Hostname: page-component-76fb5796d-qxdb6 Total loading time: 0 Render date: 2024-04-25T21:27:18.861Z Has data issue: false hasContentIssue false
  • English
  • Français

Protecting Healthcare Personnel in Outpatient Settings: The Influence of Mandatory Versus Nonmandatory Influenza Vaccination Policies on Workplace Absenteeism During Multiple Respiratory Virus Seasons

Published online by Cambridge University Press:  08 March 2018

John Frederick ,
Alexandria C. Brown ,
Derek A. Cummings ,
Charlotte A. Gaydos ,
Cynthia L. Gibert ,
Geoffrey J. Gorse ,
Jenna G. Los ,
Ann-Christine Nyquist ,
Trish M. Perl  and
Connie S. Price
...Show all authors
John Frederick
Affiliation:
Veterans Affairs (VA) New York Harbor Healthcare System (NYHHS), New York, New York
Alexandria C. Brown
Affiliation:
Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts
Derek A. Cummings
Affiliation:
Department of Biology and Emerging Pathogens Institute, University of Florida, Gainesville, Florida
Charlotte A. Gaydos
Affiliation:
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
Cynthia L. Gibert
Affiliation:
Infectious Diseases Section, Medical Service, Washington DC VA Medical Center George Washington University School of Medicine and Health Sciences, Washington, DC
Geoffrey J. Gorse
Affiliation:
VA St Louis Health Care System, St Louis, Missouri Division of Infectious Diseases, Allergy and Immunology, Department of Medicine, St Louis University School of Medicine, St Louis, Missouri
Jenna G. Los
Affiliation:
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
Ann-Christine Nyquist
Affiliation:
Children’s Hospital Colorado, Aurora, Colorado Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
Trish M. Perl*
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Texas Southwestern, Dallas, Texas
Connie S. Price
Affiliation:
Denver Health and Hospital Authority, Denver, Colorado Division of Infectious Diseases, Department of Medicine, University of Colorado, Denver, Colorado
Lewis J. Radonovich
Affiliation:
Centers for Disease Control and Protection, National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, Pennsylvania
Nicholas G. Reich
Affiliation:
Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts
Maria C. Rodriguez-Barradas
Affiliation:
Michael E. DeBakey VA Medical Center, Houston, Texas Department of Medicine, Baylor College of Medicine, Houston, Texas
Mary T. Bessesen
Affiliation:
VA Eastern Colorado Health Care System, Denver, Colorado Department of Medicine, University of Colorado-Denver, Denver, Colorado
Michael S. Simberkoff*
Affiliation:
Veterans Affairs (VA) New York Harbor Healthcare System (NYHHS), New York, New York Division of Infectious Disease, Department of Medicine, NYU School of Medicine, New York, New York
*
Address correspondence to Michael S. Simberkoff, MD, VA New York Harbor Healthcare System, 423 East 23rd Street #111, New York, NY 10010 (Mike.simberkoffmd@va.gov) or Trish M. Perl, MD, MSc, University of Texas Southwestern Medical Center; 5323 Harry Hines Blvd; Dallas, TX 75390 (Trish.Perl@UTSouthwestern.edu).
Address correspondence to Michael S. Simberkoff, MD, VA New York Harbor Healthcare System, 423 East 23rd Street #111, New York, NY 10010 (Mike.simberkoffmd@va.gov) or Trish M. Perl, MD, MSc, University of Texas Southwestern Medical Center; 5323 Harry Hines Blvd; Dallas, TX 75390 (Trish.Perl@UTSouthwestern.edu).
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVE

To determine the effect of mandatory and nonmandatory influenza vaccination policies on vaccination rates and symptomatic absenteeism among healthcare personnel (HCP).

DESIGN

Retrospective observational cohort study.

SETTING

This study took place at 3 university medical centers with mandatory influenza vaccination policies and 4 Veterans Affairs (VA) healthcare systems with nonmandatory influenza vaccination policies.

PARTICIPANTS

The study included 2,304 outpatient HCP at mandatory vaccination sites and 1,759 outpatient HCP at nonmandatory vaccination sites.

METHODS

To determine the incidence and duration of absenteeism in outpatient settings, HCP participating in the Respiratory Protection Effectiveness Clinical Trial at both mandatory and nonmandatory vaccination sites over 3 viral respiratory illness (VRI) seasons (2012–2015) reported their influenza vaccination status and symptomatic days absent from work weekly throughout a 12-week period during the peak VRI season each year. The adjusted effects of vaccination and other modulating factors on absenteeism rates were estimated using multivariable regression models.

RESULTS

The proportion of participants who received influenza vaccination was lower each year at nonmandatory than at mandatory vaccination sites (odds ratio [OR], 0.09; 95% confidence interval [CI], 0.07–0.11). Among HCP who reported at least 1 sick day, vaccinated HCP had lower symptomatic days absent compared to unvaccinated HCP (OR for 2012–2013 and 2013–2014, 0.82; 95% CI, 0.72–0.93; OR for 2014–2015, 0.81; 95% CI, 0.69–0.95).

CONCLUSIONS

These data suggest that mandatory HCP influenza vaccination policies increase influenza vaccination rates and that HCP symptomatic absenteeism diminishes as rates of influenza vaccination increase. These findings should be considered in formulating HCP influenza vaccination policies.

Infect Control Hosp Epidemiol 2018;39:452–461

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 4 , April 2018 , pp. 452 - 461
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

a

ResPECT Team members: Trish Perl, MD, MSc, Johns Hopkins University, Baltimore, MD; Justin Getka, BA, Johns Hopkins University, Baltimore, MD; Tina Hoang, MS, Johns Hopkins University, Baltimore, MD; Rose Kajih, PharmD, Johns Hopkins University, Baltimore, MD; Amanda Krosche, BS, Johns Hopkins University, Baltimore, MD; Meghan Kubala, MS, MD, Johns Hopkins University, Baltimore, MD; Jenna Los, MLA, Johns Hopkins University, Baltimore, MD; Liandra Presser, MD, Johns Hopkins University, Baltimore, MD; Kathleen Pulice, MS, Johns Hopkins University, Baltimore, MD; Margaret Spach, DDS, Johns Hopkins University, Baltimore, MD; Michael S. Simberkoff, MD, VA New York Harbor Healthcare System, New York, NY; Cynthia Akagbosu, BA, MA, VA New York Harbor Healthcare System, New York, NY; Madeline Dansky, BA, VA New York Harbor Healthcare System, New York, NY; Benedict J. Frederick, BA, VA New York Harbor Healthcare System, New York, NY; Marilyn Last, RN, VA New York Harbor Healthcare System, New York, NY; Scott Laverie, RN, VA New York Harbor Healthcare System, New York, NY; Courtney Pike, BA, VA New York Harbor Healthcare System, New York, NY; Shefali Rikhi, BS, VA New York Harbor Healthcare System, New York, NY; Nicole Spector, RN, VA New York Harbor Healthcare System, New York, NY; Christine A. Reel-Brander, RN, VA New York Harbor Healthcare System, New York, NY; Connie Price, MD, Denver Health and Hospital Authority, Denver, CO; Katie Gorman, BS, Denver Health and Hospital Authority, Denver, CO; Amy Irwin, DNP, RN, Denver Health and Hospital Authority, Denver, CO; Sean O’Malley, Denver Health and Hospital Authority, Denver, CO; Kevin Silva, BS, Denver Health and Hospital Authority, Denver, CO; Trish M. Perl, MD, MSc, University of Texas Southwestern Medical Center, Dallas, TX; Deepa Raj, MPH, University of Texas Southwestern Medical Center, Dallas, TX; Mary Bessesen, MD, VA Eastern Colorado Healthcare System, Denver, CO; Jill C. Adams BSN, BA, VA Eastern Colorado Healthcare System, Denver, CO; Shannon Kingery, BS, VA Eastern Colorado Healthcare System, Denver, CO; Stefanie Tuder, BS, VA Eastern Colorado Healthcare System, Denver, CO; Erron Fruchter-Palmer, MPH, VA Eastern Colorado Healthcare System, Denver, CO; Ann-Christine Nyquist, MD, MSPH, Children’s Hospital Colorado, Denver, CO; Megan Brocato, BA, Children’s Hospital Colorado, Denver, CO; Cynthia Gibert, MD, MSc; Laura Chopko, BA, Washington DC VA Medical Center, Washington, DC; Kathy Haines, MSW, MPH, Washington DC VA Medical Center, Washington, DC; Caitlin Langhorne, MPH, Washington DC VA Medical Center, Washington, DC; Dana Silver, BA, Washington DC VA Medical Center, Washington, DC; Courtney Southard, MPH, Washington DC VA Medical Center, Washington, DC; Maria C. Rodriguez-Barradas, MD; Barbara Kertz, MS; Mahwish Mushtaq, MD, MPH, VA Michael C. DeBakey Medical Center, Houston, TX; Blanca Vargas, MD, VA Michael C. DeBakey Medical Center, Houston, TX; Edward Fisher, MS, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Pittsburgh, PA; Ronald Shaffer, PhD, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Pittsburgh, PA; Lewis J. Radonovich, MD, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Pittsburgh, PA; Aaron Eagan, MPH, RN, Veterans Health Administration Office of Public Health, Gainesville, FL; Melanie Lipka, BS, HandyMetrics, Toronto, Ontario, Canada; Michael Tsang, PhD, HandyMetrics, Toronto, Ontario, Canada; Charlotte Gaydos, DrPH, Laboratory Core at Johns Hopkins University, Baltimore, MD; Jeffrey Holden, MA, Laboratory Core at Johns Hopkins University, Baltimore, MD; Alexandra Valsamakis, MD, PhD, Laboratory Core at Johns Hopkins University, Baltimore, MD; Geoffrey J. Gorse, MD, Laboratory Core at VA St Louis Healthcare System and St Louis University School of Medicine, St Louis, MO; Michelle Mitchell, BS, Laboratory Core at VA St Louis Healthcare System and St Louis University School of Medicine, St Louis, MO; Gira B. Patel, MS, Laboratory Core at VA St Louis Healthcare System and St Louis University School of Medicine, St Louis, MO; Yinyi Yu, BS, Laboratory Core at VA St Louis Healthcare System and St Louis University School of Medicine, St Louis, MO; Andre Hackman, BA, REDCap Core at Johns Hopkins University, Baltimore, MD; Michael Sherman, BS, REDCap Core at Johns Hopkins University, Baltimore, MD; Derek Cummings, PhD, MPH, MSc, Statistical and Epidemiologic Core, University of Florida, Gainesville, FL; Alexandria C. Brown, PhD, University of Massachusetts, Amherst, MA; Nicholas G. Reich, PhD, Statistical and Epidemiologic Core, University of Florida, Gainesville, FL; Justin Lesser, PhD, MHS, MS, Johns Hopkins University, Baltimore, MD.

PREVIOUS PRESENTATION. Parts of this manuscript were presented as a poster at ID Week 2017 on October 6, 2017, in San Diego, California.

References

REFERENCES

1. Groshkopf, LA, Sokolow, LZ, Broder, KR, et al. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP)—United States, 2017–2018. Morb Mortal Wkly Rep Recomm Rep 2017;66(RR-2):1–20.Google Scholar
2. Centers for Disease Control (CDC). Adult immunization: recommendations of the Immunization Practices Advisory Committee (ACIP). Morb Mortal Wkly Rep 1984;33(Suppl 1):1S–68S.Google Scholar
3. Pearson, ML, Bridges, CB, Harper, SA. Healthcare Infection Control Practices Advisory Committee (HICPAC), Advisory Committee on Immunization Practices (ACIP). Influenza vaccination of health-care personnel: recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Advisory Committee on Immunization Practices (ACIP). Morb Mortal Wkly Rep Recomm 2006;55(RR-2):1–16.Google ScholarPubMed
4. Fiore, AE, Uyeki, TM, Broder, K, et al. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP). Morb Mortal Wkly Rep Recomm 2010;59(RR-8):1–62.Google ScholarPubMed
5. Black, CL, Yun, X, Ball, SW, et al. Influenza vaccination coverage among health care personnel—United States, 2015–16 influenza season. Morb Mortal Wkly Rep 2016;65:1009–1015.Google ScholarPubMed
6. Talbot, TR, Babcock, H, Caplan, AL, et al. Revised SHEA position paper: influenza vaccination of healthcare personnel. Infect Control Hosp Epidemiol 2010;31:987–995.CrossRefGoogle ScholarPubMed
7. Potter, J, Stott, DJ, Roberts, MA, et al. Influenza vaccination of health care workers in long-term-care hospitals reduces the mortality of elderly patients. J Infect Dis 1997;175:1–6.CrossRefGoogle ScholarPubMed
8. IDSA policy on mandatory immunization revision. Infectious Diseases Society of America website. https://www.idsociety.org/uploadedFiles/IDSA/Policy_and_Advocacy/Current_Topics_and_Issues/Immunizations_and_Vaccines/Health_Care_Worker_Immunization/Statements/IDSA%20Policy%20on%20Mandatory%20Immunization%20Revision%20083110.pdf. Updated 2010. Accessed January 19, 2017.Google Scholar
9. IDSA/SHEA/PIDS policy on mandatory immunization of health care personnel according to the ACIP-recommended vaccine schedule. Infectious Diseases Society of America website. https://www.idsociety.org/uploadedFiles/IDSA/Policy_and_Advocacy/Current_Topics_and_Issues/Immunizations_and_Vaccines/Health_Care_Worker_Immunization/Statements/IDSA_SHEA_PIDS%20Policy%20on%20Mandatory%20Immunization%20of%20HCP.pdf. Published 2013. Accessed January 19, 2017.Google Scholar
10. Babcock, HM, Gemeinhart, N, Jones, M, Dunagan, WC, Woeltje, KF. Mandatory influenza vaccination of health care workers: translating policy to practice. Clin Infect Dis 2010;50:459–464.CrossRefGoogle ScholarPubMed
11. Stewart, AM, Cox, MA. State law and influenza vaccination of health care personnel. Vaccine 2013;31:827–832.CrossRefGoogle ScholarPubMed
12. Caplan, A, Shah, NR. Managing the human toll caused by seasonal influenza: New York State’s mandate to vaccinate or mask. JAMA 2013;310:1797–1798.Google ScholarPubMed
13. Rakita, RM, Hagar, BA, Crome, P, Lammert, JK. Mandatory influenza vaccination of healthcare workers: a 5-year study. Infect Control Hosp Epidemiol 2010;31:881–888.CrossRefGoogle Scholar
14. Honor roll: honorees with influenza vaccination mandates. Immunization Action Coalition website. http://www.immunize.org/honor-roll/influenza-mandates/honorees.asp. Updated 2018. Accessed January 16, 2018.Google Scholar
15. Sullivan, SJ, Jacobson, R, Poland, GA. Mandating influenza vaccination for healthcare workers. Expert Rev Vaccines 2009;8:1469–1474.CrossRefGoogle ScholarPubMed
16. Demicheli, V, Jefferson, T, Al-Ansary, LA, Ferroni, E, Rivetti, A, Di Pietrantonj, C. Vaccines for preventing influenza in healthy adults. Cochrane Database Syst Rev 2014:CD001269. doi: 10.1002/14651858.CD001269.pub5.Google ScholarPubMed
17. Lemaitre, M, Meret, T, Rothan-Tondeur, M, et al. Effect of influenza vaccination of nursing home staff on mortality of residents: a cluster-randomized trial. J Am Geriatr Soc 2009;57:1580–1586.CrossRefGoogle ScholarPubMed
18. Ahmed, F, Lindley, MC, Allred, N, Weinbaum, CM, Grohskopf, L. Effect of influenza vaccination of healthcare personnel on morbidity and mortality among patients: systematic review and grading of evidence. Clin Infect Dis 2014;58:50–57.CrossRefGoogle ScholarPubMed
19. Van Buynder, PG, Konrad, S, Kersteins, F, et al. Healthcare worker influenza immunization vaccinate or mask policy: strategies for cost effective implementation and subsequent reductions in staff absenteeism due to illness. Vaccine 2015;33:1625–1628.CrossRefGoogle ScholarPubMed
20. Thomas, RE, Jefferson, T, Lasserson, TJ. Influenza vaccination for healthcare workers who care for people aged 60 or older living in long-term care institutions. Cochrane Database Syst Rev 2016:CD005187. doi: 10.1002/14651858.CD005187.pub5.Google ScholarPubMed
21. Serres, GD, Skowronski, DM, Ward, BJ, et al. Influenza vaccination of healthcare workers: critical analysis of the evidence for patient benefit underpinning policies of enforcement. PLoS One 2017;12:e0163586. doi: 10.1371/journal.pone.0163586.CrossRefGoogle ScholarPubMed
22. Hayward, AC. Influenza vaccination of healthcare workers is an important approach for reducing transmission of influenza from staff to vulnerable patients. PLoS One 2017;12:e0169023. doi: 10.1371/journal.pone.0169023.CrossRefGoogle ScholarPubMed
23. Radonovich, LJ, Bessesen, MT, Cummings, DA, et al. The Respiratory Protection Effectiveness Clinical Trial (ResPECT): a cluster-randomized comparison of respirator and medical mask effectiveness against respiratory infections in healthcare personnel. BMC Infect Dis 2016;16:243. doi: 10.1186/s12879-016-1494-2.CrossRefGoogle ScholarPubMed
24. Abstract: Influenza Vaccination for Hospital Employees (IDWeek 2012 Meeting). Infectious Disease Society of America website. https://idsa.confex.com/idsa/2012/webprogram/Paper36658.html. Published 2012. Accessed January 19, 2017.Google Scholar
25. Reich, NG, Cummings, DAT, Lauer, SA, et al. Triggering interventions for influenza: the ALERT algorithm. Clin Infect Dis 2015;60:499–504.CrossRefGoogle ScholarPubMed
26. Hadfield, J. MCMC methods for multi-response generalized linear mixed models: the MCMCglmm R package. J Statist Soft 2010;33(2). doi: 10.18637/jss.v033.i02. CrossRefGoogle Scholar
27. Zeileis, A, Kleiber, C, Jackman, S. Regression models for count data in R | Zeileis |. J Statist Soft 2008;27(8). doi: 10.18637/jss.v027.i08.CrossRefGoogle Scholar
28. R Studio Team. RStudio: integrated development for R. R Studio website. http://www.rstudio.com/. Published 2015. Accessed January 16, 2018.Google Scholar
29. Frenzel, E, Chemaly, RF, Ariza-Heredia, E, et al. Association of increased influenza vaccination in health care workers with a reduction in nosocomial influenza infections in cancer patients. Am J Infect Control 2016;44:1016–1021.CrossRefGoogle ScholarPubMed
30. Wang, TL, Jing, L, Bocchini, JA. Mandatory influenza vaccination for all healthcare personnel: a review on justification, implementation and effectiveness. Curr Opin Pediatr 2017;29:606–615.CrossRefGoogle ScholarPubMed
31. Maltezou, HC, Poland, GA. Immunization of health-care providers: necessity and public health policies. Healthcare 2016;4:47. doi: 10.3390/healthcare4030047.CrossRefGoogle ScholarPubMed
32. Cheema, S, Vinnard, C, Foster-Chang, S, Linkin, DR. A time off incentive was not associated with influenza vaccination acceptance among healthcare workers. Influenza Res Treat 2013;2013:209491. doi: 10.1155/2013/209491.Google Scholar
33. Anikeeva, O, Braunack-Mayer, A, Rogers, W. Requiring influenza vaccination for health care workers. Am J Public Health 2009;99:24–29.CrossRefGoogle ScholarPubMed
34. Steckel, CM. Mandatory influenza immunization for health care workers—an ethical discussion. AAOHN J 2007;55:34–39.CrossRefGoogle ScholarPubMed
35. Immunization and infectious diseases. US Office of Disease Prevention and Health Promotion website. https://www.healthypeople.gov/2020/topics-objectives/topic/immunization-and-infectious-diseases. Accessed January 19, 2017.Google Scholar
36. Black, CL, Yue, X, Ball, SW, et al. Influenza vaccination coverage among health care personnel—United States, 2014–15 influenza season. Morb Mortal Wkly Rep 2015;64:993–999.CrossRefGoogle ScholarPubMed
37. Wilde, JA, McMillan, JA, Serwint, J, Butta, J, O’Riordan, MA, Steinhoff, MC. Effectiveness of influenza vaccine in health care professionals: a randomized trial. JAMA 1999;281:908–913.CrossRefGoogle ScholarPubMed
38. Derber, CJ, Shankaran, S. Health-care worker vaccination for influenza: strategies and controversies. Curr Infect Dis Rep 2012;14:627–632.CrossRefGoogle ScholarPubMed
39. Abstract: Universal Employee Influenza Vaccination Decreases Employee Sick Days (IDWeek 2012 Meeting). Infectious Diseases Society of America website. https://idsa.confex.com/idsa/2012/webprogram/Paper37051.html. Published 2012. Accessed January 20, 2017.Google Scholar
40. McKevitt, C, Morgan, M, Dundas, R, Holland, WW. Sickness absence and “working through” illness: a comparison of two professional groups. J Public Health Med 1997;19:295–300.CrossRefGoogle ScholarPubMed
41. Krane, L, Larsen, EL, Nielsen, CV, Stapelfeldt, CM, Johnsen, R, Risør, MB. Attitudes towards sickness absence and sickness presenteeism in health and care sectors in Norway and Denmark: a qualitative study. BMC Public Health 2014;14:880. doi: 10.1186/1471-2458-14-880.CrossRefGoogle ScholarPubMed
42. Influenza. The Joint Commission website. http://www.jointcommission.org/topics/hai_influenza.aspx. Accessed January 20, 2017.Google Scholar
43. Chiu, S, Black, CL, Yue, X, et al. Working with influenza-like illness: presenteeism among US health care personnel during the 2014–2015 influenza season. Am J Infect Control 2017;45:1254–1258.CrossRefGoogle ScholarPubMed