Hospitals hit the 90% mark for health care worker flu shots
Tracking doctors continues to challenge EHPs
A majority of U.S. hospitals has achieved the Healthy People 2020 goal of vaccinating at least 90% of their employees against influenza, but they have struggled to track the vaccinations of doctors, advanced practice nurses and physician assistants.
By mid-May, 4,254 hospitals reported their 2013-2014 influenza vaccination rates, as required by the Centers for Medicare & Medicaid Services (CMS), and their median vaccination rate for employees was 90%, according to a preliminary review of the data.
That represents great progress in vaccinating health care personnel, says Megan C. Lindley, MPH, deputy associate director for science at the Immunization Services Division of the National Center for Immunization & Respiratory Diseases at the Centers for Disease Control and Prevention. "It’s definitely impressive and worthy of congratulations to the hospitals," she says.
The high rates also reflect a steady movement toward mandatory vaccination policies. The Immunization Action Coalition in St. Paul, MN, maintains an "honor roll" of hospitals and other health care organizations that have mandated influenza vaccination. It now contains more than 400 hospitals.
Every month, more hospitals ask to be added to the list, says Deborah Wexler, MD, executive director of the Immunization Action Coalition. The coalition began the honor roll as a recognition program in October 2009 with 11 hospitals and health systems. "It’s snowballing," she says.
Hospitals also achieved a median rate of 92% influenza vaccination for students, trainees and volunteers. But one in five reported the vaccination status of licensed independent practitioners — doctors, advanced practice nurses and physician assistants — as "unknown."
"The licensed independent practitioners are very difficult to track," acknowledged Lindley. "They’re infrequently at the facility if they only occasionally round on patients, and their vaccination data isn’t stored at the hospital as it is for employees."
This is the first year that CMS will include hospital influenza vaccination rates in its public reporting, available at www.hospitalcompare.hhs.gov.
Tracking is a challenge
Behind the scenes, employee health professionals have been working hard to provide all these influenza vaccinations and to track employees, students, volunteers and licensed independent practitioners. It hasn’t been easy.
CDC adjusted the measure for this year, which is reported through the agency’s National Healthcare Safety Network, to count individuals who spent even part of a day in a hospital. Last year, hospitals were told only to count employees and others who had worked in the hospital for 30 days or more.
That 30-day threshold was difficult — or even impossible — for many employee health professionals to track. "Our members were very pleased that they listened to their stakeholders," says Dee Tyler, RN, COHN-S, FAAOHN, executive president of the Association of Occupational Health Professionals in Healthcare (AOHP) and director of Medical Management for Coverys in East Lansing, MI.
Yet there are still substantial challenges, particularly related to people who worked at the hospital only near the October 1 beginning of the influenza reporting period.
"The volunteers were our biggest challenge because they may have volunteered in October and they may not have volunteered since, and they may no longer live in the state," says Melanie Swift, MD, director of the Vanderbilt Occupational Health Clinic in Nashville, TN.
"They’re hard to track down," she says. "If they didn’t get their vaccine from us, we’re tracking them down to see if they got it someplace else."
CMS allows individuals to sign an attestation that they received the vaccine elsewhere.
EHPs partner with other departments, such as volunteer services, to gather the vaccination data. But employees often require repeated follow up. Some people seem to need to be nagged before they respond, says Swift.
"About the third time you notify them, they wake up and realize you really don’t have the flu shot record they thought you had all the time," she says.
Licensed independent practitioners often work at multiple hospitals, and it hasn’t been easy for hospitals to gather their vaccination information. AOHP had requested more modifications in the measure to ease that burden.
"Our occupational health professionals are taxed," says Tyler. "It is a lot of extra work for them to report these numbers. It takes time and man hours away from caring for employees."
CDC will continue to consider changes in the measure, Lindley says. "It’s a constant effort to balance having a measure that is comprehensive and useful from an infection control and risk standpoint with a measure that is feasible for facilities to report," she says. "We’re certainly aware of the difficulties. It’s something we’re continuing to keep an eye on."
Because of those difficulties, the CDC measure doesn’t require reporting of vaccinations of contract workers — even though hospitals use a large number of agency nurses, Lindley notes.
Will the public pay attention?
What will the public think of the influenza vaccination reporting? How will they interpret or use this measure of quality?
"We’re establishing a protection rate for the patients and health care personnel in that facility," says Lindley. She notes that the Joint Commission accrediting agency also requires hospitals to monitor their influenza vaccination rates and to work toward a goal of 90% vaccination.
Wexler of the Immunization Action Coalition says she believes the reporting will have an impact. "A high level of vaccination indicates a high level of attention to patient safety," she says. "I hope the public will pay attention to it because that will help drive the effort to make sure that health care workers get vaccinated."
Tyler is less sure of the value of the reporting, particularly as it relates to licensed independent practitioners. Because they work at multiple facilities, they are counted multiple times in vaccination measures, she says.
In a position statement, AOHP endorsed the use of a comprehensive influenza vaccination program, including education of health care workers. If the hospital cannot achieve a 90% rate through a voluntary program, then "the organization may need to consider mandating the vaccine," AOHP said.
Some hospitals have been able to reach the 90% goal without a mandate, Tyler says. "We feel that vaccination is an important way to protect our patients and prevent the spread of infection," she says.
[Editor’s note: CDC compiled a list of strategies for collecting influenza vaccination data, which is available at www.cdc.gov/nhsn/PDFs/HPS/General-Strategies-HCP-Groups.pdf.]
