Few VA Hospitals Mandate Flu Vaccines for Healthcare Staff

June 7, 2018

By Marilynn Larkin

NEW YORK (Reuters Health) - Despite a recent increase in influenza vaccination mandates for healthcare personnel (HCP) among non-Veterans Affairs hospitals in the U.S., fewer than 5% of VA hospitals have such mandates, researchers say.

"Prior data shows, not surprisingly, that hospitals mandating vaccination receipt, and moreover hospitals that mandate receipt and enforce penalties, have the highest health care personnel vaccination rates," Dr. M. Todd Greene of the VA Ann Arbor Healthcare System and the University of Michigan told Reuters Health.

"Our study found a significant increase in hospital mandatory vaccination requirements between 2013 and 2017," he said by email. "It is likely that this increase, found primarily in non-VA hospitals, is, at least in part related to public reporting requirements that were put into place during the time frame of the surveys."

The team's earlier data were drawn from questionnaires sent to infection prevention specialists at all U.S. hospitals with more than 50 beds and to all VA hospitals, regardless of size. For the 2017 followup, the researchers repeated the survey, but changed the methods to include infection prevention specialists at a random sample of 900 general hospitals of any size that have an intensive care unit, as well as all VA hospitals.

As reported online June 1 in JAMA Network Open, 59% of hospitals responded to the 2017 survey, including 526 non-VA hospitals and 73 VA hospitals. Among those, mandatory influenza vaccination requirements for HCP increased significantly from 37.1% in 2013 to 61.4% in 2017. The change was driven by non-VA hospitals, as Dr. Greene noted, as requirement policies increased from 44.3% in 2013 to 69.4% in 2017.

By contrast, the prevalence of VA hospitals with vaccination mandates rose from 1.3% in 2013 to 4.1% in 2017, a nonsignificant difference.

The authors also found that 25% more nonprofit hospitals reported having mandates than their for-profit counterparts. Further, all hospitals mandating vaccination had allowable declinations; however, 25.7% of hospitals with mandates did not impose penalties for noncompliance.

Among hospitals that did not have flu vaccine mandates, 68.4% (75.2% non-VA; 52.9% VA) had policies for declination and 40.9% required non-vaccinated HCP to wear masks (non-VA 57.8%; VA 1.4%).

Dr. Hilary Babcock of Washington University School of Medicine in St. Louis, author of a related editorial, told Reuters Health by email, "Influenza vaccination remains a key element of a healthcare facility influenza management plan, which also includes early identification and isolation of affected patients and supportive sick leave policies that facilitate ill employees remaining home while ill."

"Most HCP are willing to get the influenza vaccine," she noted. "In survey studies of those who don't routinely get it every year, a range of reasons are cited, including inconvenience, too busy, a belief that they don't need it as they rarely get ill, and concerns that it is not very effective."

"This study confirms that more healthcare facilities are utilizing mandates to push their influenza vaccination rates to the CDC's Healthy People 2020 goal," she said. "Multiple studies over the last few years have shown that mandates are the most effective way to reach and sustain a high rate of influenza vaccination at facilities."


JAMA Network Open 2018.

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