Get the shot!

After years of talk, recommendations by a slew of medical groups, and thousands of hours spent on less-effective alternatives, policies mandating immunization for health-care workers are finally catching on. Southeastern Pennsylvania has been unusually aggressive, with more than half the region's hospitals reporting that 90 percent or more of their employees were vaccinated last year.

Most gave workers a choice: get the shot or lose your job.

Administrators at Chester County Hospital, like virtually all health systems, had long urged vaccination and offered it free. When records showed employee immunization rates no better than the 67 percent national average for health-care workers, they added a mandate last fall.

Dennis Berman, 61, the hospital's director of medical oncology, has never missed a day of work, competed every year in the Broad Street Run - and had never bothered to get the vaccine. Although the mandate left him little choice, he said the self-reflection it inspired was more powerful than the threat of termination. He called it "growing up."

"Before, I was concerned about what effect it would have on me if I got the flu," Berman said, "and now it is what effect it would have on others if I gave it to them."

Hospitals are full of patients whose immune systems have been weakened by chemotherapy or have other medical conditions that could turn deadly with the flu. The virus can be contagious for a day before symptoms appear, and when they do doctors often work anyway. High absenteeism in a hospital ward or emergency room can be dangerous.

A federal advisory committee first recommended that health-care workers be vaccinated in 1983. Uptake was slow.

Hospitals mounted campaigns and sent roaming vaccine carts to deliver flu shots on all shifts in all wards. They wooed workers with celebrities, parties, and prizes.

Many required workers to sign forms acknowledging that by declining a flu shot they were putting patients at risk. The forms helped Virtua Health persuade 85 percent of its employees to get immunized.

CTCA Eastern Regional Medical Center in the Northeast doubled its employee vaccination rate to 90 percent this year, a spokeswoman said, with a broad effort that included encouraging patients to ask their medical-care providers if they'd been vaccinated.

Greg Poland, director of the Vaccine Research Group at the Mayo Clinic in Rochester, Minn., thought mandates would be more effective. His first proposal, more than a decade ago, brought ridicule and charges that he was trying to break labor unions, he said.

In 2005, Virginia Mason Medical Center in Seattle took him up on the idea and achieved a 98 percent vaccination rate. Employee absenteeism dropped. Others took notice.

Among the early adopters, in 2009, were Children's Hospital of Philadelphia and the Hospital of the University of Pennsylvania. Then came the H1N1 (swine flu) pandemic.

"That really focused our attention on the need to prevent everything we could possibly prevent," said Connie Cutler, director of infection prevention at Main Line Health.

The system mandate that took effect the following year allowed two exemptions: medical (signed by a doctor) and religious (signed by a clergy leader). Cutler said one employee was terminated last year and eight, mostly part-time or per-diem, left this year. Of the system's 10,000 employees, 99.92 percent were vaccinated.

Pediatric hospitals are reservoirs of influenza, and babies under six months cannot be vaccinated. A key strategy is to surround them with a "cocoon" of immunized workers for protection.

Children's promoted vaccination for direct-care ("hands on") workers in high-risk settings (ICU) in 2004, gradually expanding the target group and adding consequences for noncompliance until it became mandatory for all providers, including students and volunteers, in buildings where patients were cared for.

The move prompted an unfair-labor-practice charge, which the hospital won. Seven employees were terminated for refusing the vaccine the first year. Those were the only job losses, and 99.5 percent of the staff is now immunized every year.

"Now everyone knows 'OK, it's time for us to get vaccinated,' and the amount of effort put in by the people who support and drive the program, and the amount of resistance, has dropped dramatically," said Susan Coffin, medical director of infection prevention.

Several medical groups now support mandatory flu vaccine for health-care workers, and the Centers for Medicare and Medicaid Services in 2015 will reduce reimbursement for hospitals that do not report rates of vaccination for their staff.

Vaccine strategies vary around the country. Of health systems that responded to a recent Inquirer survey, Lourdes was the only one in South Jersey to report mandatory flu shots for all workers, beginning last fall.

It was the norm in Southeastern Pennsylvania, where several big systems - Abington, Aria, Crozer-Keystone, Einstein, Jefferson, Main Line, and Penn - required flu shots.

A comprehensive survey by the Pennsylvania Department of Health last spring found that hospitals in the Southeastern Pennsylvania were five times more likely to have immunized at least 90 percent of their workers compared to hospitals elsewhere in the state.

It did not say why.

Some point to an abundance of teaching hospitals, or the early adopters' zeal to help.

When a hospital tells the community, "we think this is so important that we are going to require this of our staff," said Poland, of the Mayo Clinic, "what is the other hospital going to say?"

Hospital Staffs Vaccinated in S.E. Penna.

Twenty-seven of the 44 hospitals statewide that immunized 90 percent or more employees against the flu last year are located in the Philadelphia region (listed below). All eight of those that also achieved 90 percent for licensed independent practitioners and for students, trainees, and volunteers are here as well.
Abington Memorial Hospital; Aria Health (Frankford, Torresdale, Bucks County); Belmont Behavioral Health; Bryn Mawr Hospital; Bryn Mawr Rehab Hospital; Children’s Hospital of Philadelphia; Crozer-Chester Medical Center*; Delaware County Memorial Hospital; Doylestown Hospital; Einstein Medical Center; Einstein Medical Center Elkins Park; Good Shepherd Penn Partners; Grand View Hospital; Hospital of the University of Pennsylvania; Lankenau Hospital; Lansdale Hospital; LifeCare Hospitals of Chester County;Methodist Hospital; MossRehab; Paoli Hospital; Pennsylvania Hospital; Penn Presbyterian Medical Center; Riddle Memorial Hospital; St. Christopher’s Hospital for Children; Springfield Hospital*; Taylor Hospital; Thomas Jefferson University Hospital.

*Inadvertently omitted from original report by health system
SOURCE: Pennsylvania Department of Health

Contact Don Sapatkin at 215-854-2617 or dsapatkin@phillynews.com.