BJC Occupational Health Services coordinates and standardizes occupational health programs through the Council of Occupational Health Professionals, which includes a representative from each facility. Some programs allow health care workers to sign declination forms stating that they understand the risks of not receiving the influenza vaccine to themselves, their patients, and their families. Annual influenza vaccination was first recommended for health care workers by the Advisory Committee on Immunization Practices in [ 3 , 20 , 21 ]. Several requests cited chemotherapy or an immu-nosuppressed state as reasons not to get the vaccine, even though these groups are at high risk for complications from influenza and are specifically recommended to be vaccinated. This is generally mild and usually goes away after a day or two. In part, this seems to have been due to other problems gaining prominence and displacing the issue of mandatory vaccination of HCWs from a priority position. Hospital leaders receive incentives based on their hospital's performance on scorecard measures. Concerns identified included that wearing a mask revealed personal health information about the HCWs decision not to vaccinate, masks were not effective, and the policy was designed to coerce HCWs [ 34 ]. Influenza vaccination of health care workers reduces employee illness and absenteeism [ 4 , 13—15 ]. The impact of these statements is still being studied [ 28—30 ]. Stories of production delays, low vaccine supplies, and rationing caused long lines at vaccination clinics and resulted in public anxiety [ 28 ]. In each instance a technically feasible solution was available policies stream. Most healthy adults may be able to infect others beginning 1 day before symptoms develop and up to 5 to 7 days after becoming sick. The arbitrator agreed with the union position citing that the policy was not supported by regulatory or statutory authority. CDC recommends an annual flu vaccine as the first and best way to protect against influenza.
Because organizational vaccination rates remained below target levels, influenza vaccination was made a condition of employment for all employees in By winter , UIIP was in its second year and the issue of mandatory vaccination of HCWs was beginning to become controversial and disputed in the courts [ 25 ]. Despite these efforts, rates were still suboptimal Figure 1. Employees who were neither vaccinated nor exempted by 15 December were suspended without pay. The remaining hospitals and service organizations had no noncompliant employees. In addition, the year that the program was implemented had a mild influenza season; therefore, finding reduced absenteeism would be difficult to link to the vaccination program. Several requests cited chemotherapy or an immu-nosuppressed state as reasons not to get the vaccine, even though these groups are at high risk for complications from influenza and are specifically recommended to be vaccinated. That means that you may be able to pass on the flu to someone else before you know you are sick, as well as while you are sick. Of requested medical exemptions, Feedback was provided not less than weekly to managers at the facilities. Employees still not vaccinated or exempt by 15 January were terminated for failure to meet their conditions of employment. Multiple strategies to enhance vaccination rates have been suggested, but national rates have remained low. Flu vaccination coverage was lowest among health care personnel working in long-term care facilities In each instance a technically feasible solution was available policies stream. Medical exemption requests were reviewed by occupational health nurses and their medical directors. Flu vaccination coverage was lowest among administrative and non-clinical support staff Discussion The mandatory vaccination program successfully increased vaccination rates at a large multihospital health care organization. More recently, declination statements have been suggested as a way to increase vaccination rates. The mandatory program markedly increased vaccination rates across all facilities. Denials included an explanation of the reason for denial on the form. Hospitals are located in urban, suburban, and rural settings and range from 40 to beds. Other requests did not include enough information to make a determination of the validity of the request. The National Health Interview Survey rates of influenza vaccination among health care workers during — are shown with the trend line. In the politics stream, the governmental agenda is formulated and the list of issues or problems to be given attention is prioritized. Vaccination rates in increased by
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