Population Mortality and Laws Encouraging Influenza Vaccination for Hospital Workers.

BACKGROUND: Since 1995, 14 states have passed laws encouraging or mandating influenza vaccination for hospital workers. Although the Centers for Disease Control and Prevention recommends vaccinating health care workers to reduce disease transmission and patient risk, the effect of these laws on pneumonia and influenza mortality is unknown. OBJECTIVE: To measure the effect of state-level hospital worker influenza vaccination laws on pneumonia and influenza mortality. DESIGN: Quasi-experimental observational study. SETTING: United States. PARTICIPANTS: Population of all states from 1995 to 2017. INTERVENTION: State adoption of a law promoting influenza vaccination for hospital workers. MEASUREMENTS: Pneumonia and influenza mortality per 100 000 persons by state and by month, both population-wide and separately by age group, obtained from restricted-access National Vital Statistics System files. Linear and log-linear models were used to compare changes in mortality rates for adopting versus nonadopting states. RESULTS: Implementation of state laws requiring hospitals to offer influenza vaccination to their employees was associated with a 2.5% reduction in the monthly pneumonia and influenza mortality rate (-0.16 deaths per 100 000 persons [95% CI, -0.29 to -0.02]; P = 0.022) during the years when the vaccine was well matched to the circulating strains. The largest effects occurred among elderly persons and during peak influenza months. LIMITATION: Utilization of large-scale national data precluded analysis of more specific outcomes, such as laboratory-confirmed or hospital-acquired influenza. CONCLUSION: State laws promoting hospital worker vaccination against influenza may be effective in preventing pneumonia- and influenza-related deaths, particularly among elderly persons. Vaccinating hospital workers may substantially reduce the spread of influenza and protect the most vulnerable populations. PRIMARY FUNDING SOURCE: None.

Deterrence approach on the compliance with electronic medical records privacy policy: the moderating role of computer monitoring.

BACKGROUND: This study explored the possible antecedents that will motivate hospital employees' compliance with privacy policy related to electronic medical records (EMR) from a deterrence perspective. Further, we also investigated the moderating effect of computer monitoring on relationships among the antecedents and the level of hospital employees' compliance intention. METHODS: Data was collected from a large Taiwanese medical center using survey methodology. A total of 303 responses was analyzed via hierarchical regression analysis. RESULTS: The results revealed that sanction severity and sanction certainty significantly predict hospital employees' compliance intention, respectively. Further, our study found external computer monitoring significantly moderates the relationship between sanction certainty and compliance intention. CONCLUSIONS: Based on our findings, the study suggests that healthcare facilities should take proactive countermeasures, such as computer monitoring, to better protect the privacy of EMR in addition to stated privacy policy. However, the extent of computer monitoring should be kept to minimum requirements as stated by relevant regulations.

Association of State Laws With Influenza Vaccination of Hospital Personnel.

INTRODUCTION: Healthcare personnel influenza vaccination can reduce influenza illness and patient mortality. State laws are one tool promoting healthcare personnel influenza vaccination. METHODS: A 2016 legal assessment in 50 states and Washington DC identified (1) assessment laws: mandating hospitals assess healthcare personnel influenza vaccination status; (2) offer laws: mandating hospitals offer influenza vaccination to healthcare personnel; (3) ensure laws: mandating hospitals require healthcare personnel to demonstrate proof of influenza vaccination; and (4) surgical masking laws: mandating unvaccinated healthcare personnel to wear surgical masks during influenza season. Influenza vaccination was calculated using data reported in 2016 by short-stay acute care hospitals (n=4,370) to the National Healthcare Safety Network. Hierarchical linear modeling in 2018 examined associations between reported vaccination and assessment, offer, or ensure laws at the level of facilities nested within states, among employee and non-employee healthcare personnel and among employees only. RESULTS: Eighteen states had one or more healthcare personnel influenza vaccination-related laws. In the absence of any state laws, facility vaccination mandates were associated with an 11-12 percentage point increase in mean vaccination coverage (p<0.0001). Facility-level mandates were estimated to increase mean influenza vaccination coverage among all healthcare personnel by 4.2 percentage points in states with assessment laws, 6.6 percentage points in states with offer laws, and 3.1 percentage points in states with ensure laws. Results were similar in analyses restricted only to employees although percentage point increases were slightly larger. CONCLUSIONS: State laws moderate the effect of facility-level vaccination mandates and may help increase healthcare personnel influenza vaccination coverage in facilities with or without vaccination requirements.

Issues in understanding the impact of the Needlestick Safety and Prevention Act on hospital sharps injuries.

OBJECTIVE: Measuring the effect of the Needlestick Safety and Prevention Act (NSPA) is challenging. No agreement exists on a common denominator for calculating injury rates. Does it make a difference? How are the law and safety-engineered devices related? What is the effect on injuries and costs? This study examines those issues in assessing the impact of the legislation on hospital worker percutaneous injuries. METHODS: Using a historic prospective design, we analyzed injury data from 85 hospitals. Injury rates were calculated per 100 full-time equivalents, 100 staffed beds, and 100 admissions each year from 1995 to 2005. We compared changes for each denominator. We measured the proportion of the injury rate attributed to safety-engineered devices. Finally, we estimated a national change in injuries and associated costs. RESULTS: For all denominators, a precipitous drop in injury rates of greater than one-third ([Formula: see text]) occurred in 2001, immediately following the legislation. The decrease was sustained through 2005. Concomitant with the decrease in rates, the proportion of injuries from safety-engineered devices nearly tripled ([Formula: see text]) across all denominators. We estimated annual reductions of more than 100,000 sharps injuries at a cost savings of $69-$415 million. CONCLUSIONS: While the data cannot demonstrate cause and effect, the evidence suggests a reduction in hospital worker injury rates related to the NSPA, regardless of denominator. It also suggests an association between the increase in safety-engineered devices and the reduction in overall injury rates. The decreases observed translate into significant reductions in injuries and associated costs.

Industrial relations conflict in Irish hospitals: a review of Labour Court cases.

PURPOSE: The purpose of this paper is to explore the nature of industrial relations (IR), and IR conflict in the Irish healthcare sector. DESIGN/METHODOLOGY/APPROACH: The paper is based on a thematic analysis of Labour Court cases concerning hospitals over a ten-year period. FINDINGS: The findings of the paper indicate that the nature of IR conflict is changing in healthcare. The paper suggests that alternative manifestations of IR conflict evident in the Irish healthcare sector include: absenteeism as a form of temporary exit; and resistance. The key groups in the sector are discussed in the context of their contrasting disputes. The themes which characterise negotiations are identified as precedent, procedure and partnership. RESEARCH LIMITATIONS/IMPLICATIONS: The research was conducted in the healthcare sector, and thus its transferability is limited. Caution is also required as the research pertains to one national setting, which despite sharing some structural similarities with other health and IR systems, is a unique context. The paper highlights the importance of recognising IR conflict in its various forms. It is further suggested that managing the process of IR conflict may be significant in furthering change agendas. ORIGINALITY/VALUE: The value of the paper centres on the investigation of alternative manifestations of IR conflict in the healthcare sector.

Hospital policies, state laws, and healthcare worker influenza vaccination rates.

This study used hierarchical linear modeling to determine the relative contribution of hospital policies and state laws to healthcare worker (HCW) influenza vaccination rates. Hospital mandates with consequences for noncompliance and race were associated with 3%-12% increases in HCW vaccination; state laws were not significantly related to vaccination rates.

[Legal position of non-medical personnel in hospitals]. / Rechtliche Stellung nichtärztlichen Personals im Krankenhaus.

There are currently many assistant professions in the German healthcare system which have either a more nursing or a more medical character. All these assistant professions have in common that as yet they do not require uniform training criteria but members of these professions undertake some aspects of medical activities. At the center lies the difficulty of more political than legal discussion on whether members of these assistant professions and also nursing personnel are allowed to or should undertake medical activities. This article illuminates the legal status quo.

Diversion of drugs within health care facilities, a multiple-victim crime: patterns of diversion, scope, consequences, detection, and prevention.

Mayo Clinic has been involved in an ongoing effort to prevent the diversion of controlled substances from the workplace and to rapidly identify and respond when such diversion is detected. These efforts have found that diversion of controlled substances is not uncommon and can result in substantial risk not only to the individual who is diverting the drugs but also to patients, co-workers, and employers. We believe that all health care facilities should have systems in place to deter controlled substance diversion and to promptly identify diversion and intervene when it is occurring. Such systems are multifaceted and require close cooperation between multiple stakeholders including, but not limited to, departments of pharmacy, safety and security, anesthesiology, nursing, legal counsel, and human resources. Ideally, there should be a broad-based appreciation of the dangers that diversion creates not only for patients but also for all employees of health care facilities, because diversion can occur at any point along a long supply chain. All health care workers must be vigilant for signs of possible diversion and must be aware of how to engage a preexisting group with expertise in investigating possible diversions. In addition, clear policies and procedures should be in place for dealing with such investigations and for managing the many possible outcomes of a confirmed diversion. This article provides an overview of the multiple types of risk that result from drug diversion from health care facilities. Further, we describe a system developed at Mayo Clinic for evaluating episodes of potential drug diversion and for taking action once diversion is confirmed.