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State of California—Health and Human Services Agency
California Department of Public Health

AFL 10-29
September 16, 2010

General Acute Care Hospitals

Regulatory Requirements for Compliance with Senate Bill 739: Mandatory Reporting of Influenza Vaccination/Declination of Hospital Personnel, 2010-2011 Influenza Season
(Supersedes AFL 08-17)

Authority:      Senate Bill (SB) 739 (Speier, Chapter 526,Statutes of 2006); California Code of Regulations, Title 22, Section 70739


Accrediting and Licensing

This is the only copy being sent to your facility. Please distribute copies to all of the following persons:

Chief Executive Officer
Chief Nurse Executive
Chief Medical Officer
Director, Medical Staff Office
Director, Quality Management Department
Infection Control Committee Chair
Infection Prevention and Control Professionals
Employee Health Professionals
Director, Volunteer Department


A. 2010-2011 Influenza Vaccination/Declination Surveillance Form for California General Acute Care Hospitals (PENDING)
B. Sample 1: Influenza Vaccination Consent (PENDING)
C. Sample 2: Influenza Vaccination Received Elsewhere (PENDING
D. Sample 3: Influenza Vaccine Written Declination (PENDING)

Health and Safety Code Section 1288.5 et.seq. has required California general acute care hospitals to report influenza vaccination and declination rates to the California Department of Public health (CDPH) since the 2008-2009 influenza season. The statute requires that each hospital annually offer onsite influenza vaccinations, if available, to all hospital employees at no cost to the employee. Each general acute care hospital must require its employees to be vaccinated, or if the employee elects not to be vaccinated, to declare in writing that he or she has declined the vaccination.

In order to comply with this mandate, during the 2010-2011 influenza season, each general acute care hospital must ensure that ALL employees are offered education on influenza and the opportunity to receive the influenza vaccine at no cost to the employee. In order to meet these requirements, influenza vaccination programs must perform outreach to 100% of hospital personnel.

Additionally, Health and Safety Code Section 1288.8(b) also requires that hospitals report to the department the influenza vaccination status of all healthcare personnel (HCP) and requires the department to make this information public. The Centers for Disease Control and Prevention (CDC) clarifies the term HCP refers to all paid and unpaid persons working in health-care settings who have the potential for exposure to infectious materials, including body substances, contaminated medical supplies and equipment, contaminated environmental surfaces, or contaminated air. HCP might include (but are not limited to) physicians, nurses, nursing assistants, therapists, technicians, emergency medical service personnel, dental personnel, pharmacists, laboratory personnel, autopsy personnel, students and trainees, contractual staff not employed by the health-care facility, and persons (e.g., clerical, dietary, housekeeping, maintenance, and volunteers) not directly involved in patient care but potentially exposed to infectious agents that can be transmitted to and from HCP.

In order to improve the quality of the data reported to the department, reporting requirements have been clarified for the upcoming season. At the same time, the department recognizes that many hospitals have not yet put into place systems to collect influenza vaccination information from all categories of employee and non-employee HCP. To address this issue, the department has established preferred categories for reporting this season. These categories were selected based on input from a number of hospitals.

Facility Reporting Requirements for 2010-2011 Influenza Season:

The requirements below apply to the 2010-2011 influenza season (beginning September 1, 2010 and ending March 31, 2011).

1) Each general acute care hospital in California is required to report influenza vaccination and declination data to the department. While not mandatory, the department requests that hospitals the use the attached 2010-2011 Influenza Vaccination/Declination Surveillance Form (Attachment A) to ensure consistency statewide. The required reportable data must be submitted to CDPH no later than
April 30, 2011.

a) To ensure consistency, all vaccination and declination data should be reported using the following categories:

  1. Paid employees (employees not on extended leave or absence).
  2. Non-employee physicians (MD, DO), podiatrists, dentists.
  3. Non-employee advanced practice nurses.
  4. Non-employee physician assistants.
  5. Hospital volunteers.

b) For each of the categories (1 through 5) above, the following data must be compiled according to the influenza season, September 1, 2010 through March 31, 2011, and submitted to the department by April 30, 2011:

  • Total number vaccinated at your facility.
  • Total number that received a vaccination outside of your facility.
  • Total number that declined vaccination and were not vaccinated elsewhere.
  • Total number with unknown vaccination status.
  • The "Total" column should be the total number of staff in each of the categories above.

2) Attachments B – D are sample templates that may be used to create forms specific to your facility. The use of these templates is not mandatory. However, the department recommends that the vaccination forms and declination forms be distinct and separate from each other.

3) Education is required for employees regarding benefits of influenza vaccination and potential health consequences of influenza infection for the employees and their patients. The Centers for Disease Control and Prevention (CDC) provides messaging to address the 2010-2011 influenza recommendations in several languages. This may be downloaded at:

Facilities may incorporate the following components into the required influenza education offered prior to staff signing a vaccination consent or informed declination:

  • Influenza is a serious respiratory disease; on average, 36,000 Americans die every year from influenza-related causes.
  • Influenza virus may be shed for up to 24 hours before symptoms begin, increasing the risk of transmission to others.
  • Some people with influenza have no symptoms, increasing the risk of transmission to others.
  • Influenza virus changes often, making annual vaccination necessary. Immunity following vaccination is strongest for 2 to 6 months. In California, influenza usually begins circulating in early January and continues through February or March.
  • The influenza vaccine cannot transmit influenza. It does not, however, prevent all disease.

4) The department recommends that facilities incorporate the following phrase into all informed declination forms:

"I have declined to receive the influenza vaccine for the 2010-2011 season. I acknowledge that influenza vaccination is recommended by the Centers for Disease Control and Prevention for all healthcare workers in order to prevent infection from and transmission of influenza."

5) It is advisable that general acute care hospitals establish a process to ensure that they can provide evidence of influenza vaccination and/or verification of informed declination for all staff including registry and contracted personnel. Hospital leadership can take steps to ensure that appropriate language is inserted into contracts and credentialing renewals in order to achieve certainty that all registry and contract personnel have been vaccinated or signed an informed declination. An assessment may be sent out to ascertain if this process has been established in your hospital.

6) Hospital-specific staff vaccination/informed declination rates gathered for the 2010-2011 influenza season will be publicly posted per legislative requirements.

If you have questions about this All Facilities Letter, please contact the Healthcare-Associated Infections Program at or phone  510-412-6060.



Original Signed by Kathleen Billingsley, R.N.

Kathleen Billingsley, R.N.
Deputy Director 


cc: California Hospital Association
California Conference of Local Health Officers
HAI Advisory Committee

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