Health Care Workers (HCWs):. Rhode Island Experience. Tricia Washburn. Rhode Island Immunization Program. Whoops! There
Flu Vaccination Mandate for Health Care Workers (HCWs): Rhode Island Experience
Tricia Washburn Rhode Island Immunization Program
Overview • Background on Health Care Worker (HCW) regulations in RI • Flu vaccination mandate for HCW
• Reporting requirements for HCWs • Year 1 experience (2012-2013 flu season) • Year 2 experience (2013-2014 flu season)
Background • Regulations governing HCW immunization under statute for Licensing of Health Care Facilities (RI 2317) • Regulations apply only to HCWs in a “licensed” healthcare facility. • Regulations define a “HCW” as any person who is temporarily or permanently employed by (or at), or who is a volunteer in –a healthcare facility with direct patient contact
Health Care Facilities licensed under RIGL 23-17.71 • Adult Day Care Program • Freestanding Amb. Surg. Center • Freestanding Emerg. Care Facility • Home Care Provider • Home Nursing Care Provider • Hospice Provider • Hospital • Kidney Disease Treat. Center • Nursing Facility • Nursing Service Agency • Organized Amb. Care Facility • Physician Ambulatory Surgery Center
Flu Vaccination Mandate for HCWs CDC has recommended annual influenza vaccination for healthcare workers (HCWs) since 1984. Rhode Island • In 2007, HCW Immunization Regulations [R23-17-HCW] were amended to require: 1. Healthcare facilities (HCF) “offer” flu vaccination to all HCWs at no cost 2. HCFs monitor and report flu vaccination coverage and reasons for declination to HEALTH -- Flu vaccine was provided by state at no cost to HCFs.
Flu Vaccination Mandate for HCWs • Jan 2012: HEALTH convened a Flu Task Force (FTF) to identify barriers/improve access to flu vaccination for all Rhode Islanders, particularly for HCWs. – FTF recommends flu vaccination mandate for HCWs. – After careful review of the data new regulations were promulgated and public hearing went well – In response to many complaints from HCW’s and their attorneys HEALTH agreed to resubmit proposed regulations to include masking requirement.
Flu Vaccination Mandate for HCWs • Oct 2012: Flu vaccination mandate for HCWs enacted: – By December 15 of each year, HCWs get flu vaccine, or has medical or refusal form on file. – Unvaccinated HCWs should wear a surgical mask during direct patient contact when flu is declared widespread.
Required for Unvaccinated HCWs Medical Exemption Form
Flu Vaccination Refusal Form
New Regulations for HCWs Reporting Requirements • Healthcare facilities should report to HEALTH: – – – – –
Total # of HCWs in the facility # of HCWs who received flu vaccination (Vaccinated) # of HCWs who declined for medical reasons (Medical Exemption) # of HCWs who declined for non-medical reasons (Declination) # of HCWs whose vaccination status was unknown (Unknown status)
• Flu Vaccination Status should be reported for: – Employee HCWs (Staff on facility payroll) – Non-employee LIPs (Licensed Independent Practitioners) – Non-employee STVs (Students/Trainees/Volunteers)
Health Care Facility Types Subject to HCW Regulations
Year 1 Experience (2012-2013 Influenza Season)
Year 1 Evaluation • Collaborated with CDC to evaluate the impact of new HCW regulations – Weekly conference calls for 6+ mo.
• Conducted evaluation survey and key informant interviews to understand how well facilities implemented new regulations. • Analyzed data reported by HCFs to estimate flu vaccination coverage for HCWs.
• Conclusion of Evaluation: State-wide flu vaccination mandate was effective in increasing flu vaccination coverage among HCWs in RI.
Year 1 Accomplishments • Awards, Presentations, and Publications – Rhode Island FTF received the 2013 Excellence Award from the National Influenza Vaccination Summit. – 1st year evaluation results presented at Brown Public Health Research Day, April 2014. – A quantitative evaluation article published in Journal of Public Health Management and Practice. – A qualitative evaluation article accepted by Journal Vaccine.
Year 2 Experience (2013-2014 Influenza Season)
Flu Vaccination Reporting Rates 2011-2012, 2012-2013, and 2013-2014 Flu Seasons
100
New HCW regulations enacted in Oct. 2012
88.7
Percent
80
59.0
60
40
26.9 20
0
2011-2012 Season (Before New Reg.)
2012-2013 Season (Year 1)
2013-2014 Season (Year 2)
Flu Vaccination Coverage among HCWs* 2011-2012, 2012-2013, and 2013-2014 Flu Seasons
New HCW regulations enacted in Oct. 2012
100
Percent
80
60
Healthy People 2020 Target = 90%
87.2
88.1
2012-2013 Season (Year 1)
2013-2014 Season (Year 2)
69.7
40
20
0
2011-2012 Season (Before New Reg.) * Among employee HCWs
Flu Vaccination Status by HCW Type 2012-2013 Season vs. 2013-2014 Season
Vaccinated
Employee HCW*
Medical Exemption
Declination
Unknown
2012-13 season
87.2
9.9 2.1
2013-14 season
88.1
9.0 2.3
2012-13 season
81.6
3.8
14.6
Non-emp LIP** 2013-14 season
86.1
2012-13 season
56.1
2.7 10.9
3.8
40.0
Non-emp STV*** 2013-14 season 0% * Staff on facility payroll * LIP: Licensed independent practitioners *** STV: Adult students/trainees & volunteers
85.9 20%
40%
3.1 10.7 60%
80%
100%
Flu Vaccination Reporting Rate by Facility Type 2013-2014 Flu Season
Freestanding Amb. Surg. Center
100
Freestanding Emerg. Care Facility
100
Hospital
100
Kidney Disease Treat. Center
100
Nursing Facility
100
Organized Amb. Care Facility
93
Physician Ambulatory Surgery Center
89
Home Care Provider
88
Home Nursing Care Provider
84
Adult Day Care Program
84
Hospice Provider
75
Nursing Service Agency
35
Overall
88.7 0
20
40
60
80
100
%
HCW* Flu Vaccination Coverage by Facility Type 2013-2014 Flu Season Healthy People 2020 Target = 90%
Physician Ambulatory Surgery Center
97
Freestanding Amb. Surg. Center
91
Nursing Facility
90
Hospital
90
Organized Amb. Care Facility
90
Kidney Disease Treat. Center
87
Adult Day Care Program
84
Hospice Provider
84
Home Nursing Care Provider
81
Freestanding Emerg. Care Facility
69
Home Care Provider
66
Nursing Service Agency
42
Overall * Among employee HCWs
88.1 0
20
40
60
80
100 %
Year 2 Accomplishments • Overall reporting rate increased substantially from 59% in Year 1 (2012-2013 flu season) to 89% in Year 2 (2013-2014 flu season). • The proportion of unknown vaccination status for nonemploy HCWs (especially for STVs) decreased substantially, indicating quality improvement in data collection. • The proportion of declination decreased for all categories of HCW’s. • “Flu vaccination coverage among HCWs during the 20132014 flu season (Year 2)” data will be published in Oct issue of the RI Medical Journal.
Thank You!
Tricia Washburn Chief, Office of Immunization 401.222.5922
[email protected] www.health.ri.gov
