NJ Hospitals Vaccinate Employees Against Flu, with Mixed Results

Andrew Kitchenman | August 31, 2015 | Health Care
State’s overall rate of inoculating workers against flu is just 64 percent, compared with 75 percent nationally

Dr. Al Sacchetti, chief of emergency medicine for Lourdes Health Systems, helped implement a program to ensure that hospital workers were vaccinated against the flu.
Although vaccinating hospital workers against the flu is a safety measure backed by state and federal health officials, New Jersey hospitals vary widely when it comes to giving their employees the needle.

The percentage of workers who received influenza vaccinations between October 2013 and March 2014 ranged from a high of 99 percent at Hackettstown Regional Medical Center to a low of 29 percent at University Hospital in Newark.

The statewide share of workers who were vaccinated was 62.4 percent, well below the national average of 75.2 percent.

As New Jersey enters another flu season, state and federal health officials recommend that hospital workers receive flu shots as a way of protecting vulnerable patients. Some hospitals have taken this message to heart by making these vaccinations mandatory. Those that have been most successful have been persistent in repeatedly making the vaccines available and have required those workers who refuse the shots to cite specific medical or religious reasons for turning them down instead of vague or general objections.

Two attempts by the Legislature to increase healthcare-worker flu vaccinations received pocket vetoes by Gov. Chris Christie in 2012 and 2014. The bills would have required healthcare facilities to offer flu shots to workers and for the workers to get a vaccination or sign a statement saying that they were declining it.

Christie said in his 2012 veto statement that he was concerned with the burden placed on hospitals and other healthcare facilities and said the bill was “inconsistent with notions of individual decision making.” Pocket vetoes occur when the governor declines to sign a bill that’s passed shortly before the end of a legislative session.

“While I am deeply committed to reducing the spread of influenza and other viruses by continuing to build healthy communities and promoting preventive medicine, I am concerned with the proliferation of compelled vaccinations,” he said.

[related]Christie’s position on vaccine mandates received national attention earlier this year when he said that parents should have “some measure of choice” over whether babies receive measles vaccines. An NJ Spotlight analysis found that vaccine rates vary widely across schools statewide.

CMS has required hospitals to make more patient safety information available to the public through its Hospital Compare site. In addition, the Centers for Disease Control and Prevention (CDC) has highlighted the importance of worker vaccinations, and the state has joined the federal government in these recommendations.

“The New Jersey Department of Health encourages all healthcare workers to get vaccinated against influenza each year to protect their patients, but also themselves and their families,” department spokeswoman Donna Leusner said.

She noted that hospitals have attempted to make it easy for workers to receive the shots, and senior state health officials have promoted flu vaccinations during visits to hospitals.

While the state doesn’t require flu vaccinations, it does require each hospital to have an infection control committee directed by an epidemiologist, a professional who investigates the causes of disease and injury.

Flu shot ranges in effectiveness, depending in part on how well scientists do in matching the flu strains used to make the vaccinations with the ones that circulate that year. Over the past 11 years, the estimated effectiveness of the vaccinations has ranged from 10 percent to 60 percent; last year it was 23 percent effective, compared with 51 percent the previous year.

While there is consensus among public-health and medical experts that flu vaccines are safe, opponents of the mandates reject that consensus and believe that an increase in diagnosed cases of autoimmune diseases and conditions such as autism can be affected by the use of a mercury-derived preservative that is employed in some flu shots. The CDC has rejected such a link.

Hospitals that are looking for an example of how to roll out a flu vaccination mandate can look to Lourdes Health System, which has been among the most successful in implementing a program with its workers. Its two hospitals are among the top five in the state in vaccine percentages: Lourdes Medical Center of Burlington County in Willingboro was third with 96 percent vaccinated, while Our Lady of Lourdes Medical Center in Camden was tied for fourth with 95 percent.

Dr. Al Sacchetti, Lourdes’ chief of emergency medicine, credited hospital executives with following through once they announced the change.

“They made it mandatory and had enough gumption to stick to their guns in making it mandatory,” he said.

Sacchetti said a key to the success was requiring that workers who cited a religious reason for not receiving the vaccinations to provide proof that it was a sincerely held belief, such as a statement from a religious leader.

“You couldn’t just say, ‘Oh, I have a religious objection.’ You had to have some proof,” Sacchetti said.

The Lourdes hospitals provided workers with information about the benefit of the vaccinations, Sacchetti said, comparing it to the basic sanitation that restaurants provide by posting signs in bathrooms requiring employees to wash their hands.

The Lourdes hospitals brought the vaccinations to workers on mobile carts multiple times during both day and night shifts, Sacchetti said.

“You do that enough, you can saturate every employee on every shift (and) you can get them covered,” he said. “You don’t say, ‘We’re offering it at 2 o’clock on Tuesday.’”

In addition to general information about the benefits of the vaccination, hospital officials personalized the message, asking workers to imagine the potential effect of them spreading the flu to the individual patients that were taking care of that week.

“Your favorite patient on the floor – Mrs. Jones — you can kill them,” Sacchetti said of the message.

This message was reinforced early on when an 8-month-old baby died in the emergency room from the flu after contracting it outside of the hospital. The hospital noted the case in a weekly summary, said Sacchetti, who described himself as a “huge vaccine zealot.”