উন্নত করার কিছু দেখছেন? একটি পরিবর্তন প্রস্তাব করুন।
Ambulatory care facilities — outpatient settings such as birth centers, dialysis centers and surgical centers — face flu vaccination rules for workers and patients that vary from state to state. This summary, from CDC's Public Health Law Program (PHLP), looks at those laws. CDC recommends that adults get a flu vaccine every year.
Why it matters
- Flu is serious: it can put anyone in the hospital, even healthy people. It spreads mostly in homes and the community; each year 5 to 20% of U.S. residents are infected, and many seek care in outpatient settings.
- Older adults die most: over the 1976 to 2007 seasons, an estimated average of 21,098 flu deaths a year occurred among adults ≥ 65 — 90% of the yearly flu deaths across all ages.
- Health care spreads it: workers can carry flu on hands or clothes to colleagues and patients. The Advisory Committee on Immunization Practices recommends yearly flu vaccination for all health care personnel. Vaccinating them has been linked to less absenteeism and fewer deaths among nursing home and elderly hospital patients.
Four kinds of requirement
| Type | The facility must… |
|---|---|
| Assessment | check a worker's or patient's vaccination status |
| Offer | offer the vaccine |
| Ensure | require proof of vaccination or immunity |
| Surgical mask | have unvaccinated or exempted workers wear a mask during flu season |
Laws for health care workers: eleven states
By facility type
- All ambulatory care facilities — Rhode Island: facilities must report "[t]he number of health care workers who received" the flu vaccine.
- Ambulatory surgical facilities — South Carolina: "[a]ll direct care staff . . . have an annual influenza vaccination unless contraindicated or offered and declined."
- Birth centers — Tennessee: an annual program including "[t]he offer of influenza vaccination to all staff."
By requirement type
| Requirement | States | Example |
|---|---|---|
| Assessment | 9 | New Hampshire surgical centers "identify, track, and report on . . . coverage rates"; Oregon surgical centers and dialysis facilities file an annual survey of staff vaccination |
| Offer | 4 | Tennessee birth centers offer it to staff and independent practitioners; Illinois surgical treatment centers, freestanding emergency centers and end-stage renal disease facilities must plan to offer it |
| Ensure | 7 | Massachusetts clinics "shall ensure that all personnel are vaccinated . . . unless an individual declines"; New Hampshire surgical centers "shall immunize all consenting personnel" |
| Surgical mask | 3 | New York: unvaccinated personnel wear "a surgical or procedure mask" where patients are present; Colorado: workers without proof of immunization mask during flu season in patient contact and common areas |
By exemption type
| Exemption | States | Example |
|---|---|---|
| Medical | 8 | Colorado accepts "a medical exemption signed by a physician, physician's assistant, advanced practice nurse or nurse midwife"; Oregon counts staff with documented contraindications. Even where the law is silent, people with a contraindication are likely not required to be vaccinated |
| Religious | 2 | Illinois employees "may decline" if vaccination "is against the person's religious beliefs"; Massachusetts clinics likewise |
| Philosophical | 8 | Tennessee outpatient diagnostic centers keep "[a] signed declination statement" from all who refuse for non-medical reasons; Rhode Island tracks workers who decline "for medical or personal reasons" |
Laws for patients: one state
Texas alone has flu vaccination laws for ambulatory care patients — only at end-stage renal disease (dialysis) facilities, and only for patients 65 or older, unless medically contraindicated.
- Offer: facilities must offer pneumococcal and influenza vaccines "to each elderly person who receives ongoing care at the facility" when a physician (or a nurse practitioner or physician assistant on a physician's behalf) finds it in the person's best interest, and must adopt and enforce a policy for it.
- Assessment: whoever gives the vaccine must "ask whether the elderly person is currently vaccinated."
- Medical exemption: they must "assess potential contraindications."
About this summary
- Method: state laws collected from WestlawNext, September 9–November 8, 2016; published April 20, 2017, updated October 2017 (the "ensure" definition was reworded, without changing the results).
- Not legal advice: PHLP cannot advise on specific cases; consult an attorney. The findings are the authors' and not necessarily CDC's official views.
- Full tables: the appendices on ambulatory care facility flu vaccination laws and the PDF.
Sources
Based on "Influenza Vaccination Laws for Ambulatory Care Facilities," Public Health Law Program, Centers for Disease Control and Prevention, produced with CDC's National Center for Immunization and Respiratory Diseases; a work of the United States government in the public domain.
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