Evaluation of Health Care Worker Vaccination Rates in Utah Outpatient Clinics
Luthy, Karlen E.
Macintosh, Janelle L. B.
Eden, Lacey M.
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Session presented on Sunday, July 26, 2015: Purpose: The purpose of this study was to explore vaccination rates of health care workers (HCW) employed in the outpatient clinic setting in Utah. It was hypothesized that Utah outpatient clinic settings (namely pediatric clinics, family practice clinics, and oncology clinics) mirrored the established vaccination policies of Utah HCWs employed in the in-patient hospital setting and the recommendations of the Utah Department of Health. Methods: Institutional Review Board approval was granted for this study prior to data collection. The study included a convenience sample of 178 clinic managers of Utah pediatric, family practice, and oncology outpatient clinics. On the initial encounter, clinic managers in the state of Utah were contacted via telephone at which time the study was explained. One month following the initial contact, participating clinic managers were sent a study packet via mail. Each packet included an informed consent document, questionnaire, self-addressed and postage-paid return envelope, and a $1.00 compensation for participation. One month following the distribution of the questionnaires, non-responders were sent a reminder packet that included another copy of the informed consent document, questionnaire, and self-addressed and postage-paid return envelope. The $1.00 incentive was not included on the follow-up mailing. Return of the questionnaire implied the subject's consent. Clinic managers retained the $1.00 incentive regardless of participation in the study. Questionnaire items were selected based on current literature regarding HCW vaccination mandates in the United States and was reviewed by a panel of public health experts. The finalized, two-page questionnaire included five demographic items, five multiple choice items, two yes/no, and three open-ended items. Frequencies, measures of central tendency and dispersion statistics were calculated for all quantitative items. Two independent researchers conducted a content analysis for open-ended items from the open-ended responses. Results: All data are collected, although what is reported here are preliminary results. A total of 178 participants completed questionnaires. Surprisingly, 50% of the outpatient Utah clinics described their vaccination policy as recommending employee vaccination, although employees were allowed to refuse without any consequence. Employees working in the back office (83%) were most often included in the clinic's vaccination policy. Of clinics with an active vaccination policy, influenza was included as part of the policies 66% of the time. Hepatitis B was also commonly included in the vaccination policies (63.8%), as well as tetanus and pertussis (59.6%) and varicella (34%). HCWs were allowed to refuse vaccinations for medical and religious reasons, additionally 48.9% of clinics allowed HCWs to refuse vaccinations for philosophical beliefs. When an inadequately vaccinated HCW became ill with a cough, rash, or fever, 36.2% of clinics required him/her to wear a mask. Surprisingly 27.7% of clinics took no action with inadequately vaccinated HCWs when they arrived at work ill. When asked to identify the greatest barrier to implementing and maintaining a clinic vaccination policy, the prevailing theme was a lack of manpower. Conclusions: The hypothesis was not supported and while the majority of in-patient HCWs in Utah are adequately vaccinated, this is not the case in the outpatient clinic setting even though the two groups of HCWs have similar vaccination guidelines as recommended by the Utah Department of Health and the Centers for Disease Control and Prevention. As influential leaders in the delivery of health care services, nurses have an ethical responsibility to promote vaccination compliance among themselves and in their places of employment. Currently, pharmacists and physicians have the highest vaccination rates, 89.9% and 84.3% respectively. Nurses, on the other hand, generally have lower vaccination rates at 77.8%. The lowest vaccination rates are medical assistants or aides at 49.2%. Therefore, there is room for improvement. Nurses can be instrumental in promoting HCW vaccination policies in all health care settings, especially the outpatient clinic setting.