Nursing home and clinic workers fall short of flu vaccination goal — again

A nurse prepared an injection of the influenza vaccine at Massachusetts General Hospital in Boston.Brian Snyder/REUTERS/File 2013

The number of health care workers in Massachusetts nursing homes and clinics vaccinated against the flu during the 2015-16 season fell far short of the national goal of 90 percent, even as it rose slightly above previous years.

That’s the news from a Massachusetts Department of Public Health report released Tuesday on flu vaccination rates at clinics, nursing homes, rest homes, and adult day health centers, where roughly two-thirds to three-quarters of workers were vaccinated.

At hospitals, where intense efforts to vaccinate workers have been underway for years, the record was better — 92 percent overall, the same as the previous year and close to the national estimate of 91.2 percent.

Health authorities, nationally and locally, have focused on getting health care workers vaccinated because they can spread influenza to people who are already sick and vulnerable to severe complications.

“We think it’s important for every health care worker, no matter where they work, to get vaccinated,” said Dr. Alfred DeMaria, state epidemiologist and medical director of the Bureau of Infectious Disease and Laboratory Sciences.

But logistical challenges and resistance by some workers have kept the rates below the ideal.

In 2014, the Massachusetts Nurses Association, a union, sued Brigham and Women’s Hospital hoping to prevent the hospital from mandating that employees be vaccinated against the flu. The hospital backed off the mandate before the court acted, and instead required that unvaccinated employees wear masks. Unvaccinated workers who provide direct patient care or who work in patient care areas must wear a mask during the flu season.

The union objects to the masks, saying there is no evidence they prevent the spread of infection. But a hospital spokeswoman said the change in policy, along with efforts to educate employees, has succeeded in boosting vaccination rates: Since the masking requirement was introduced, employee vaccination rates rose from 75 percent in 2014 to 90 percent in 2015.

Hospitals were not included in the report issued Tuesday. A separate report on hospitals remains incomplete, but DeMaria provided an overview. Of 74 hospitals reporting, he said, more than half had employee vaccination rates of 90 percent or greater. Thirty-one percent were at 85 percent to 89 percent.

DeMaria said the hospitals have been gradually getting better at ensuring workers are vaccinated, but wide differences still exist. About one-third of hospitals require vaccination as a condition of employment — but some hospitals without such mandates still have higher vaccination rates, he said.

Although much of the vaccination effort has focused on hospitals, DeMaria said nursing homes are a bigger concern, because staff and patients interact closely over longer periods of time and the residents are so frail. Also, he said, studies have shown that nursing homes with high vaccination rates have lower mortality, while the evidence for the value of vaccinating workers in other settings is less strong.

Among nursing homes, 351 of the 419 homes in Massachusetts filed reports for the 2015-2016 flu season, showing that 73 percent of employees were vaccinated on average. Ninety-eight nursing homes had vaccinated more than 90 percent of workers.

Nikko B. Mendoza, spokeswoman for 1199SEIU United Healthcare Workers East, a union that represents many nursing home workers, said the union encourages workers to get vaccinated but opposes mandating it.

The Department of Public Health requires licensed health care facilities to report influenza vaccine coverage among employees, but compliance by outpatient facilities has been spotty.

Among clinics — a broad category that includes doctors’ and dentists’ offices, counseling centers, urgent care centers, and community health centers, among others — only 142 of the 326 reported vaccination rates. An average of 66 percent of employees at those facilities were vaccinated. But 38 clinics managed to vaccinate 90 percent or more of employees.

The vaccination rate was 76 percent at rest homes and 63 percent at adult day health centers.