Immunization Programs for Health Care Personnel: CDC Recommendations

This section of CDC's guideline Infection Control in Healthcare Personnel (Part I, Infrastructure and Routine Practices) covers immunization programs for health care personnel (HCP).

The recommendations

For health care organization leaders and administrators

• 6.a. Set goals for high rates of evidence of immunity to the vaccine-preventable diseases the Advisory Committee on Immunization Practices (ACIP) recommends for health care personnel.

For occupational health services leaders and staff

• 6.b. Develop, review and update as needed immunization policies and procedures that:
• 1. follow ACIP recommendations for immunizing health care personnel;
  2. list every preplacement, annual and other job-related immunization staff should receive;
  3. set out strategies for offering vaccines and reaching high coverage;
  4. set out how to gather and review the reasons recommended vaccines were not given, to improve the program.

What an immunization program does

A program provides the services that ensure immunity: documenting evidence of immunity, giving vaccinations and boosters, and keeping records and reporting to state or local immunization information systems (IIS), also called vaccine registries. It may also offer extras such as travel vaccines for staff working abroad, or arrange them with an outside provider. A good program can:

• prevent vaccine-preventable diseases among staff;
• protect patients, and others such as staff members' families, from infectious staff;
• meet ACIP recommendations and federal, state and local requirements;
• cut the need for, and cost of, reactive measures such as postexposure prophylaxis, sick leave and work restrictions;
• make reporting of staff immunization more efficient, both internally and to payers and public health agencies.

Requirements

• The OSHA Bloodborne Pathogens standard requires employers to offer hepatitis B vaccine, at their expense, to every employee with occupational exposure to blood or other potentially infectious materials, to make it available after an exposure, and to inform employees about its efficacy, safety, administration and benefits. Employees may refuse but must sign a declination form with OSHA-prescribed wording.
• State and local requirements vary, and payers — including the Centers for Medicare & Medicaid Services — and accrediting bodies may require things such as reporting coverage to CDC's National Healthcare Safety Network and setting improvement goals.

Why coverage falls short

Despite the recommendations and requirements, immunization coverage among health care personnel is lower than it should be. Barriers vary by group and setting, and include fear of side effects or of injections, inconvenient access, a sense that vaccination isn't needed (low perceived risk or doubts about how well vaccines work), and lack of leadership support.

What raises coverage

Comprehensive programs that include mandatory immunization policies have been shown to reliably and substantially raise preplacement and annual vaccination. Other approaches used in health care facilities include:

• leaders getting vaccinated visibly, as role models;
• education and awareness campaigns;
• free vaccine, with no out-of-pocket cost;
• incentives such as cafeteria coupons or gift certificates;
• flexible delivery — multiple locations and times, mobile carts;
• signed declinations from staff who decline for non-medical reasons;
• tracking and reporting vaccination rates, for example by ward, to target areas with low coverage.

Sources

Rewritten from the Centers for Disease Control and Prevention guideline section "6. Immunization Programs," Infection Control in Healthcare Personnel (public domain), in hubnx's own words.