Learning Objectives for this Presentation:
By the end of the presentation participants will be able to understand hospital employee immunity policies (EIPs) by occupation, disease, and hospital size.

Background:
All hospital employees are at risk of exposure to/transmission of VPDs, and immunity policies may vary by occupation. A comprehensive hospital EIP assessment may show that tailored disease control/containment efforts are necessary in the event of a VPD exposure.

Objectives:
Examine EIPs in Los Angeles County (LAC) hospitals for measles, mumps, rubella, hepatitis B (hepB), varicella, and influenza, by hospital occupation and size.

Methods:
During April-June 2004, a telephone survey assessing differences in EIPs by disease and hospital occupation and size, enforcement of EIPs, and acceptable reasons for noncompliance was administered to LAC hospital infection control practitioners. Results were analyzed using logistic regression.

Results:
Of the 93 responding hospitals, 53.8% had 200+ beds and 77.4% had ERs. Physicians and nurses were categorized as ER, OB/GYN, or other physicians/nurses (OTP). EIP for influenza was least common among these physician/nurse categories (range:41.7%-46.6%) and most common for rubella (range:76.7%-96.7%) and hepB (range:90.0%-92.3%). Larger hospitals were 7-14 times more likely than smaller hospitals to have a physician/nurse EIP for measles, mumps, and varicella (OTP-mumps OR:7.0 95%CI:2.6-18.9; ER-measles OR:14.7 95%CI:3.7-58). For non-physician/nurse occupations, disease-specific EIPs were least common for medical students [range:9%(influenza)-16%(hepB)] and most common for non-medical employees [range:41%(influenza)-77%(rubella and hepB)].
Suspension/termination for EIP noncompliance differed by occupation [lowest:medical students(10.8%), highest:non-medical employees(47.3%)]. Larger hospitals were more likely than smaller hospitals to suspend/terminate OTPs (OR:4.69; 95%CI:1.69-12.98). The most accepted reason for noncompliance was medical contraindications [lowest:influenza(14.0%), highest:hepB(29.0%)]. Some hospitals reported no acceptable reasons for noncompliance with rubella(32.3%), measles(29.0%), mumps(29.0%), varicella(25.8%), and hepB(19.4%) policies.

Conclusions:
The lack of uniform policies across occupation, disease, and hospital, along with inconsistent enforcement, require a complicated, tailored approach on the part of LAC health department in order to adequately prevent/interrupt VPD transmission.