Infection Control & Hospital Epidemiology (2018), 39, 1003–1005 doi:10.1017/ice.2018.110
Concise Communication
Healthcare personnel vaccination policies in Michigan long-term care facilities
Lynsey M. Kimmins MPH1, Cristi A. Bramer MPH1, Jacklyn L. Chandler MS1 and Adam L. Hart MPH2 1Division of Immunization, Michigan Department of Health and Human Services, Lansing, Michigan and 2Division of Communicable Disease, Michigan Department of Health and Human Services, Lansing, Michigan
Abstract
Of the 461 licensed long-term care facilities (LTCFs) in Michigan, 129 responded to the first survey of LTCF healthcare personnel (HCP) immunization policies, coverage estimates, and perceived barriers to vaccination. Survey results suggest opportunities to improve HCP vaccination through polices, education, barrier removal, and HCP immunity status tracking in licensed LTCFs in Michigan.
(Received 12 February 2018; accepted 22 April 2018; electronically published June 20, 2018)
The Advisory Committee on Immunization Practices (ACIP) and the Centers for Disease Control and Prevention (CDC) recom- mend that all healthcare personnel (HCP) are vaccinated with influenza (annually), hepatitis B (HepB), tetanus, diphtheria and pertussis (Tdap), measles, mumps and rubella (MMR), and varicella to protect themselves and, potentially, their patients from serious disease.1 The Healthcare Infection Control Practices Advisory Committee (HICPAC) additionally recommend routine assessment of employee immunity status and review of HCP vaccination policies.1 Moreover, the CDC and HICPAC endorse a secure, computerized system to track HCP vaccination records to ensure access to HCP immunity status during an outbreak.1 Literature is lacking on why long-term care facility (LTCF) HCP vaccination polices are limited, why LTCF HCP vaccination coverage is low, and why tracking of LTCF HCP immunity status for HCP recommended vaccines is minimal.
Methods Survey
In total, 461 licensed LTCFs were identified from the Michigan Department of Licensing and Regulatory Affairs directory. An e-mail was sent to the LTCF administrators on January 9, 2017, with survey instructions. Follow-up e-mails were sent to nonresponders on January 17 and 19, 2017.
Data Collection
Facilities could respond for a single facility or for a facility network. Healthcare personnel were defined as all paid and unpaid persons working in healthcare with the potential for exposure to patients or to
Author for correspondence: Cristi Bramer, Michigan Department of Health and
Human Services, PO Box 30195, Lansing, MI 48909. E-mail:
BramerC@michigan.gov Cite this article: Kimmins L, et al. (2018). Healthcare Personnel Vaccination Policies
in Michigan Long-Term Care Facilities. Infection Control & Hospital Epidemiology 2018, 39, 1003–1005. doi: 10.1017/ice.2018.110
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.
infectious materials, including bodilysubstancesorcontaminated medical supplies and equipment, environmental surfaces, and/or air.1 The survey comprised 17 questions regarding facility demographics, HCP vaccination policies, and HCP vaccination barriers.
Analysis
Respondents that did not complete the survey beyond demo- graphics were excluded. The numbers of HCP and residents were described with counts, median, and interquartile range (IQR). The median was used if a range was reported for the number of HCP or residents. Counts and percentages were used to describe the frequency of vaccination policies and barriers. The HCP immunization coverage estimates were characterized using med- ian and IQR. Network respondent data were broken down to facility-level responses based on the number of sites reported; non-LTCF data were excluded. Free-text responses for primary HCP barriers were sorted by
2 independent reviewers based on the literature2–4 and response themes. Barrier categories included HCP misconceptions or lack of knowledge; fear; religious or personal beliefs and rights; no barrier or barrier not required; no response or unknown; and other. “Misconceptions or lack of knowledge” included HCP thinking that they would get the vaccine-preventable disease (VPD) from the vaccine, that the vaccine was not effective, that they were not at risk for VPD, and that VPD was not serious. “Fear” included fear of needles, vaccinations, and side effects. Vaccine specific and not required were included for non- influenza vaccines. If multiple barriers were indicated, the first was considered the primary barrier. Inter-rater reliability was assessed using an unweighted kappa coefficient, and differences in barrier categorization were discussed and agreed upon by the reviewers. This study was considered exempt by the Michigan Depart-
ment of Health and Human Services Institutional Review Board. All data were collected in SurveyMonkey and were then exported to Excel software (Microsoft, Redmond, WA) and SAS version 9.4 (SAS Institute, Cary, NC) for analysis.
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