Patients will soon be able to check the influenza vaccination rates of health care workers at the nation’s hospitals through Hospitalcompare.gov, the website of the Centers for Medicare & Medicaid Services (CMS). That specter of public reporting has helped spur the rising rates of flu vaccination in hospitals, but it will also reveal the continuing problem of tracking the vaccination status of doctors, advanced practice nurses and physician assistants who are not hospital employees.
Only 62% of licensed independent professionals received their flu vaccine in the 2013-2014 flu season, according to the reports of 4,254 hospitals for the CMS quality measure – but that figure is skewed by significant underreporting. Vaccine status was unknown for about one-third (35%) of licensed independent professionals in the hospital reports.1
"They’re a very mobile population. They’re doing work at a number of facilities," 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. "They’re not necessarily at the facility all the time and they don’t necessarily know when they’re going to be at the facility."
When the measure was developed, hospitals expressed concerns about tracking non-employees. The criteria will be reviewed in 2015, but licensed independent practitioners are likely to remain an important group because of their close patient contact, Lindley says.
"It continues to be a real balancing act between something that is feasible for hospitals and [a measure] that is comprehensive," she says.
Doctors and nurses report very high levels of influenza vaccination. In an Internet panel survey conducted for CDC, 92% of physicians, 91% of nurses and 90% of nurse practitioners and physician assistants said they received the vaccine in the 2013-2014 season.2
Health professionals were recruited for the survey through previous Internet panels and Medscape membership. CDC has been conducting Internet surveys to gain more rapid information on vaccination trends, says Lindley.
So are doctors and other licensed professionals receiving their vaccines but failing to provide documentation to all the facilities at which they work? Or does the Internet survey overstate their vaccination status?
"You’ve got motivated people who are taking time to complete the survey," says Dee Tyler, RN, COHN-S, FAAOHN, executive president of the Association of Occupational Health Professionals in Healthcare (AOHP). "I suspect that’s the correlation with such a high vaccination rate."
Employee health professionals often struggle to obtain physician participation with other initiatives, such as tuberculosis screening, she says.
CDC’s National Healthcare Safety Network, which collects the data from CMS, shows high compliance among those physicians, advance practice nurses and physician assistants who do report. Some 95% of licensed independent practitioners whose vaccine status was known had received the flu vaccine.
To track flu vaccination status, EHPs often work with the medical credentialing office or the medical staff office. Another option may be to tap into vaccine registries, says Tyler. Some states, such as Wisconsin, California, Georgia, Tennessee and Delaware, maintain registries of both child and adult immunizations that are available to health providers. (See related story, p.122.)
Hospitals hit Healthy People 2020 goal
While hospitals still struggle with vaccination of licensed independent practitioners, they have achieved high rates of employee vaccination – with or without a vaccine mandate.
Overall, 91% of hospital employees whose vaccine status was known had received the influenza immunization. That exceeds the Healthy People 2020 goal of 90% influenza immunization of health care workers.
More than half (58%) of health care workers in hospitals reported that their employers require the flu vaccine. Vaccine coverage was 80% among those who said their facilities offered free onsite vaccination for more than one day.
"We have seen voluntary vaccination programs that have had very high, successful vaccination rates," says Mark Catlin, health and safety director for Service Employees International Union (SEIU) in Washington, DC. "They make it easy for people to get vaccinated. They provide good education. They do the things that encourage people to get vaccinated."
Public reporting of vaccination rates gains the attention of hospital administrators, who make a stronger commitment to the efforts, says William Schaffner, MD, professor of preventive medicine at Vanderbilt University in Nashville, TN, and past president of the National Foundation for Infectious Diseases.
"They provide more resources and encouragement to occupational health and infection control," he says. "They let everyone in the institution know that this is what’s now expected and that helps drive [participation] up."
Mandatory policies clearly play a role in the rapid rise in vaccination rates among hospital employees. In facilities with a requirement, 98% of health care workers are vaccinated, according to the Internet survey.
Mandates also may be a factor in differences among states. For example, Rhode Island requires all health care workers to receive the flu vaccine or wear a mask during influenza outbreaks. Hospitals reported a vaccination rate of 90% of employees and 88% of licensed independent practitioners.
New Jersey had the lowest vaccination rates: 71% of hospital employees and 39% of licensed professionals.
Many nursing homes don’t offer free shots
Long-term care continues to lag in influenza immunization – despite the risk to vulnerable elderly residents.
Only 54% of nurses’ aides in long-term care facilities reported that they received the flu vaccine in 2013-2014. About 43% of long-term care workers said their employers didn’t promote or require the vaccine, and 73% said flu vaccination wasn’t available on-site.
"It’s distressing that administrators of those facilities don’t provide the vaccine on site for free," says Schaffner. "Those are such elementary aspects of health care worker influenza immunization. I was stunned when I read that, frankly."
Public health authorities and infection control organizations will likely place a new focus on long-term care, he says. Public reporting may eventually be on tap, as well. "All the things that appear to be working in hospitals should apply to long term care facilities," he says.
Strategies to track flu shots
Work with credentialing offices, sister facilities
Too many "unknowns" in your flu vaccination reporting can make it seem that your hospital’s rate is lower than it really is. Hospitals shared successful strategies they used to track the vaccination status of licensed independent practitioners (physicians, advanced practice nurses and physician assistants) with the National Healthcare Safety Network of the Centers for Disease Control and Prevention (www.cdc.gov/nhsn/PDFs/HPS/General-Strategies-HCP-Groups.pdf).
Employee health professionals often worked with medical staff coordinators, credentialing offices, licensing boards, and sister facilities to track licensed professionals. Other strategies included:
- Sent a letter along with a vaccin-ation status survey and asked LIPs to return it to the credentialing office.
- Offered vaccination and/or collected vaccination status information during staff or depart-ment meetings, grand rounds, facility rounds, volunteer activities, and lunch.
- Organized clinics for LIPs to receive the flu vaccine and complete consent forms.
- Placed telephone calls to physicians’ offices to obtain information for non-responding health providers.
- Asked the medical director to send a letter to non-responding health providers.
- Lindley MC, Bridges CB, Strikas RA, et al. Influenza vaccination performance measurement among acute care hospital-based health care personnel — United States, 2013–14 influenza season. MMWR 2014;63:812–815.
- Black CL, Yue X, Ball SW, et al. Influenza vaccination coverage among health care personnel —United States, 2013–14 influenza season. MMWR 2014;63:805–811.
