WU Mandatory Influenza Vaccination Policy

1. WU Mandatory Influenza Vaccination Policy Management Council June 14, 2013

2. Rationale • ~36k deaths/yr in the U.S. from influenza • Influenza poses a particularly serious health risk in healthcare workplace settings • Since 1984, the CDC has recommended flu vaccination for individuals working in health care settings • WUSM has used a variety of tactics to encourage employee participation in WUSM’s voluntary flu vaccination program: • Never achieved a compliance rate above 66%, even in 2009 when H1N1 flu strain was a major concern • WU employee participation at ~same level as national average for voluntary programs (67% among health care workers in 2011-12) • This past year, achieved 60% compliance rate among both WUSM employees and trainees

3. BJC Experience • BJC made flu vaccination a condition of employment in 2008 • 98.4% compliance rate among ~26k employees • 90 (0.3%) received religious exemptions • 321 (1.2%) received medical exemptions • 8 employees (0.03%) were terminated for failure to comply • 21 adverse events following vaccination: • 11 sore arms • 5 possible allergic reactions • 1 fainting • 2 fever/myalgias • 1 URI • 1 chronic inflammatory demyelinating polyneuropathy which could not be linked to vaccine because of several other antecedent triggers

4. Mandatory Vaccination – Other Organizations • In addition to the CDC, numerous professional organizations have endorsed mandatory flu vaccination for health care workers, including • American Medical Association • American Hospital Association • The Joint Commission • American College of Physicians • American Academy of Pediatrics • Association for Professionals In Infection Control & Epidemiology (APIC) • Other academic institutions with mandatory flu vaccination policies: • Johns Hopkins • Emory • UC Davis • Loyola • CHOP, Denver Childrens, Cincinnati Childrens

5. WU Mandatory Flu Vaccination Policy • Developed by a working group including: • Larry Shapiro Alison Whelan Legail Chandler • Jim Crane Kelley Mullen Ann Prenatt • Hilary Babcock Jennifer Reneau Joe Sklansky • Karen Winters Alan Glass John Powers • Modeled after Hopkins and BJC policies • As a condition of employment and/or access to patient care or clinical care areas, all healthcare personnel (HCP) who provide patient care services or work in patient care or clinical care areas must receive an annual influenza vaccination by December 15 • HCP’s include all Washington University employees, faculty, staff, residents, fellows, students, trainees, independent contractors, temporary agency personnel, volunteers, and vendors who provide patient care services or work in patient care or clinical care areas

6. WU Mandatory Flu Vaccination Policy • Patient care or clinical care areas include the physical or recognized borders of inpatient and outpatient areas where patients may be seen or wait to be seen, evaluated, treated, and/or studied • Examples of patient care or clinical care areas include, but are not limited to the following: • Barnes-Jewish Hospital • St. Louis Children’s Hospital • Center for Advanced Medicine, • Barnes-Jewish West County Hospital & Medical Office Buildings • MBMC, Christian, BJSPH, Progress West) • The Orthopedic Center in Chesterfield • Siteman Cancer Center South County • 4444 Forest Park (Physical Therapy, IVF program) • 4488 Forest Park building (Alzheimers program) • McMillan (Eve Clinic, Neurology Clinics) • Chase Park Plaza Sleep Center

7. WU Mandatory Flu Vaccination Policy • Influenza vaccination will be provided free of charge to all University-employed and University-enrolled HCP through Occupational Health Services/Student Health Services • Prior to the annual onset of influenza season and when the most current vaccination • recommendations are published by the Centers for Disease Control and Prevention, the University will inform applicable personnel about (1) vaccination requirements; (2) dates when vaccination is available; (3) procedures for receiving vaccination; (4) procedures for submitting written documentation of vaccination obtained outside of the University; (5) procedures for requesting an exemption; and (6) consequences of failing to obtain vaccination. • HCP who obtain influenza vaccination through other providers will be required to provide documentation of vaccination that is acceptable to the University in its sole discretion. Vaccinated and exempt HCP will receive a colored identification badge clip. 

8. WU Mandatory Flu Vaccination Policy Exemptions Medical: Exemptions to mandatory vaccination may be granted based on certain medical contraindications, including history or documented test indications of severe allergy to the vaccine or its components and history of Guillain-Barré syndrome. HCP seeking a medical exemption must submit an exemption request form and documentation of medical contraindications by November 1. Medical exemptions are valid only for the flu season in which they are granted. Religious: Exemptions to mandatory vaccination may be granted based on sincerely held religious beliefs, practices or observances. HCP seeking a religious exemption must submit an exemption request form and any requested documentation (see Appendix 2) by November 1. Infection control procedures: For the safety of patients and others during influenza season, HCP who are granted an exemption will be encouraged to wear a surgical or isolation mask when entering patient care or clinical care areas and may be denied access to certain patient care or clinical areas.

9. WU Mandatory Flu Vaccination Policy • Compliance • HCP who are University employees and who fail to obtain an influenza vaccination or exemption by December 15 will be placed on unpaid suspension for a period of up to 30 days • HCP who are University students and who fail to obtain an influenza vaccination or exemption by December 15 will not be allowed to participate in patient care or clinical activities or to access patient care or clinical care areas, restrictions which may adversely impact course performance and completion of course and program requirements. • If an influenza vaccination or exemption has not been obtained by the end of the 30-day period, or by December 15 for students, the HCP will be subject to further remedial and disciplinary action, including but not limited to i) denial of access to patient care or clinical areas; ii) referral to the appropriate Associate Dean and/or Committee on Academic and Professional Evaluation of Students; iii) suspension or dismissal from applicable programs; and/or iv) termination of employment or service contracts.

10. WU Mandatory Flu Vaccination Policy • Next Steps • Develop written administrative procedures to support policy implementation • Develop a Communication Plan: • Forums: FPP CPC, Management Council, CAC, Department Meetings, The Record, Dean Announce, etc • Create collateral materials: • PowerPoint presentations, • FAQ document, • Business and clinic manager talking points

11. WU Mandatory Flu Vaccination Policy COMMENTS AND SUGGESTIONS