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BACKGROUND: Healthcare personnel (HCP) who are ill with influenza can transmit infection to patients in healthcare facilities, increasing length-of-stay and mortality. To reduce this risk, the Los Angeles County (LAC) Health Officer issued an order mandating influenza vaccination or masking for unvaccinated HCP for the duration of influenza season. The order includes HCPs at all acute care hospitals, and skilled nursing and intermediate care facilities, from the start of the 2013-14 influenza season. We evaluated the impact of this order on HCP vaccination rates; the occurrence of nosocomial influenza infections; and absenteeism among hospital employees.
METHODS: We surveyed infection control professionals, laboratory directors and human resource staff at 99 LAC acute care facilities for two influenza seasons pre-order (2011-12, 2012-13) and one season post-order (2013-14). Data collected include HCP vaccination rates, positive inpatient influenza laboratory results, nosocomial influenza cases (positive > 3 days post-admission), and absenteeism data. We compared the proportion of nosocomial influenza infections pre-order to the proportion of nosocomial influenza infections post-order.
RESULTS: To date, HCP vaccination data have been reported from 49/99 facilities. HCP vaccination increased from 75.2% before the order to 86.2% in 2013-14. Rates varied between facilities and influenza seasons from 33% to 98% in 2011-12, 36% to 95% in 2012-13, and 65% to 97% in 2013-14. Laboratory data were reported for all 3 seasons from 30 facilities. There was no significant difference in the proportion of nosocomial influenza infections pre-order compared to post-order. Among 29 facilities reporting absenteeism data, the average missed number of days during the influenza season per employee decreased from 5.5 in 2012-13 to 2.7 in 2013-14.
CONCLUSIONS: Preliminary findings suggest the Health Officer mandate was effective in increasing HCP vaccination. Substantial differences in vaccination coverage between facilities suggest variations in implementation effectiveness. One of the most important impacts of the mandate may have been to substantially increase the HCP vaccination rate among facilities with the lowest pre-order rates. The reduction in absenteeism is difficult to interpret given the different severity of respiratory disease seasons. While analyzing nosocomial influenza rates as a proportion of all confirmed influenza hospitalization controls for these differences, differences in vaccine effectiveness may affect nosocomial transmission of influenza. The health officer order continues in effect allowing DPH to monitor the impact over future influenza seasons. Policies such as a Health Officer order can give healthcare facilities more leverage to enforce effective evidence-based practices to improve infection control and prevention.