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Major Article| Volume 50, ISSUE 4, P369-374, April 2022

Influenza vaccination of home health care staff and the impact on patient hospitalizations

      Highlights

      • Older adults are at high risk for influenza and are more likely to develop serious complications.
      • Influenza vaccination of healthcare workers can help protect older patients from acute respiratory disease.
      • Influenza vaccination among home health care workers are suboptimal.
      • Home health care agencies with influenza vaccination requirements had higher influenza vaccination rates.
      • Home health care agency's influenza vaccination policies are associated with reduced respiratory infection-related hospitalization among older patients.

      Abstract

      Background

      Influenza is associated with significant morbidity and mortality for adults aged 65 years and older. Influenza vaccination of health care workers is recommended. There is limited evidence regarding influenza vaccinations among health care workers in the home health care (HHC) setting and their impact on HHC patient outcomes.

      Methods

      A national survey of HHC agencies was conducted in 2018-2019 and linked with patient data from the Centers for Medicare and Medicaid Services. Adjusted logistic regression models were used to estimate the association between hospital transfers due to respiratory infection during a 60 day HHC episode and staff vaccination policies.

      Results

      Only 26.2% of HHC agencies had staff vaccination requirements and 71.2% agencies had staff vaccination rates higher than 75%. Agency policies for staff influenza vaccination were associated with reduced hospital transfers due to respiratory infection among HHC patients.

      Discussion

      Influenza vaccination rates among HHC staff were low during the 2017-2018 influenza season. Policymakers may consider vaccination mandates to improve health care worker vaccination rates and protect patient safety.

      Conclusions

      This study sheds light on the potential impact of COVID-19 vaccination among HHC workers on patient outcomes. COVID-19 vaccination mandates could prove to be a vital tool in the fight against COVID-19 variants and infection outbreaks.

      Key Words

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      References

      1. Centers for Disease Control and Prevention (CDC). Estimated Influenza Illnesses, Medical visits, Hospitalizations, and Deaths in the United States — 2018–2019 influenza season. Available at: https://www.cdc.gov/flu/about/burden/2018-2019.html. Updated September 29, 2021. Accessed October 20, 2021.

        • Czaja CA
        • Miller L
        • Alden N
        • et al.
        Age-related differences in hospitalization rates, clinical presentation, and outcomes among older adults hospitalized with influenza-U.S. influenza hospitalization surveillance network (FluSurv-NET).
        Open Forum Infect Dis. 2019; 6: ofz225
      2. Medicare Payment Advisory Commission (MedPAC). Report to the Congress: Medicare Payment Policy. Available at: https://www.medpac.gov/document/march-2019-report-to-the-congress-medicare-payment-policy/. Updated March 15, 2019. Accessed October 20, 2021.

      3. Avalere Health. Home Health Chartbook 2019: Prepared for the Alliance for Home Health Quality and Innovation. Available at: http://ahhqi.org/images/uploads/AHHQI_2019_Home_Health_Chartbook_Final_Updated_10.3.2019.pdf. Updated October 3, 2019. Accessed October 10, 2019.

        • Shang J
        • Larson E
        • Liu J
        • Stone P.
        Infection in home health care: Results from national Outcome and Assessment Information Set data.
        Am J Infect Contr. 2015; 43: 454-459
        • Domnich A
        • Arata L
        • Amicizia D
        • Puig-Barbera J
        • Gasparini R
        • Panatto D.
        Effectiveness of MF59-adjuvanted seasonal influenza vaccine in the elderly: A systematic review and meta-analysis.
        Vaccine. 2017; 35: 513-520
        • Hayward AC
        • Harling R
        • Wetten S
        • et al.
        Effectiveness of an influenza vaccine programme for care home staff to prevent death, morbidity, and health service use among residents: cluster randomised controlled trial.
        BMJ. 2006; 333: 1241
        • Eibach D
        • Casalegno JS
        • Bouscambert M
        • et al.
        Routes of transmission during a nosocomial influenza A(H3N2) outbreak among geriatric patients and health care workers.
        J Hosp Infect. 2014; 86: 188-193
        • Grohskopf LA
        • Sokolow LZ
        • Broder KR
        • et al.
        Prevention and control of seasonal influenza with vaccines: recommendations of the advisory committee on immunization practices-United States, 2018-19 influenza season.
        MMWR Recomm Rep. 2018; 67: 1-20
      4. Infections Disease Society of America. IDSA Policy on Mandatory Immunization of Health Care Workers Against Seasonal and Pandemic Influenza. Available at: https://www.idsociety.org/globalassets/idsa/policy--advocacy/current_topics_and_issues/immunizations_and_vaccines/health_care_worker_immunization/statements/idsa-policy-on-mandatory-influenza-immunization-of-health-care-workers-pdf. Published August 31, 2010. Accessed October 20, 2021.

      5. American College of Physicians. ACP Policy on Patient Safety and Health Care Provider Immunization. Available at: https://www.acponline.org/acp_policy/policies/healthcare_provider_immunization_2013.pdf. Published December 2013. Accessed October 20, 2021.

      6. Acero C, Razzaghi H, Black C, et al. Influenza vaccination coverage among health care personnel — United States, 2019–2020 influenza season [updated October 1, 2020]. Accessed October 20, 2021. https://www.cdc.gov/flu/fluvaxview/hcp-coverage_1920estimates.htm

        • Cabin W
        • Himmelstein DU
        • Siman ML
        • Woolhandler S.
        For-profit medicare home health agencies' costs appear higher and quality appears lower compared to nonprofit agencies.
        Health Aff (Millwood). 2014; 33: 1460-1465
        • Dick AW
        • Murray MT
        • Chastain AM
        • et al.
        Measuring quality in home health care.
        J Am Geriatr Soc. 2019; 67: 1859-1865
        • Shang J
        • Chastain AM
        • Perera UGE
        • et al.
        The state of infection prevention and control at home health agencies in the United States prior to COVID-19: A cross-sectional study.
        Int J Nurs Stud. 2021; 115103841
        • Harrison JM
        • Dick AW
        • Stone PW
        • et al.
        Infection trends in home health care, 2013-2018.
        Infect Control Hosp Epidemiol. 2021; 42: 1388-1390
        • Jenkin DC
        • Mahgoub H
        • Morales KF
        • Lambach P
        • Nguyen-Van-Tam JS.
        A rapid evidence appraisal of influenza vaccination in health workers: An important policy in an area of imperfect evidence.
        Vaccine X. 2019; 2100036
        • Black CL
        • Yue X
        • Ball SW
        • et al.
        Influenza vaccination coverage among health care personnel - United States, 2017-18 influenza season.
        MMWR Morb Mortal Wkly Rep. 2018; 67: 1050-1054
        • Rosati RJ
        • Zales M
        • Landers S.
        The benefits and challenges of the influenza vaccination among home health care workers.
        Home Health Care Manage Pract. 2016; 28: 178-183
        • Dini G
        • Toletone A
        • Sticchi L
        • Orsi A
        • Bragazzi NL
        • Durando P.
        Influenza vaccination in health care workers: A comprehensive critical appraisal of the literature.
        Hum Vaccin Immunother. 2018; 14: 772-789
        • Madigan EA
        • Kenneley I.
        Barriers and facilitators to provision of influenza and pneumococcal vaccines in home health care agencies.
        Home Health Care Manag Pract. 2015; 27: 13-17
        • Pitts SI
        • Maruthur NM
        • Millar KR
        • Perl TM
        • Segal J.
        A systematic review of mandatory influenza vaccination in health care personnel.
        Am J Prev Med. 2014; 47: 330-340
        • Carrera M
        • Lawler EC
        • White C.
        Population mortality and laws encouraging influenza vaccination for hospital workers.
        Ann Intern Med. 2021; 174: 444-452
      7. Centers for Disease Control and Prevention (CDC). Nursing Home COVID-19 Vaccination Data Dashboard. CDC/National Health Care Safety Network (NHSN). Available at:https://www.cdc.gov/nhsn/covid19/ltc-vaccination-dashboard.html#anchor_1594393306. Accessed December 13, 2021.

      8. Centers for Medicare & Medicaid Services (CMS). Biden-Harris Administration Issues Emergency Regulation Requiring COVID-19 Vaccination for Health Care Workers. Available at: https://www.cms.gov/newsroom/press-releases/biden-harris-administration-issues-emergency-regulation-requiring-covid-19-vaccination-health-care. Updated November 4, 2021. Accessed November 5, 2021.

        • Madigan EA
        • Fortinsky RH.
        Interrater reliability of the outcomes and assessment information set: Results from the field.
        Gerontologist. 2004; 44: 689-692