By Thom Wellington

Commissioning inspectors are interested in programs that improve safety and drive successful patient outcomes. To that end, hospitals are not only reviewing the impact of medical equipment care toward patient outcomes they are also moving to expand influenza vaccination to make humans safer. In fact, more health care systems are expanding immunization demands beyond clinical staff and demanding outside contractors also participate. Research shows that human interaction with patients and the patient environment can be negatively impacted by those not immunized. Consequently, maintaining human health in the healthcare setting is just as important as quality-structured programs to keep medical equipment safe.

Hospitals have struggled with implementing internal immunization programs for years due to employee fears and sometimes unconvincing data. Employees understood the significance of maintaining equipment and the environment related to quality outcomes, but overlooked their own effect. Not only from a clinical perspective is an influenza vaccination program important, internal programs also act as a good role model to patients.

“During the 2014–15 season, when [vaccine effectiveness] against medically attended illness caused by any influenza virus was less than 20%, vaccination was estimated to prevent 11,000-144,000 influenza-associated hospitalizations and 300-4,000 influenza-associated deaths,” according to the CDC. In 2017, a study in Pediatrics was the first of its kind to show that flu vaccination also significantly reduced a child’s risk of dying from influenza. The study went on to comment that the more people who get vaccinated, the more people will be protected from flu, including older people, very young children, pregnant women, and people with certain long-term health conditions who are more vulnerable to serious flu complications.

Even with healthcare worker participation below 60%, hospitals must push forward with their programs. Commitment to a flu prevention program is required under accreditation agencies. “The Joint Commission established an Infection Control requirement for all Joint Commission-accredited organizations to establish an annual influenza vaccination program for all employees, including licensed independent practitioners and non-clinical staff,” Michael Kulczycki, executive director of Ambulatory Health Care at the the Joint Commission.

According to the Johns Hopkins All Children’s Hospital FAQ web page, “The safety and well-being of our patients are at the heart of Johns Hopkins All Children’s Hospital’s mission. Each year, approximately 36,000 people die and 226,000 are hospitalized due to the flu. These are preventable deaths. Requiring an annual flu vaccine demonstrates our commitment to protect the safety and health of our patients, many of whom already have weakened immune systems, as well as visitors, co-workers and our families.”

Participation programs
The same can be said about participating in flu shot programs as buckling your seat belt when getting in a car. That seat belt is there to protect you from serious injury or death. Flu shot vaccines are the same; the vaccine has protective qualities irrespective of the strain. Hospitals, along with the CDC, have developed programs that educate apprehensive healthcare employees. The CDC offers help with communication to staff, including a customizable brochure for in-house employees called “I Won’t Spread the Flu”. To further that end, hospitals have also included incentive programs to garner employee support. Examples include the following:
- Gift certificates to popular local coffee shops for participants
- Cash incentives
- Acknowledgement/Participation stickers for employee badges

Unfortunately, there are still employees that refuse to participate, and healthcare systems don’t want to end up with a costly and often public legal battle. Some facilities require non-participating employees to wear a paper respirator during flu season while working in the hospital.

Going deeper with vaccine demands
Premiere health systems in the United States are expanding the demand for staff to have flu shots to include outside vendors working in their facilities. UNC Healthcare and the Cleveland Clinic have programs or plans that ask for contractors to receive flu shot vaccines. Many children’s hospitals are also demanding vendors comply with an internal requirement for vaccines.

Johns Hopkins’ inclusion policy not only focuses on outside vendors working in the facility, it also includes volunteers, students, trainees, and temporary workers in flu vaccine participation.

The CDC makes similar observations while noting the imperative to create better shots. “Although more effective vaccines are needed, vaccination prevents a substantial burden of influenza-related illness annually,” the agency wrote in its latest flu report. The CDC Advisory Committee on Immunization Practices (ACIP) recommends not only clinical staff be vaccinated, it includes, dietary, pharmacy, laundry, security, maintenance, billing, and even autopsy personnel.

Everyone recognizes the importance of maintaining medical equipment in excellent condition for patient safety. Maintaining the health of workers in the healthcare environment is just as critical for quality outcomes. The facts demonstrate the value of expanding flu vaccine participation beyond the clinical staff, and the trend will continue as quality outcomes and safety improvement drive change.