STATE LAW, INFLUENZA VACCINATION & HEALTHCARE PERSONNEL: An Update For The National Influenza Vaccine Summit Alexandra M. Stewart

December 13, 2012

DISCLOSURES • This project was funded by: – AHRQ, CDC, NVPO, OHW on behalf of the Federal Increasing Influenza Vaccination Coverage Among Healthcare Workers Working Group

• Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or of the Occupational Safety and Health Administration However, I am solely responsible for the project’s findings. • Period of Performance: Fall 2010 – Summer 2011 Government project managers were Mark Grabowski amd Ray Strikas. 2

PROJECT GOALS • Analyze state laws that address mandatory influenza vaccination of HCP • Develop recommendations & model language for state laws that will decrease transmission of flu from HCP to patients • Collaborate with states to create a legal environment that encourages flu vaccination of all HCP

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METHODS: State Law Review 1. After extensive discussion with experts and a literature review, we Identified 6 elements of a comprehensive mandatory flu vaccination program: • • • • • •

2. 3. 4. 5.

definition of affected personnel definition of an affected employer outline health care employer obligations outline health care personnel obligations incorporate an exemption policy include a standard of care (The next slide describes the elements in detail)

Identified state laws that address flu vaccination of HCP Compared each state’s law to the 6 essential elements Developed state summaries to describe each state’s law Drafted a model law that incorporates the 6 elements 4

ELEMENTS OF THE MODEL LAW AFFECTED HCP

Paid or unpaid, employee, staff, contractor, clinician, emergency medical technician, ambulance driver, volunteer, student, trainee, clergy & others who have direct/indirect contact with patients or contaminated material

AFFECTED EMPLOYERS

Acute care hospital, adult day program, ambulatory surgical facility, child day care facility, correctional facility, home health care agency, hospice, intermediate care facility, long-term care facility, nursing home, outpatient clinic, physician office, rehab. center, residential health care, skilled nursing facility, urgent care center, dialysis center, occupational health center

EMPLOYER OBLIGATIONS

1. 2. 3. 4. 5. 6.

HCP OBLIGATIONS

1. Receive the vaccination according to law 2. Choose site of administration 3. Provide employer with appropriate documentation

EXEMPTIONS

1. Medical Contraindication 2. Personal Belief 3. Religious 4. Declination Statement

STANDARD

Advisory Committee on Immunization Practices (ACIP) of the CDC

Choose appropriate timing for administration Provide vaccine at no cost to HCP Document immunization status of HCP Comply with reporting requirements of public health authorities Develop & conduct education campaigns Manage non-compliant HCP (Progressive discipline)

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STATE LAWS ADDRESSING HCP FLU VACCINATION (n=21) NH VT

WA

MT

ND

OR

AK

ID NV CA

WY

AZ

CO

OK

It’s interesting to note how the laws have evolved since we began this project. The 2 new regulations are stronger than the older laws and directly HI address some of the primary barriers to a successful program.

MO AR

PA OH

WV

KY

VA

RI NJ DE

GA

SC

CT MD

NC

TN MS AL

TX

NY

MI IL IN

KS

NM

WI

IA

NE UT

MA

MN

SD

ME

DC

LA FL

Alabama, Arkansas, California, D.C., Illinois, Kentucky, Maine, Maryland, Massachusetts, N. Hampshire, N. York, N. Carolina, Oklahoma, Pennsylvania, Rhode Island, S. Carolina, Tennessee, Texas, Utah, Virginia Colorado (03/30/12), Rhode Island (10/12)

SOURCE: GWU/SPHHS, Developing a Model State Law, Summer 2011, Updated 12/12

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RHODE ISLAND & COLORADO AFFECTED HCP

COLORADO: Paid by the health care entity (Excludes: volunteers/contractors) RHODE ISLAND: Paid, unpaid, contractor, housekeeping, laundry, maintenance, administrative staff (Excludes: Visitors)

AFFECTED HCE

COLORADO: Hospital, Hospital Unit, Ambulatory Surgical Center, LTC RHODE ISLAND: Any institutional health service provider (Excludes: 1) Private practitioners’ offices 2) Christian Science institutions 3) Providers of free hospice care 4) Dept. of Behavioral Health, Developmental Disabilities facilities 7

RHODE ISLAND & COLORADO EMPLOYER OBLIGATIONS

COLORADO: 1) Develop written policy 2) Inform all HCP of requirement 3) Provide vaccine when it is readily available 4) Enforce policy & provide masks for unvaccinated HCP 5) Maintain documentation of vaccination status 6) Track & report vaccination rates annually for Health Dept.

Other HCEs not listed shall: 1) Conduct an assessment to develop a flu vx policy 2) develop a written policy that offers flu vx, documents status, educates HCP, tracks & reports vaccination rate annually for Health Dept. Excludes: HCEs that have vaccinated a targeted % of HCP (60% by 12/31/12 75%/2013 90%/2014)

RHODE ISLAND: 1) Require vaccination 2) Provide free vaccine 3) Track & record vaccination levels for the Dept. of Health 4) Require unvaccinated HCP to wear surgical masks during direct patient contact, when flu is widespread 5) Provide free masks 6) Pay $100 fine for each breach 8

RHODE ISLAND & COLORADO HCW COLORADO: OBLIGATIONS Comply with policy RHODE ISLAND: Comply with policy regardless of any provision in any Collective bargaining agreement or other contract or policy Section 5.7

EXEMPTION POLICY

COLORADO: Medical RHODE ISLAND: 1) Medical 2) Signed Declination Form including agreement to wear mask & pay $100 fine for each breach = unprofessional conduct

STANDARD OF CARE

COLORADO: None identified

RHODE ISLAND: ACIP 9

CONCLUSION • State law is the more effective & reliable method to increase HCP vaccination when compared to individual facility-based policies: – – – –

Statewide impact Establish uniform requirements Incorporate all HCP & HCE Governing framework is already established

• The most effective state law would include all 6 elements of the model • NEXT STEPS: 1) How federal policies impact uptake (FEDS have a role (Education, Recommendations, Building Evidence Base, Managing Federal Personnel); 10

RESOURCES • Project materials are available at: http://www.gwumc.edu/sphhs/departments/healthpolicy/influenza/

• We are available to: – – – – – – –

Collaborate with state & local policymakers, program administrators Update or modify existing policies Support coalitions that increase HCP flu vaccination Develop state case studies to support policy change Draft & present testimony before legislators Conduct public health analyses Develop educational materials

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