Mandatory Influenza Vaccination For Healthcare Workers: The Virginia Mason Story

1. Mandatory Influenza Vaccination For Healthcare Workers: The Virginia Mason Story Beverly Hagar RN, BSN, COHN-S Virginia Mason Medical Center Webinar, Mountain Pacific Quality Health March, 2013 1

2. Virginia Mason Health System • Main clinic and hospital in Seattle • Multi-specialty group practice 480+ physicians 5500 FTEs • More than 1 million outpatient visits per year • 16,000 inpatient admissions per year • 336-bed tertiary care hospital

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4. In 2004Virginia Mason Medical Centermade influenza vaccination a condition for employment for all staff. A vaccine shortage that year meant our campaign mandate had to be on hold until 2005.

5. The First!! • We were the first vertically integrated healthcare facility in the USA to make influenza vaccination a condition of employment

6. “Simply put, there has to be a “first” ---an innovator, a pioneer, a trailblazer.”Commentary by Thomas R. Talbot MD, MPH and William Schaffner, MD, Infection Control and Hospital Epidemiology, September 2010, Vol. 31, No 9

7. Why a Requirement?

8. VMMC Why a Requirement? • 2004 we ran several rapid process improvement workshops to look at ways to improve delivery of flu vaccination to our patients and staff • Three facts from the literature were striking: • Influenza vaccine is safe and effective in healthy adults • Immunizing health care workers results in a safer environment for patients • Voluntary programs to immunize health care workers had not been very effective.

9. Our Strategic Plan

10. Influenza Kills

11. Influenza Kills • 610,000 life-years lost annually • 3.1 million days of hospitalization • 314 million outpatient visits • Estimated cost burden of $87 billion in the USA • Despite the fact that we have an effective vaccine.

13. The Facts: Health Care Workers (HCW) come to work when sick • HCW in Kansas: 47% reported working with an influenza like illness (ILI) • Nurse study, 95.5% reported direct patient contact with high risk patients • 78% had ILI; 80% of those went to work ill

14. Other Rationale • Studies have shown that increased immunization of HCW’s decreased risk in patients in acute care settings. • Studies have shown that increased vaccination rates in chronic care facilities correlates with reduced patient mortality, ILI illness and hospitalizations for ILI • Outbreaks in medical settings have been traced to HCW’s

15. What We Know • Influenza • Can Kill • Is easy to spread • HCW’s come to work with ILI • Can spread virus even when asymptomatic • In those most at risk, the vaccine is not as effective • Healthy young adults: vaccine is safe and effective

16. Healthcare Worker Vaccination What is our ethical responsibility to our patients??

17. Nurse Week 12/2005

18. Why is Healthcare Worker Vaccination Important? • We may serve as a vehicle for transmission of flu • We may be in contact with high risk patients • Absenteeism can stress the healthcare system • We may help reduce patient mortality • We need to educate patients and model behavior—be a myth buster!!

19. Public Health Rationale for Mandatory HCW Seasonal Influenza Vaccination • Volunteer programs largely unsuccessful • High morbidity, mortality and costs • Vulnerability of elderly, sick, immunocompromised populations to HCW infection • Precedents- annual TB, Hep B, MMR, LTC facilities • Improve institutional safety • Decrease HCW illness and absenteeism • Helpful in pandemic preparation

20. According to Dr. Michael BellCDC’s Associate Director for Infection Control: “I think it is absolutely essential that health care personnel be vaccinated annually with seasonal influenza vaccine, not only for their own protection, but also to protect patients in the hospital. I think an important concern to keep in mind is that an infectious health care provider can come into the hospital early in the course of their disease and spread a potentially dangerous infection to the very vulnerable individuals in hospital settings. The vaccination protects not only the health care provider, but also that individuals patients.” CDC Briefing, June 18, 2009

21. Role of the Infection Control Practitioner and the Employee Health Nurse • Tackle the myths • Educate Healthcare workers & patients (the Oprah test) • Support vaccination and vaccination programs • Monitor rates and programs for improvement recommendations • Be a pro-active leader for vaccination, not only in your facility, but in your community

22. I will never forget that the only reason I'm standing here today is because somebody, somewhere stood up for me when it was risky. Stood up when it was hard. Stood up when it wasn't popular. And because thatsomebody stood up, a few more stood up. And then a few thousand stood up. And then a few million stood up. And standing up, with courage and clear purpose, they somehow managed to change the world.BARACK OBAMA, speech, Jan. 8, 2008“Yes We Can!!”

23. Mandatory Vaccination: Ethical Issues • Autonomy of the individual- personal rights • Protection of the community at large (public health issue) • First “do no harm” • Voluntary efforts not as successful

24. Pros of Mandatory Vaccination • Highly effective • Acts in the patients best interest • Protects patients and workforce and community at large • Embedded in culture of safety • Less work to manage non-compliance