We already encourage them to stay home from work when they are sick. Unfortunately, by the time a HCP has symptoms of influenza, they may have already exposed many patients since the virus is shed for 1–2 days before symptoms begin. Further, many studies show that HCP often go to work while they are sick and may be infectious to others. Start planning early to make sure all employees in your work setting receive annual influenza vaccination before the influenza season begins.
Ask the Experts: Influenza: For Healthcare Personnel
Because HCP provide care to patients at high risk for complications of influenza, they should be considered a high-priority group for receiving vaccination. Achieving high rates of vaccination among HCP will protect staff and their patients, and reduce disease burden and healthcare costs. Vaccination rates of HCP are still too low; overall only 80% of HCP reported influenza vaccination during the 2021–22 season.
Influenza vaccination key points for HCP include:
- All HCP should be educated regarding the benefits of influenza vaccination
- Influenza vaccine should be administered annually to all eligible HCP
- A signed declination should be obtained from HCP who decline influenza vaccination
- Healthcare facilities should monitor HCP influenza vaccination coverage and declination at regular intervals
- HCP vaccination coverage should be used as one measure of a patient-safety quality program
In 2011, ACIP published “Immunization of Health-Care Personnel,” which includes information about all recommended vaccines (see www.cdc.gov/mmwr/pdf/rr/rr6007.pdf).
It is important to vaccinate all healthcare personnel, including paid and unpaid workers who may be exposed to patients or infectious materials. This includes direct patient care staff (e.g., physicians, nurses, and therapists), and staff and volunteers in pharmacy, radiology, laboratory, human resources, facilities management (housekeeping), food services, and laundry. Vaccination should include healthcare staff in all settings, such as hospitals, outpatient clinics, pharmacies, emergency response, nursing homes and assisted living facilities, and home care.
All people working in long-term care facilities who do not have a valid contraindication should receive annual influenza vaccination.
Since January 2007 the Joint Commission has required accredited organizations to offer annual influenza vaccination to staff, volunteers, and licensed independent practitioners who have close patient contact.
Every year more healthcare facilities are adopting mandatory vaccination policies for their employees. Immunize.org has included more than 1,330 of these on its Honor Roll for Patient Safety, which gives special recognition to institutions that enforce mandatory vaccination for all personnel who are in the vicinity of a patient (including volunteers and housekeeping staff). To read about the policies of the various facilities included in the Honor Roll, go to www.immunize.org/honor-roll/influenza-mandates/honorees.asp. In addition, the National Adult and Influenza Immunization Summit (NAIIS) has developed tools to assist post-acute and long-term care facilities that plan to implement influenza vaccination requirements for HCP at www.izsummitpartners.org/naiis-workgroups/influenza-workgroup/tools-for-ltcf/. We hope reviewing these policies and tools will give you the information you need to assist in developing a policy for your facility.
Though vaccination is the most effective means of protecting your patients from influenza, there may be instances where employees are not vaccinated for medical or personal reasons. In these instances, you may want to consider reassigning unvaccinated workers to non-patient areas or requiring that they wear masks throughout the influenza season.
If a vaccine is covered under the National Childhood Vaccine Injury Act—and almost all vaccines routinely administered to adults are (with the exception of PPSV and zoster)—it is mandatory under federal law to give the VIS for that vaccine to the vaccinee. Therefore, when you give influenza vaccine to employees and staff, you are required by law to provide them with a VIS.
Some studies have shown an increase in HCP influenza vaccine acceptance when decliners are required to sign such a statement. In addition, such statements can help a vaccination program assess the reasons for declination and plan future educational efforts. Immunize.org has posted the following suggested declination form for healthcare workers at www.immunize.org/catg.d/p4068.pdf.
There are many professional associations that have issued policy statements supporting mandatory healthcare worker influenza vaccination. You can find information about these organizations as well as a list of more than 1,330 healthcare settings that have implemented mandatory vaccination programs on Immunize.org’s website at Immunize.org’s Influenza Vaccination Honor Roll web section at www.immunize.org/honor-roll/influenza-mandates/.