From the Journals

Many hospitals had no mandatory flu vaccine requirements in 2017

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Knowledge gaps remain on vaccination benefit

This study suggests a significant increase in use of mandatory influenza vaccination policies during 2013-2017, driven mainly by increases at non–Veterans Affairs (VA) hospitals and little change at VA facilities. However, there are some caveats to the findings that should be considered, Hilary M. Babcock, MD, MPH, wrote in an editorial referencing the study.

The sample for the 2013 and 2017 surveys included different facilities and different size facilities, so direct comparisons cannot be made, according to Dr. Babcock.

Moreover, the survey questions were worded somewhat differently in the two surveys, and it does not appear that “mandate” was defined by the study authors, she said in her editorial.

The VA recently issued a directive that all health care personnel should receive influenza vaccination and wear masks during influenza season. This new directive provides an “excellent opportunity” to address knowledge gaps regarding the effects of influenza vaccination of health care personnel on patient outcomes, according to Dr. Babcock.

“While the assumption that decreasing the risk of influenza in health care personnel will result in decreased risk of influenza in patients cared for by those health care personnel is common sense, for acute care settings, it is still largely an assumption,” Dr. Babcock wrote. “Hopefully, the Veterans Health Administration will combine this initiative with thoughtful, planned, patient outcome assessments to help define the anticipated benefit of these efforts.”

Dr. Babcock is with Washington University and the BJC HealthCare Infection Prevention & Epidemiology Consortium, both in St. Louis. These comments are derived from her editorial in JAMA Network Open (2018;1[2]:e180144). Dr. Babcock reported no conflict of interest disclosures related to her editorial.


FROM JAMA Network Open

Many U.S. hospitals still did not have influenza vaccination requirements for health care personnel as of summer 2017, suggested the results of a national survey.

Nearly two-thirds of hospitals had mandatory influenza vaccination in place in 2017, up from just one-third in 2013, according to survey responses submitted by infection preventionists working at Veterans Affairs (VA) and non-VA hospitals.

However, that substantial increase was driven almost entirely by the non-VA hospitals: Fewer than 5% of VA hospitals in 2017 had mandatory requirements for health care personnel who provided care for veterans, according to M. Todd Greene, PhD, MPH, with the Patient Safety Enhancement Program at the Veterans Affairs Ann Arbor Healthcare System/University of Michigan and his coauthors.

Despite recommendations to vaccinate health care personnel against influenza, there are several challenges and barriers to implementing the practice, the authors wrote in JAMA Network Open.

“Mandating influenza vaccination remains a controversial topic, with uncertainty of the effectiveness of health care personnel influenza vaccination in reducing patient morbidity and mortality, different conclusions regarding the grading of the evidence, and numerous legal and ethical precedents to be carefully considered,” they wrote.

Their study was based on 1,062 responses to a panel survey of infection preventionists conducted every 4 years. The survey asked providers about practices used in their hospitals to prevent health care–associated infections.

Compared with 2013, when only 37.1% of non-VA hospitals had mandatory influenza vaccination requirements, the 2017 survey showed a significant increase to 61.4% (P less than .001), Dr. Greene and his colleagues wrote in their report.


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