C. Employees who are hired during the influenza season must comply within 2 weeks of the first day worked.

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1 APPROVAL as appropriate: Policy and Procedure Board Exec Dir Med Dir Other Dir/Mgr REVIEWED BY LEGAL COUNSEL Yes No Date: x Name: x POLICY STATUS: _X Approved Pending Title: Employee Influenza Vaccinations Responsible Party: G Long PAC/Immunization Div/Dept/Serv Area: Patient Care Services/Nursing Committee Volume: Number: HR.EH.014 Date of Issue: 5/14 Page 1 of 9 PURPOSE: To provide policy and procedures for annual seasonal influenza vaccination of employees* as a condition of employment, and to protect patients, employees, caregivers, family members, and the community from influenza. The Centers for Disease Control and Prevention (CDC) has recommended annual influenza immunization for all workers in health care settings since 1981, to prevent the spread of influenza. Mandatory Flu vaccination programs are now routine nationwide and are endorsed by many health care organizations, patient safety and infectious disease associations. GHC-SCW recognizes and supports the benefits of an annual influenza program. Influenza vaccination is a key component in the prevention of influenza to patients and co-workers along with appropriate hand hygiene and standard precautions, including cough etiquette. POLICY: All covered persons are required to either receive an influenza vaccination during the current influenza vaccination season or provide an approved GHC-SCW exemption form by the third Wednesday in November of each calendar year as a condition of employment. Employees may obtain an exemption request form through the GHC-SCW Intranet in the Forms Area or by contacting Employee Health (EH). PERSONS AFFECTED This policy applies to all staff*, both part-time and full-time, including temporary, per diem, contractors, interns, and students. Affiliation agreements and contracts should place the responsibility for this requirement on the school or agency. *For purposes of this policy, all persons affected shall be referred to as "employees" even though no employment relationship may exist. PROCEDURE: A. All employees* are required to receive an influenza vaccine annually or provide an approved exemption request by the third Wednesday in November of each calendar year. B. Employees may choose to receive the vaccine from another provider, but must provide documentation of the vaccine to Employee Health by the deadline of each year. C. Employees who are hired during the influenza season must comply within 2 weeks of the first day worked. D. Exemption forms are due October 15 of each calendar year and are available on the GHC-SCW Intranet Forms Area or through Employee Health. Employees may revoke their exemption request in the future with proper documentation. Falsification of exemption requests may be cause for discipline up to and including termination. Review Date Revision Date

2 Page 2 of 10 E. Employees who receive exemptions due to an approved exemption request will be required to wear a mask when experiencing any flu-like symptoms (following), and working in direct patient care. F. NOTE: Per the CDC, most healthy adults may be able to infect other people beginning 1 day before symptoms develop and up to 5 to 7 days after becoming sick. Symptoms start 1 to 4 days after the virus enters the body. That means that you may be able to pass on the flu to someone else before you know you are sick, as well as while you are sick. Some people can be infected with the flu virus but have no symptoms. During this time, those persons may still spread the virus to others. The flu usually comes on suddenly. People who have the flu often feel some or all of these Influenza like Illness (ILI) symptoms: Fever* or feeling feverish/chills Cough Sore throat Runny or stuffy nose Muscle or body aches Headaches Fatigue (tiredness) Some people may have vomiting and diarrhea, though this is more common in children than adults. DO NOT use fever as the determination to stay home since not everyone with flu will have a fever; you will spread the flu virus further. Any employee with Influenza Like Illness: fever, shivering, chills, malaise, dry cough, loss of appetite, body aches and nausea, typically in connection with a sudden onset of illness, will not be allowed to work. Employees must stay at home until at least 24 hours after they are free of fever or signs of a fever without the use of fever-reducing medications. See Policy HR.EH.007 G. Employee Health and HR will notify employees who are out of compliance, and their managers on or before the Third Wednesday in November each year. Managers will be notified of employees who received an approved vaccine exemption so that they can monitor employee masking. H. Any employee who is not compliant with this policy by the deadline will terminated. Employee Health will maintain records documenting vaccinations and exemption requests. I. If a national vaccine shortage occurs, GHC-SCW leadership may modify, suspend or revoke all or part of this policy. References: Center for Disease Control and Prevention: MMWR: Immunizations of Health Care Workers; November 25,

3 Page 3 of 10 GHC-SCW Influenza Vaccination Policy Questions and Answer Overview: Why is GHC-SCW making the influenza vaccine a condition of employment? To ensure we are doing all we can to help our patients live well and to protect their health and safety, GHC-SCW requires that all personnel receive the annual influenza vaccination as a condition of employment. Getting a vaccination is one of the most effective ways to help prevent unnecessary deaths and stem the spread of this preventable disease. We want everyone to be protected as GHC-SCW cares about you, your family, and the safety of our patients. Mandatory Flu vaccination programs are now routine nationwide and are endorsed by many health care organizations, patient safety and infectious disease associations. Whom does the policy apply to? The GHC-SCW policy applies to all employees*, staff- both part-time and full-time, including temporary, per diem, contractors, interns, and students. Affiliation agreements and contracts should place the responsibility for this requirement on the school or agency. *For purposes of this policy, all persons affected shall be referred to as "employees" even though no employment relationship may exist. By what date do I need to receive my influenza vaccine? All personnel must be vaccinated prior to the third Wednesday in November each year, commencing November19, Are there exemptions from the policy? In rare instances, a medical or non-medical exemption request may be granted. What will happen if I choose not to be vaccinated? If you choose not to be vaccinated, you will not be allowed to work as of the annual cutoff date, which is the third Wednesday of November each year. You will be subject to termination of employment. Reasons for the policy: Why do I need to be vaccinated every influenza season? Flu viruses are constantly changing and it is not unusual for new flu virus strains to emerge each year. The flu vaccine is formulated annually to keep up with the flu viruses as they change. In addition, multiple studies have shown that the body s immunity to influenza viruses (acquired either through natural infection or vaccination) declines over time. Being vaccinated each year provides the best protection against influenza throughout the flu season. I do not have direct patient contact. Why must I be vaccinated? It is too difficult to determine where to draw the line between those personnel that have contact with patients and those who do not. Almost everyone comes into contact with someone, who comes into contact with someone who has contact with patients.

4 Page 4 of 10 Vaccine Effectiveness: Who is recommended to be vaccinated against influenza? Beginning with the vaccination season, ACIP recommended annual vaccination for all people ages 6 months and older who do not have a contraindication to the vaccine. When should influenza vaccine be given? We will begin offering vaccine as soon as vaccine becomes available, usually late August. Protective immunity does not develop until 1 2 weeks after vaccination. If I already had the flu this year do I still need to be vaccinated? Yes. Influenza vaccine commonly contains multiple influenza vaccine virus strains. Infection from one virus type does not confer immunity to other types and it would not be unusual to have exposure to more than one type during a typical influenza season. By all means, get vaccinated! How long does immunity from influenza vaccine last? Protection from influenza vaccine is thought to persist for a year because of waning antibody and because of changes in the circulating influenza virus from year to year. Some insist they "got the flu" after receiving the injectable vaccine in the past. Is that possible? There are several reasons why this misconception persists: (1) To many people "the flu" is any illness with fever and cold symptoms. If they get any viral illness, they may blame it on the flu shot or think they got "the flu" despite being vaccinated. Influenza vaccine only protects against certain influenza viruses, not all viruses. (2) Protective immunity does not develop until 1 2 weeks after vaccination. Some people who are vaccinated later in the season (December or later) may get influenza shortly afterward. These late vaccines develop influenza because they were exposed to someone with the virus before they became immune. It is not the result of the vaccination. (3) Less than 1% of people who are vaccinated with the injectable vaccine develop flu-like symptoms, such as mild fever and muscle aches, after vaccination. These side effects are not the same as having influenza, but people confuse the symptoms. (4) The influenza vaccine is not 100% effective, especially in older persons. How are the viruses selected to make the influenza vaccine each year? The influenza viruses selected for inclusion in the seasonal flu vaccines are updated each year based on which influenza virus strains are circulating, how they are spreading, and how well current vaccine strains protect against newly identified strains. Each year, in the previous February/March timeframe, the composition of the vaccine is determined based on the previous influenza season and what is happening in the Southern hemisphere, since history shows that the virus begins there and then moves north. Is the vaccine really effective for this year s influenza strains? How well the flu vaccine works each year depends in part on how closely related (or matched ) the viruses in the vaccine are to the flu viruses circulating that year. It is not possible in advance of the influenza season to predict how well the vaccine and circulating strains will be matched, and how that may affect vaccine effectiveness. Vaccine effectiveness also varies depending on how well a vaccinated person responds to the vaccine in terms of making protective antibodies. Elderly persons and others who may have weakened immune systems may have a lower antibody response than young, healthy persons.

5 Page 5 of 10 Can the seasonal flu vaccine provide protection even if the vaccine is not a good match? Yes, antibodies created through vaccination with one strain of influenza viruses will often offer protection against related strains of influenza viruses. Therefore, even though circulating influenza viruses may drift or change from the time the vaccine composition is decided, the vaccine may cross-protect against circulating viruses. The mismatch may result in reduced effectiveness against the variant viruses, but it still can provide some protection. In addition, it is important to remember that the influenza vaccine contains three virus strains; so the vaccine would still protect against the other two viruses. Vaccine Safety: Is the vaccine safe for me to receive? The same process to produce and test the vaccine has been used for decades, and is repeated year after year. There is a small risk associated with any vaccination. It is important to consider the risk versus the benefit, and determine if the minimal risk outweighs the risk of doing nothing and potentially causing personal illness and possibly life-threatening illness to our patients. The degree of risk is similar to that of TB testing and rubella vaccinations already required for health care personnel. Other systems that have implemented similar policies have not seen an increase in negative vaccine-related incidents. Can the influenza vaccine actually give me the flu? No. The injectable (inactivated) vaccine offered through Employee Health cannot cause influenza because it contains only killed viruses. It is not possible for them to cause disease. You may experience some localized symptoms (redness, soreness, or swelling at the injection site), fever of less than 101 degrees, and aches after being vaccinated. These nuisance-type symptoms are caused by your immune system making protective antibodies. The antibodies are what allow the body to fight against flu. Symptoms typically resolve within 48 hours. Is it safe for me to be vaccinated if I am pregnant? Yes. The seasonal flu shot has been given safely to millions of pregnant women over many years. Flu shots have not been shown to cause harm to pregnant women or their babies. It is important to be vaccinated if you are pregnant as pregnant women have a higher risk for serious complications from influenza than non-pregnant women of reproductive age. Pregnant women with influenza also have a greater chance of serious problems affecting their unborn babies, including premature labor and delivery. Influenza vaccine will protect pregnant women, their unborn babies, and protect the baby after birth. What if I am breastfeeding? Seasonal flu vaccines should be given to breastfeeding mothers. Breastfeeding is fully compatible with flu vaccination, and preventing the flu in mothers can reduce the chance that the infant will get the flu. This is especially important for infants younger than 6 months old, since they are too young to be vaccinated. Exemption Request Process: What if I feel a medical or non-medical exemption is warranted and I cannot receive the influenza vaccine? In the rare instance that the flu vaccine is contraindicated, you may obtain the appropriate exemption request form on the GHC-SCW Intranet Forms Area Link (hyperlink) or from Employee Health. The completed form must be returned to Employee Health prior to October 15. A team will review all requests and you will be notified in writing as to whether or not your request has been approved. Employees who receive exemptions will be required to wear a mask when experiencing any flu-like symptoms, and working in direct patient care. If an exemption request is denied, you must be vaccinated or provide proof of vaccination obtained elsewhere prior to the third Wednesday in November, commencing

6 Page 6 of 10 November 19, Any costs associated with gathering exemption documentation will be your responsibility (e.g. copay for a doctor s visit or a charge for medical records). What if I have an exemption from another healthcare organization? Will that exemption transfer to GHC-SCW? No, the exemption will not automatically transfer. Exemption criteria can vary from one healthcare organization to another. You must formally request an exemption at GHC-SCW by completing and submitting the GHC-SCW exemption request forms. What if I miss the October 15 deadline to apply for an exemption? You must return your exemption request form before October 15 to allow time for the committee review process. The third Wednesday in November compliance deadline will still be applicable, and you will not be allowed to work or practice at GHC-SCW after that date, even if the exemption request is in process. How will I know if my exemption request is granted? The review team will meet regularly to review any exemption request forms submitted. As soon as a form is reviewed, Employee Health will notify you of the results in writing. Will my manager know about my request for an exemption? Managers will be notified if you are granted an exemption. They will not be told whether it is a medical exemption or a non-medical exemption. They will not be provided any details regarding your exemption. Your manager needs to be notified when an exemption is granted, as they must ensure you are in compliance with the policy. What if my exemption request is denied? You will have until the third Wednesday in November to receive the vaccination. Is there an appeal process? Unless there is new information that had not previously been reviewed, there is no appeal process. If additional information becomes available, it may be submitted to Employee Health for consideration. Medical Exemptions: What medical conditions will be accepted for a medical exemption? GHC-SCW will utilize recommendations from the Centers for Disease Control and Prevention when evaluating exemption requests for medical contraindications. Medical exemptions may include: Documented severe adverse reaction to previous influenza vaccinations Significant, severe allergy to eggs (anaphylactic or systemic reaction) History of Guillain-Barré Syndrome within (6) weeks of a previous influenza vaccination Who can sign my medical exemption form? The medical exemption form must be completed and signed by your primary care provider. This would be the provider who conducts your annual physical exams and sees you for health maintenance exams. May I complete my own Medical Exemption Request form if I am a healthcare provider? No, the medical professional that provides your routine medical care must sign this form. Do I need to reapply every flu season for a medical exemption? You only need to apply for a medical exemption one time, if the medical condition is permanent. If the condition is temporary, you must reapply for a medical exemption each flu season.

7 Page 7 of 10 Non-Medical Exemptions: Do I need to reapply every flu season for a non-medical exemption? Yes. You must reapply every flu season if you feel a non-medical exemption is warranted. Who should complete and sign the request form for a non-medical exemption? You should complete and sign that form. Be sure to explain in detail your reason for the request. Include any supporting statements or attachments which you feel might assist us in evaluating your request. We will review requests on a caseby-case basis. Masking: What kind of mask should I wear? A surgical mask is recommended for droplet precautions. N-95 or PAPR respirators may also be worn. If I am granted an exemption, do I need to wear a mask all the time when I am at work during the influenza season? Employees who receive exemptions will be required to wear a mask when experiencing any flu-like symptoms as outlined in the Influenza Policy, and working in direct patient care. Masks may be worn between patients. May I wear the same mask all day? No. The mask must be changed: after four hours of continuous use after contact with an isolation patient or inside isolation room when soiled when going to breaks and lunch periods How will I know when influenza season starts and ends? Employee Health will send an to all employees announcing the beginning and end of the influenza season. It will also be posted on GHC-SCW Intranet. How do I explain the mask to a patient? Masked workers should offer an explanation to patients, utilizing the following script: I m wearing this mask to protect you because I m not able to be vaccinated against the flu. Vaccination Deadline: By what date must I be vaccinated? You must be vaccinated prior to the third Wednesday in November in each calendar year, commencing November 19, Where do I get vaccinated? You may receive a free flu vaccination at a GHC flu clinic, from a nursing co-worker by a nursing appointment, at a provider visit, or from Employee Health at several Administration Building flu clinics. Watch for communications on the GHC-SCW Intranet listing the specific locations and hours. What if I receive a flu vaccine somewhere else? If you prefer to be vaccinated elsewhere at your expense, proof of vaccination must be provided to GHC-SCW. Students, interns, temporary employees, and contractors will be required to submit proof of vaccination to Employee Health.

8 Page 8 of 10 What is considered proof of vaccination? Acceptable proof of vaccination includes a practitioner s note, a receipt, or a copy of the administration record. The documentation must identify the specific vaccination given, the date of vaccination, and the provider s name. What if I am on a leave of absence and will not return until after the November deadline? All employees on a leave of absence must be vaccinated prior to returning to work. Please schedule an appointment with Employee Health to receive the vaccine. If you choose to receive the vaccination elsewhere, you will need to provide Employee Health with proof of vaccination before returning from your leave of absence. What if there is a shortage of vaccine? In the event of a shortage of vaccines, personnel will receive additional instruction as to the distribution of the vaccine to ensure our most vulnerable patients are protected. What about new hires? Influenza vaccination will be integrated into the new hire process just like any other pre-employment requirement. For More Information: Where can I go for more information about the influenza policy? More information will be available on the GHC-SCW Connection Intranet Where can I go for more information about the influenza vaccine? The CDC (Centers for Disease Control) website, which may be accessed at Where does GHC-SCW gather its information about the influenza vaccine? The CDC website referenced above, MMWR (a weekly CDC news bulletin), and the Vaccine Information Statement prepared by the CDC. Whom do I contact if I have questions about the policy? You may contact Employee Health at ext or glong@ghcscw.com.

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