title: Qualitative evaluation of Rhode Island's healthcare worker influenza vaccination regulations.
abstract: OBJECTIVE
  To evaluate Rhode Island's revised vaccination regulations requiring healthcare workers (HCWs) to receive annual influenza vaccination or wear a mask during patient care when influenza is widespread.
  
  
  METHODS
  Semi-structured telephone interviews conducted in a random sample of healthcare facilities.
  
  
  METHODS
  Rhode Island healthcare facilities covered by the HCW regulations, including hospitals, nursing homes, community health centers, nursing service agencies, and home nursing care providers. Participants Staff responsible for collecting and/or reporting facility-level HCW influenza vaccination data to comply with Rhode Island HCW regulations.
  
  
  METHODS
  Interviews were transcribed and individually coded by interviewers to identify themes; consensus on coding differences was reached through discussion. Common themes and illustrative quotes are presented.
  
  
  RESULTS
  Many facilities perceived the revised regulations as extending their existing influenza vaccination policies and practices. Despite variations in implementation, nearly all facilities implemented policies that complied with the minimum requirements of the regulations. The primary barrier to implementing the HCW regulations was enforcement of masking among unvaccinated HCWs, which required timely tracking of vaccination status and additional time and effort by supervisors. Factors facilitating implementation included early and regular communication from the state health department and facilities' ability to adapt existing influenza vaccination programs to incorporate provisions of the revised regulations.
  
  
  CONCLUSIONS
  Overall, facilities successfully implemented the revised HCW regulations during the 2012-2013 influenza season. Continued maintenance of the regulations is likely to reduce transmission of influenza and resulting morbidity and mortality in Rhode Island's healthcare facilities.
authors.affiliation: National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road N.E., Atlanta, GA 30333, USA. Electronic address: MLindley@cdc.gov.
authors.forename: Megan C
authors.initials: MC
authors.lastname: Lindley
authors.affiliation: Independent Healthcare Consultant, Providence, RI USA.
authors.forename: Donna
authors.initials: D
authors.lastname: Dube
authors.affiliation: Carter Consulting, Inc., 2310 Parklake Dr. NE, Suite 535, Atlanta, GA 30345, USA.
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Kalayil
authors.affiliation: Division of Community, Family Health, and Equity, Rhode Island Department of Health, 3 Capitol Hill, Providence, RI 02908, USA.
authors.forename: Hanna
authors.initials: H
authors.lastname: Kim
authors.affiliation: Division of Community, Family Health, and Equity, Rhode Island Department of Health, 3 Capitol Hill, Providence, RI 02908, USA.
authors.forename: Kristi
authors.initials: K
authors.lastname: Paiva
authors.affiliation: Division of Community, Family Health, and Equity, Rhode Island Department of Health, 3 Capitol Hill, Providence, RI 02908, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Raymond
mesh_terms: D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006268:Health Facilities / Q000706:statistics & numerical data*; D006282:Health Personnel; D006291:Health Policy; D006801:Humans; D007251:Influenza, Human / Q000517:prevention & control*; D012237:Rhode Island; D014611:Vaccination / Q000706:statistics & numerical data*
keywords: Healthcare personnel; Influenza; Occupational health; Qualitative research; Vaccination