New! CEO Webcast Slides
You can view the presentation to the September 2, 2010 web conference for CEO and hospital leaders.
WSHA BOARD MOTION APPROVED:
On July 31, 2010, the WSHA board unanimously approved a motion asking all hospitals in Washington State to adopt a policy consistent with the legislation described above by September 30, 2010.
Hospital CEOs will be asked to commit to implementing policies that include at a minimum the following principles:
- Health care workers (see definition below) shall provide annual documentation of influenza immunization to the hospital or if they are not vaccinated will wear a surgical mask or take alternate steps as determined by the hospital’s infection control program while unvaccinated for influenza and when flu is active in the community.
- All hospitals shall report employee and medical staff influenza vaccination rates to the Washington State Hospital Association annually.
- If after consulting with vaccine suppliers, public health officials, hospital employee health and infection control staff, the hospital concludes a shortage of vaccine exists such that individuals who wish to receive the vaccine cannot do so, the hospital may suspend the vaccination requirement for a period of time not to exceed one year.
Health care worker is defined to mean an employee, member of the medical staff, independent contractor, licensee, or other individual who is involved in the delivery of health care services.
WSHA staff will send commitment letters to hospitals within the next week. Board members will follow up with hospitals that do not agree to the commitment. WSHA’s Patient Safety Program will continue hosting events supporting implementation, including a Safe Table Call on September 14, 2010.
For more information about the immunization policy please contact Taya Briley at (206) 216-2554 or tayab@wsha.org. For information on the Safe Table call please contact Cat Ernevad at (206) 577-1820 or cate@wsha.org.
Background
Infections pose a serious risk to people who are sick, elderly, and young – the very people hospitals serve. The 97 hospital members of the Washington State Hospital Association are committed to eliminating hospital acquired infections. Influenza is a serious and common infection that patients acquire in hospitals.
In 2009, the board of the hospital association requested that WSHA pursue legislation ensuring health care workers in Washington hospitals be immunized for influenza or follow alternate infection control protocols (such as wearing a mask). Despite a very favorable hearing in Olympia, the legislation failed. One reason it failed was all concerned – including nursing union leaders – publicly testified that hospitals clearly have the right and ability to adopt a vaccine requirement without legislation being enacted.
Since then, WSHA staff has engaged in a series of conversations with hospital representatives about how to proceed to protect patients from the flu. Staff spoke with infection control personnel, employee health professionals, human resources executives, nursing leaders, and chief executive officers. The issue was discussed at WSHA’s Patient Safety Safe Table meetings, Regional Hospital Councils, the Patient Safety and Public Policy Committees of the WSHA board, and the WSHA board itself. The majority of WSHA members urged the association to move hospitals forward collectively in adopting policies similar to was what included in the proposed legislation.
National groups have also expressed strong support for health care worker vaccination policies that mandate immunization including:
- Society for Healthcare Epidemiology of America
- Association for Professionals in Infection Control and Epidemiology
- Infectious Diseases Society of America
Working with Labor
On August 31, 2010 WSHA staff met with representatives of United Staff Nurses Union Local 141, SEIU Healthcare 1199 NW, and the Washington State Nurses Association regarding flu immunization policy. A number of WSHA hospitals have expressed interest in the union position regarding influenza vaccination, which is reflected in the unions' (1) model policy and (2) model declination form. The unions and WSHA are exploring whether there is a way for all organizations to stand behind a single flu immunization policy and WSHA staff will report more on this effort later in September.
Flu Immunization Implementation Toolkit
Sample implementation materials are provided below. (Click on the heading links below to access them). The models are based on successfully implemented policies from several WSHA member hospitals. Each hospital is unique with its own structural, employment, and legal considerations. Hospital representatives should obtain independent legal advice in determining the approach that works best in their organizations. Hospitals may modify the materials.
MODEL POLICY: WSHA' model policy is short but it incorporates all of the above elements. ospitals should modify it to reflect their own choices and circumstances. Several hospitals with similar policies included their policy language in an existing fitness for duty policy or infection control policy.
DECLINATION OF SEASONAL INFLUENZA VACCINATION FORM: This form can be used with unionized employees. There are some hospitals that have achieved high immunization rates among unionized employees who have the opportunity to decline immunization. These hospitals typically require that employees wear a mask as an alternate method of infection control. Declination forms can be used to track employees who do not wish to receive the influenza vaccine. Some hospitals have found the declination forms to be cumbersome and have chosen not to use them.
REASONABLE ACCOMMODATION FORM: This form may be used with non-unionized employees where the hospital wishes to make immunization a condition of employment. The form reflects an approach where immunizations are mandated, but if a person has a medical condition/disability or a religious objection, the person can request a reasonable accommodation. The hospital can choose whether to request documentation of the need for accommodation (for example, physician documentation or statement from a religious leader). The reasonable accommodation contemplated in the form is to wear a mask or follow alternative infection control guidelines. Based on the decision in Virginia Mason Hospital v. Washington State Nurses Association, 511 F.3d 908, 915 (9th Cir. 2007), using this type of policy with unionized employees may invite a challenge that the immunization policy is a mandatory subject of bargaining.
EMPLOYEE EDUCATION MODULE: A number of hospitals require employees to receive education about influenza and have found that voluntary immunization rates increase with proper education. We have a web-based educational module available for you to use. Some hospitals require education for all employees, others only for those declining the immunization vaccine.
DEAR HEALTH CARE WORKER LETTER: This model letter is written to inform health care workers of a new immunization policy. It is written in a general way and will need to be adapted according to your organization.
MODEL NEWSLETTER ARTICLE We have provided a model newsletter article for use in employee news publications. The newsletter is fairly general and will need to be tailored to reflect the policy adopted by your hospital.
ENGAGING HOSPITAL STAFF: Even with a new policy, finding positive ways to engage staff in the vaccination effort and making it easy for staff to be immunized is critically important. Last year, WSHA sent a bulletin describing a number of resources for running a successful immunization campaign. Please continue to use these resources and ideas as you work to implement new policies.
JOURNAL ARTICLES: A number of current journal articles and resources about influenza vaccination can be found at the Immunization Action Coalition.
LEGAL CHALLENGES: Thanks to work already done by WSHA member hospitals in implementing influenza vaccination policies, the legal issues involved with adoption of these policies are somewhat clearer than even a couple of years ago. If additional legal challenges arise, WSHA will likely be involved.
NEXT STEPS/TIMELINE:
- August 2010: WSHA staff will distribute and work to collect commitment letters.
- August 31, 2010: WSHA staff will send you an update on the number of commitment letters signed.
- September 30, 2010: Participating hospitals should "go live" with their policies if they have not done so already.
Also during the July/August timeframe, WSHA will work to provide educational opportunities on adoption of flu immunization policies, such as web casts to hospitals.
Please forward this bulletin to occupational health personnel or any others in your facility who may be interested in this information. Please contact Taya Briley at (206) 216-2554 or tayab@wsha.org with any questions.