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June 11, 2013
Mandatory Flu Shot Policy Doesn't Result in Mass Employee Exodus, Loyola Study Shows
Loyola vaccination program is in its fourth year with 99 percent compliance
MAYWOOD, Ill. - Mandatory influenza (flu) vaccination as a condition of employment does not mean employees will leave en masse, according to a four-year analysis of vaccination rates at Loyola University Health System.
“ ’First do no harm’ is our mandate as health-care workers,” said Jorge Parada, MD, MPH, FACP, FIDSA, study author and professor of medicine at Loyola University Chicago Stritch School of Medicine. “We have a fiduciary responsibility to perform hand hygiene and adhere to contact precautions, and flu vaccines should be considered in the same vein. We should do all we can to not pass along illness to our patients.” Loyola has sustained a 99 percent compliance average since adopting the mandatory flu vaccination protocol four years ago.
Flu infections result in approximately 150,000 hospital admissions and 24,000 deaths annually. The Centers for Disease Control and Prevention (CDC) recommends that all health-care personnel receive the annual flu vaccine, yet the national average for vaccination of health-care professionals is only 64 percent.
“Just as construction workers must wear steel-toed boots and hard hats on job sites as a condition of employment, we believe that health-care workers should get a flu shot to work in a hospital,” said Parada, who leads the vaccination program at Loyola.
Infection prevention specialists worked with a multidisciplinary task force at Loyola to develop a facilitywide policy that made flu vaccination a condition of employment. Parada presented his study of the four-year program last week at the annual conference of the Association for Professionals in Infection Control and Epidemiology.
As one of the first medical centers in the country to implement mandatory flu vaccinations, Loyola began with the full backing of the hospital’s senior leadership.
“Starting in 2008, our staff members were no longer allowed to simply not bother to get influenza vaccination, instead they were required by Employee Health to state “yes” or “no” when asked to be vaccinated and provide a reason for why if they declined the vaccine,” Parada said. This delineation brought Loyola’s overall vaccination rate up to 72 percent, well above the CDC’s goal of having more than 60 percent of health-care professionals vaccinated.
“This was still well short of what we at Loyola felt we should achieve to maximize patient safety,” Parada said. “After all, this still meant more than 1 in 4 staff were not being immunized."
In 2009 Loyola chose to mandate flu vaccination as a condition of employment and extended this mandate to students, volunteers and vendors. To support and encourage compliance, the center’s communications department developed facilitywide reminder emails and created short videos, which were displayed on flat screens throughout the hospital.
In the first year of the mandatory policy (2009/10 season), 99.2 percent of employees received the vaccine, 0.7 percent were exempted for religious/medical reasons and 0.1 percent refused vaccination and chose to terminate employment. In 2012, four years later, the results have been sustained: 98.7 percent were vaccinated, 1.2 percent were exempted and 0.06 percent refused vaccination.
“In reality our numbers were even better than that, of the five people who refused vaccination in the mandatory period, three were unpaid volunteers who later reconsidered, received vaccine and returned to Loyola. The two others were part-time staff, each with only a 10 percent time commitment at Loyola . . . truly reflecting a 0.002 vaccine refusal rate,” Parada said. Over the course of four years, fewer than 15 staff members (including volunteers) out of approximately 8,000 total chose termination over vaccination.
“Near-universal flu immunization is achievable and sustainable with a mandatory vaccination policy,” Parada said. “Our employees and associates now understand that this is the way Loyola does business and we believe that patient safety has been enhanced as a result.”
Loyola University Health System (LUHS) is a member of Trinity Health. Based in the western suburbs of Chicago, LUHS is a quaternary care system with a 61-acre main medical center campus, the 36-acre Gottlieb Memorial Hospital campus and more than 30 primary and specialty care facilities in Cook, Will and DuPage counties. The medical center campus is conveniently located in Maywood, 13 miles west of the Chicago Loop and 8 miles east of Oak Brook, Ill. The heart of the medical center campus is a 559-licensed-bed hospital that houses a Level 1 Trauma Center, a Burn Center and the Ronald McDonald® Children's Hospital of Loyola University Medical Center. Also on campus are the Cardinal Bernardin Cancer Center, Loyola Outpatient Center, Center for Heart & Vascular Medicine and Loyola Oral Health Center as well as the LUC Stritch School of Medicine, the LUC Marcella Niehoff School of Nursing and the Loyola Center for Fitness. Loyola's Gottlieb campus in Melrose Park includes the 255-licensed-bed community hospital, the Professional Office Building housing 150 private practice clinics, the Adult Day Care, the Gottlieb Center for Fitness, Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park.