title: Evaluation of the impact of the 2012 Rhode Island health care worker influenza vaccination regulations: implementation process and vaccination coverage.
abstract: BACKGROUND
  In October 2012, the Rhode Island Department of Health (HEALTH) amended its health care worker (HCW) vaccination regulations to require all HCWs to receive annual influenza vaccination or wear a surgical mask during direct patient contact when influenza is widespread. Unvaccinated HCWs failing to wear a mask are subject to a fine and disciplinary action.
  
  
  OBJECTIVE
  To describe the implementation of the 2012 Rhode Island HCW influenza vaccination regulations and examine their impact on vaccination coverage.
  
  
  METHODS
  Two data sources were used: (1) a survey of all health care facilities subject to the HCW regulations and (2) HCW influenza vaccination coverage data reported to HEALTH by health care facilities. Descriptive statistics and paired t tests were performed using SAS Release 9.2.
  
  
  METHODS
  For the 2012-2013 influenza season, 271 inpatient and outpatient health care facilities in Rhode Island were subject to the HCW regulations.
  
  
  METHODS
  Increase in HCW influenza vaccination coverage.
  
  
  RESULTS
  Of the 271 facilities, 117 facilities completed the survey (43.2%) and 160 facilities reported vaccination data to HEALTH (59.0%). Between the 2011-2012 and 2012-2013 influenza seasons, the proportion of facilities having a masking policy, as required by the revised regulations, increased from 9.4% to 94.0% (P < .001). However, the proportion of facilities implementing Advisory Committee on Immunization Practices-recommended strategies to promote HCW influenza vaccination did not increase. The majority of facilities perceived benefits to collecting HCW influenza vaccination data, including strengthening infection prevention efforts (83.2%) and improving patient and coworker safety (75.2%). Concurrent with the new regulations, influenza vaccination coverage among employee HCWs in Rhode Island increased from 69.7% in the 2011-2012 influenza season to 87.2% in the 2012-2013 season.
  
  
  CONCLUSIONS
  Rhode Island's experience demonstrates that statewide HCW influenza vaccination requirements incorporating mask wearing and moderate penalties for noncompliance can be effective in improving influenza vaccination coverage among HCWs.
authors.affiliation: Division of Community, Family Health, and Equity, Rhode Island Department of Health, Providence (Dr Kim and Mss Paiva and Raymond); Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island (Dr Kim); National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (Ms Lindley); Independent Healthcare Consultant, Providence, Rhode Island (Ms Dube); and Carter Consulting, Inc, Atlanta, Georgia (Ms Kalayil).
authors.forename: Hanna
authors.initials: H
authors.lastname: Kim
authors.forename: Megan C
authors.initials: MC
authors.lastname: Lindley
authors.forename: Donna
authors.initials: D
authors.lastname: Dube
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Kalayil
authors.forename: Kristi A
authors.initials: KA
authors.lastname: Paiva
authors.forename: Patricia
authors.initials: P
authors.lastname: Raymond
mesh_terms: D001291:Attitude of Health Personnel; D006282:Health Personnel / Q000706:statistics & numerical data; D006291:Health Policy; D006801:Humans; D007252:Influenza Vaccines / Q000494:pharmacology* / Q000627:therapeutic use*; D007251:Influenza, Human / Q000517:prevention & control*; D032541:Mass Vaccination / Q000592:standards*; D015397:Program Evaluation / Q000592:standards*; D012237:Rhode Island
chemical_list: D007252:Influenza Vaccines
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