Public health masking mandates improve hospital healthcare personnel vaccination rates

Abstract

Influenza vaccination of health care personnel (HCP) reduces absenteeism, prevents nosocomial transmission, and protects the community.1Ahmed F. Lindley M.C. Allred N. Weinbaum C.M. Grohskopf L. Effect of influenza vaccination of healthcare personnel on morbidity and mortality among patients: systematic review and grading of evidence.Clin Infect Dis. 2014; 58: 50-57Crossref PubMed Scopus (162) Google Scholar, 2Miller B.L. Ahmed F. Lindley M.C. Wortley P.M. Increases in vaccination coverage of healthcare personnel following institutional requirements for influenza vaccination: a national survey of US hospitals.Vaccine. 2011; 29: 9398-9403Crossref PubMed Scopus (42) Google Scholar Many hospitals have policies on HCP influenza vaccination or a mask mandate, yet the effects of government regulatory body mandates to reinforce these policies have not been well described. Some state public health departments have vaccination or mask mandates for the entire state, like New York,3New York State Department of Health Flu mask requirements.https://www.health.ny.gov/professionals/nursing_home_administrator/dal_nh_13-04_flu_mask_requirement.htmDate: 2017Google Scholar whereas others, like California, leave it up to individual counties. The California Department of Public Health (CDPH) publishes an annual report on hospital HCP influenza vaccination through the National Healthcare Safety Network influenza vaccination module.4California Department of Public Health Healthcare personnel influenza vaccination reporting in California hospitals, 2015-2016.http://www.cdph.ca.gov/programs/hai/Pages/HCPInfluenzaVaxReport.aspxDate: 2017Google Scholar Many county public health officers have issued HCP vaccination or mask mandates. Data for the 2015-2016 influenza season was available for 54 of the 58 California counties. There were 282 hospitals in 34 counties with a vaccination or mask mandate and 107 hospitals in 20 counties without a vaccination or mask mandate. A total of 739,473 HCP were vaccinated (81.7%) and 165,296 declined (18.2%) (Table 1). The CDPH 2015-2016 goal was 78% vaccination.Table 1California health care personnel vaccination rates by counties with and without influenza vaccination or mask mandate*Source: http://www.cdph.ca.gov/programs/hai/Documents/2015-HCP-Flu-T01.pdf.With mandateWithout mandateTotalVaccinated600,958 (82.4)138,515 (79.0)739,473 (81.7)Not vaccinated128,483 (17.6)36,813 (21.0)165,296 (18.2)Total729,411175,328904,769NOTE. Values are presented as n (%).* Source: http://www.cdph.ca.gov/programs/hai/Documents/2015-HCP-Flu-T01.pdf. Open table in a new tab NOTE. Values are presented as n (%). There was an 82.4% vaccination rate in counties with a vaccination or mask mandate and 79.0% vaccinate rate in counties without a vaccination or mask mandate. Proportional t tests and z score tests were performed. The difference in the 2 rates was 3.4% (95% confidence interval, 3.19-3.6; χ2 = 1094.82; P < .0001) (z score = 32.95; P = 0). Although the 3.4% difference was small, it was significant considering the total number of vaccinated HCP was 739,473. Although the mask mandate may not be the only factor influencing a higher HCP vaccination rate, it suggests that a mask mandate may help. The CDPH data suggest that individual county public health department vaccination or mask mandates improve HCP influenza vaccination rates. Infection preventionists (IPs) in all health care settings could petition their local or state public health departments to issue HCP influenza vaccination or masking mandates.5Centers for Disease Control and Prevention (CDC) A complete list influenza vaccination regulations for all 50 states.https://www2a.cdc.gov/vaccines/statevaccsApp/AdministrationbyVaccine.asp?Vaccinetmp=InfluenzaGoogle Scholarhttps://www.cdc.gov/mmwr/international/relres.htmlGoogle Scholar Perhaps vaccination or mask mandates should include all HCP in hospitals, long-term care facilities, clinics, offices, and patient vehicle transport.