As a group, health care workers have a dismal record of getting an annual flu shot. Nationwide, only somewhere around 42% roll up their sleeves each year, despite their frequent exposure to sick individuals every flu season.
Worse, infected Health Care Workers (HCWs) are well positioned to pass on the flu virus to non-infected patients. How often this happens is anyone's guess, but it most certainly does happen.
While most hospital and medical facilities encourage that their employees get the flu shot each year, it is almost unheard of to mandate that they do so.
Earlier this year, APIC, the Association for Professionals in Infection Control and Epidemiology, released a statement recommending that "influenza vaccine be required annually for all healthcare personnel with direct patient care."
This issue was explored by CIDRAP Editor Robert Roos last October in his article on the subject.
Robert Roos News Editor
Oct 10, 2008 (CIDRAP News) – In the face of chronic low influenza vaccination rates among healthcare workers, the leading US society of infection control professionals says it's time to require medically eligible workers to either get the immunization or sign a form saying they understand the risks to patients if they skip it.
"As part of a comprehensive strategy, we recommend that influenza vaccine be required annually for all healthcare personnel with direct patient care," the Association for Professionals in Infection Control and Epidemiology (APIC) said in a policy statement released yesterday.
"Organizations should adopt a system in which an informed declination is obtained from employees that decline for other than medical reasons," the statement continues. "This information should be utilized by the facility to develop improvement strategies for the following vaccine season."
APIC urges vaccination for all medical and nonmedical personnel in contact with patients or patient samples, including physicians, nurses, physical therapists, dieticians, religious workers, and cleaning, kitchen, and laboratory personnel.
Although APIC uses the word `required' in their recommendation, it does provide of an `opt-out'. Employees could sign a form that states that they understand the risk to patients if they skip the shot.
According to an article in the Anchorage Daily News, Providence Alaska Medical Center appears to be going further in pursuit of universal compliance than even APIC recommended.
Their new policy?
Either get the flu shot, or look for other employment.
Needless to say, this decree isn't going down well with some of the staff.
Forcing anyone to inject a substance, no matter how `safe' (a relative term) it is presumed to be, is fraught with controversy. After all, reactions to the flu vaccine are rare, but they do happen.
But patient (and co-worker) safety is a legitimate issue. Flu shots reduce (but don't eliminate) the odds of getting and spreading the flu each year.
Hospitals argue that they have a responsibility to protect their patients.
We find ourselves at the precarious intersection of a person's right to choose whether or not to take a vaccine, and a hospital's need to protect patients, and other employees, from potentially contagious individuals.
There are economic, moral, and liability issues involved here, and no easy answers.
With APIC's recent declaration, it is likely that more medical facilities will test the `mandatory' vaccine waters in the near future.
Lisa Demer/Anchorage Daily News
Published Sunday, December 14, 2008
Anchorage Daily News
ANCHORAGE, Alaska — Many of us debate whether to get flu vaccines every year, but at Providence Alaska Medical Center, workers have no choice: The hospital is requiring all employees to get flu shots by year’s end or face dismissal.
Its new policy is cutting edge -- and controversial, especially among nurses.
Infectious disease experts say the measure makes good health sense. It is intended to protect patients, already ill, from being infected with potentially deadly influenza while hospitalized.
Doctors on the hospital’s infection control committee unanimously supported the requirement, said infectious disease physician Megan Clancy.
“They said ’our vaccination rates are terrible to the point of being embarrassing, and we really need to fix this problem,”’ said Clancy, Providence’s medical director of infection control.
Nationally, fewer than half of health care workers receive flu vaccines, even though the U.S. Centers for Disease Control and Prevention recommends they do so. Even if health care workers don’t get ill from flu themselves, they can pass germs on to people who are frail.
Before this year at Providence, about 40 percent of employees were vaccinated, Clancy said. That’s close to the 42 percent tallied nationally during the 2005-06 flu season.
But with the new mandate at Providence, close to 70 percent of employees have been vaccinated, with the deadline a few weeks away, said Becky Hultberg, Providence communications director.
Many nurses don’t want to be forced to get a shot that carries health risks of its own and doesn’t always work, according to the nurses’ union. Some employees are struggling with whether to tolerate the poke in the arm, or face consequences, said Debbie Thompson, executive director of the Alaska Nurses Association.
Thompson said she’s fielded 300 to 400 calls on the controversy.
“If someone said you had to have a flu shot or lose your job, what would your reaction be?” she said.
The nurses’ union has filed a grievance protesting the policy.
“Our goal is to work with employees to ensure both their participation and their continued employment. Ultimately, some employees may have to decide if they want to continue to work at Providence,” Hultberg wrote in an e-mail.
Neither Alaska Regional Hospital nor the Alaska Native Medical Center requires all employees to get flu vaccines, but they strongly encourage it.
According to the CDC Website:
Fifteen states have regulations regarding vaccination of HCP in long-term--care facilities, six states require that health-care facilities offer influenza vaccination to HCP, and four states require that HCP either receive influenza vaccination or indicate a religious, medical, or philosophical reason for not being vaccinated.