    provided to staff and administration

http//www.cdc.gov/flu/professionals/acip/specific
populations.htm
15
2010-11 Influenza Prevention Control
Recommendations Additional Information about
Vaccination of Specific Populations
  • Policies that work best to achieve this coverage
    goal might vary among facilities. Studies have
    demonstrated that organized campaigns can attain
    higher rates of vaccination among HCP with
    moderate effort and by using strategies that
    increase vaccine acceptance. A mandatory
    influenza vaccination policy for HCP, exempting
    only those with a medical contraindication, has
    been demonstrated to be a highly effective
    approach to achieving high vaccine coverage among
    HCP. Hospitals and health-care systems that have
    mandated vaccination of HCP often have achieved
    coverage rates of more than 90, and persons
    refusing vaccination who do not have a medical
    contraindication have been required to wear a
    surgical mask during influenza season in some
    programs

http//www.cdc.gov/flu/professionals/acip/specific
populations.htm
16
IDSA Policy on Mandatory Immunization of Health
Care Workers Against Seasonal and Pandemic
Influenza
  • The Infectious Diseases Society of America (IDSA)
    supports universal immunization of health care
    workers (HCWs) against influenza by health care
    institutions (inpatient and outpatient) through
    mandatory vaccination programs, as these programs
    are the most effective means to protect patients
    against the transmission of seasonal and pandemic
    influenza by HCWs. IDSA supports a policy in
    which influenza vaccination is a condition of
    employment, unpaid service, or receipt of
    professional privileges. Employees who cannot be
    vaccinated due to medical contraindications or
    because of vaccine supply shortages should be
    required to wear masks or be re-assigned away
    from direct patient care

www.idsociety.org/redirector.aspx?id15413
17
IDSA Policy on Mandatory Immunization of Health
Care Workers Against Seasonal and Pandemic
Influenza
  • IDSA also is supportive of comprehensive
    educational efforts that inform HCWs about the
    benefits and risks of influenza immunization to
    both patients and HCWs, and other efforts that
    support implementation of a comprehensive
    infection control program.
  • Original policy contained in IDSAs Pandemic and
    Seasonal Influenza Principles for U.S. Action
    (See Recommendation 6) January 2007
  • Revised to address 2009 H1N1 influenza remove
    declination for philosophical reasons and to
    specify the steps that should be taken to protect
    patients from being infected by unimmunized HCWs
    September 30, 2009
  • Revised to specify that annual influenza
    vaccination should be a condition of initial and
    continued employment and/or professional
    privilege and to remove declination for
    religious reasons July 28, 2010

www.idsociety.org/redirector.aspx?id15413
18
IDSA Policy on Mandatory Immunization of Health
Care Workers Against Seasonal and Pandemic
Influenza
  • RATIONALE
  • 1) Several studies demonstrate that immunizing
    HCWs against influenza protects patients against
    acquiring the virus from HCWs, reducing patient
    morbidity and mortalitythus, universal
    immunization of HCWs against seasonal and
    pandemic influenza is a critical patient safety
    issue.
  • 2) Immunizing HCWs against seasonal and pandemic
    influenza also protects the individual HCW from
    falling ill due to these potentially
    life-threatening infections as well as from
    missing work during influenza outbreaks, further
    negatively impacting patient care.
  • 3) Decades of scientific data demonstrate Food
    and Drug Administration-approved influenza
    vaccines to be safe, effective, and cost-saving.
  • 4) Educational programs and easy access to
    influenza immunization have resulted in mildly
    improved coverage in many health care systems in
    recent years, but generally have not achieved
    acceptable levels of coveragemost successful
    educational programs still average only 40 to 70
    percent coverage.
  • 5) Several large health care systems and
    individual hospitals have adopted policies
    requiring mandatory influenza immunization such
    that employees who cannot be vaccinated or who
    choose not to be vaccinated are required to wear
    masks or are re-assigned away from direct patient
    care.
  • 6) Physicians and other health care providers
    must have two special objectives in view when
    treating patients, namely, to do good or to do
    no harm" (Hippocratic Corpus in Epidemics Bk. I,
    Sect. 5, trans. Adams), and have an ethical and
    moral obligation to prevent transmission of
    infectious diseases to their patients.

www.idsociety.org/redirector.aspx?id15413
19
The Pennsylvania Patient Safety Authority.
PA-PSRS 2010 annual survey. 2010. unpublished
results.
20
The Pennsylvania Patient Safety Authority.
PA-PSRS 2010 annual survey. 2010. unpublished
results.
21
The Pennsylvania Patient Safety Authority.
PA-PSRS 2010 annual survey. 2010. unpublished
results.
22
Group Exercise
  • Share language from your institutions patient
    bill-of-rights or similar standard that
    specifically addresses patient safety. How does
    it relate to the recommendations discussed?
  • Share language from your institutions current
    HCW flu vaccination policy. How does it align to
    the recommendations discussed?
  • We will use these examples to build a collection
    of policy issues and (potential) answers for
    the website

23
Opening paragraphs of policy see
http//pahcwfluvax.org/case-studies/main-line-heal
th-case-study/
24
VaccineVolume 28, Issue 13, 16 March 2010, Pages
2517-2521 Physician attitudes towards influenza
immunization and vaccine mandatesJennifer E.
deSante, Arthur Caplan, Frances Shofer, Amy J.
Behrman Abstract Aim We surveyed physicians
opinions and acceptance of influenza
immunization. Scope A web-based survey was
sent to all physicians in two academic
departments during spring 2009. Results 227
(40.5) physicians responded. Physicians who
frequently cared for high-risk patients
self-reported higher immunization rates than
physicians with infrequent contact (P  0.0002).
There were no significant differences in
immunization rates between emergency medicine
(EM) and internal medicine (IM), between those
with and without children at home, nor by age
group. A majority (84.6) supported mandatory
vaccination. IM physicians were more supportive
of mandates than EM physicians (P lt 0.0001).
Conclusion Self-reported immunization rates were
high among study physicians. Acceptance of
mandatory vaccination was substantial, but varied
by specialty.
25
Vaccine Volume 29, Issue 9 pp. 1727-1854 (17
February 2011) Regular Papers Employee
designation and health care worker support of an
influenza vaccine mandate at a large pediatric
tertiary care hospital Original Research Article 
pdf here  Vaccine_Feemster et al_HCW Flu
Vaccinations_Feb 2011 Kristen A. Feemster,
Priya Prasad, Michael J. Smith, Chris Feudtner,
Arthur Caplan, Paul Offit, Susan E.
CoffinAbstractAim Determine predictors of
support of a mandatory seasonal influenza vaccine
program among health care workers (HCWs).Scope
Cross-sectional anonymous survey of 2443 (out of
8093) randomly selected clinical and non-clinical
HCWs at a large pediatric network after
implementation of a mandatory vaccination program
in 200910.Results388 HCWs (58.2) completed
the survey and 75.2 of respondents reported
agreeing with the new mandatory policy. Most
respondents (72) believed that the policy was
coercive but gt90 agreed that the policy was
important for protecting patients and staff and
was part of professional ethical responsibility.
When we adjusted for attitudes and beliefs
regarding influenza and the mandate, there was no
significant difference between clinical and
nonclinical staff in their support of the mandate
(OR 1.08, 95 C.I. 0.94, 1.26).ConclusionsAttitu
des and beliefs regarding influenza and the
mandate may transcend professional role. Targeted
outreach activities can capitalize on beliefs
regarding patient protection and ethical
responsibility.
26
Appendix Joint Commission Standards 2011 QA on
HCW seasonal influenza vaccination
Adapted from Jason L. Schwartz, MBE, AM, Center
for Bioethics Department of History Sociology
of Science University of Pennsylvania NVAC Health
Care Personnel Influenza Vaccination Subgroup 31
May 2011
27
Joint Commission on Accreditation of Health-Care
Organizations
  • 3/3/2011
  • Q What does my organization have to do about
    this years influenza season to satisfy Joint
    Commission requirements?
  • A Critical Access Hospitals, Hospitals, and Long
    Term Care facilities have a standard specific to
    Healthcare Worker Influenza Vaccination Programs
    (See standard IC.02.04.01).  Other health care
    settings, such as Ambulatory Care, Home Health
    Care, Laboratory, and Behavioral Health Care (for
    example, day care and residential) settings do
    not have specific standards however, as part of
    their infection prevention and control activities
    these organizations need to assess their risks
    and take actions to protect their patients and
    health care workers (See standards IC.01.03.01
    and IC.02.01.01)

Adapted from Jason L. Schwartz, MBE, AM, Center
for Bioethics Department of History Sociology
of Science University of Pennsylvania NVAC Health
Care Personnel Influenza Vaccination Subgroup 31
May 2011
http//www.jointcommission.org/about/JointCommissi
onFaqs.aspx?faq433
28
Joint Commission on Accreditation of Health-Care
Organizations
  • 3/3/2011
  •  In 2006, The Joint Commission announced a new
    infection control standard requiring accredited
    hospitals, critical access hospitals, and long
    term care facilities to offer influenza
    vaccinations to health care workers, including
    licensed independent practitioners and
    volunteers. The Joint Commission developed the
    standard in response to recommendations by the
    Centers for Disease Control and Prevention (CDC)
    making the reduction of influenza transmission
    from health care professionals to patients a top
    priority in the United States

Adapted from Jason L. Schwartz, MBE, AM, Center
for Bioethics Department of History Sociology
of Science University of Pennsylvania NVAC Health
Care Personnel Influenza Vaccination Subgroup 31
May 2011
29
Joint Commission on Accreditation of Health-Care
Organizations
  • 3/3/2011
  • The Joint Commission standard IC.02.04.01
    requires Critical Access Hospitals, Hospitals,
    and Long Term Care facilities to do the
    following
  • Establish an annual influenza vaccination program
    that includes, at a minimum, staff and licensed
    independent practitioners.
  • Provide access to influenza vaccinations on site.
  • Educate staff and licensed independent
    practitioners about influenza vaccination,
    non-vaccine control measures (such as hand
    hygiene, sneeze and cough etiquette), and the
    diagnosis, transmission, and potential impact of
    influenza.
  • Annually monitor vaccination rates and reasons
    for nonparticipation in the organizations
    immunization program.
  • Implement enhancements to the program to increase
    participation.

Adapted from Jason L. Schwartz, MBE, AM, Center
for Bioethics Department of History Sociology
of Science University of Pennsylvania NVAC Health
Care Personnel Influenza Vaccination Subgroup 31
May 2011
30
Joint Commission on Accreditation of Health-Care
Organizations
  • 3/3/2011
  • Q Does The Joint Commission require signed
    influenza vaccination declination forms?
  • A No. The Joint Commission does not require
    declinations from individuals refusing influenza
    vaccination. For Critical Access Hospitals,
    Hospitals, and Long Term Care facilities, the
    Joint Commission does require that organizations
    collect and evaluate reasons health care workers
    do not get vaccinated in order to improve the
    organizations health care worker influenza
    program. It does benefit ALL health care settings
    to understand why their health care workers do
    not get vaccinated in order to protect their
    patients, residents, or individuals served

Adapted from Jason L. Schwartz, MBE, AM, Center
for Bioethics Department of History Sociology
of Science University of Pennsylvania NVAC Health
Care Personnel Influenza Vaccination Subgroup 31
May 2011
31
Joint Commission on Accreditation of Health-Care
Organizations
  • 3/3/2011
  • However, the CDCs Interim Guidance on Infection
    Control Measures for 2009 H1N1 Influenza in
    Healthcare Settings, Including Protection of
    Healthcare Personnel posted on October 14, 2009,
    states
  • To improve adherence, vaccination should be
    offered to healthcare personnel free of charge
    and during working hours. Vaccination campaigns
    with incentives such as lotteries with prizes
    should be considered. Healthcare facilities
    should require personnel who refuse vaccination
    to complete a declination form. (Accessed
    10/16/09)
  • The Occupational Safety and Health Administration
    (OSHA) will also be releasing further guidance
    within the next several weeks. View the OSHA
    statement from October 14, 2009. (Accessed
    10/16/09).

Adapted from Jason L. Schwartz, MBE, AM, Center
for Bioethics Department of History Sociology
of Science University of Pennsylvania NVAC Health
Care Personnel Influenza Vaccination Subgroup 31
May 2011
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