# 5635
Hospital acquired infections are the bane of modern health care, with MRSA, C. Diff, garden variety staph, various pneumonias, and other infections estimated to cost tens of thousands of lives and add billions of dollars to healthcare costs each year.
And while we tend to think of bacterial infections in this context most of the time, every year there are legitimate concerns over the spread of influenza in healthcare facilities as well.
These concerns have sparked repeated calls for mandatory yearly vaccination of HCWs (Health Care Workers) against the flu.
A few recent blogs on that contentious subject include:
APIC Calls For Mandatory Flu Vaccination For HCWs
AAP: Recommends Mandatory Flu Vaccinations For HCWs
SHEA: Mandatory Vaccination Of Health Care Workers
IDSA Urges Mandatory Flu Vaccinations For Healthcare Workers
While strongly advocating HCW influenza vaccination, the CDC has stopped short of mandating them. I blogged on this back on June 23rd, 2010 in CDC: Proposed Influenza Infection Control Guidance.
While many infection control experts see this as a long overdue step in patient and co-worker protection, the obstacles that lay before these sorts of policies are substantial.
This is a hugely divisive issue, with many HCWs believing that it is an infringement of their rights to decide what will be injected into their bodies.
I’ve covered HCW’s objections to forced flu shots in the past, including:
HCWs: Developing a Different Kind Of Resistance
Given that hospitalized patients are often at increased risk of serious illness or death from influenza, reasonable measures that can reduce the spread of the virus – such as improved vaccination rates and better infection control measures - are vital areas that many healthcare facilities need to review and improve.
In recent years a few large hospitals have managed to implement mandatory flu vaccinations, including Seattle’s Virginia Mason Medical Center and BJC Heathcare of St. Louis, Missouri (see here and here).
However, it is possible to achieve high vaccination rates without mandating vaccination, as the following article published in the current edition of Infection Control and Hospital Epidemiology points out.
An Alternate Approach To Improving Healthcare Worker Influenza Vaccination Rates
Lisa M. Esolen, Kimberly Kilheeney, Richard E. Merkle
Essentially, this approach allows HCWs with medical or ethical objections to flu vaccination to opt out and elect to wear a surgical facemask during flu season when in close contact with patients.
Although full access to the article is available only to SHEA members (the first page is available to all), the Society for Healthcare Epidemiology in America has published a press release with the details.
Society for Healthcare Epidemiology of America
Health system achieves high flu vaccination rates by mandating masking
CHICAGO (June 15, 2011) – Geisinger Health System vaccinated more than 92% of all employees against influenza this season, with a modification of a mandatory program. On average, fewer than half of all healthcare workers receive flu vaccinations.
In an article published in July's Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America, Dr. Lisa Esolen demonstrated the effectiveness of Geisinger's influenza vaccination that helped achieve high rates of vaccine compliance for two consecutive years. This past season, 2010-2011, Geisinger had vaccinated 95% of clinical employees and 92% of all employees by mid-December. Since hospitals continue to release vaccine until the end of March, final vaccination rates were not known at that the time of this publication.
"Influenza vaccination rates among hospital employees has received extensive attention in recent years," said Lisa Esolen, MD, Systems Director, Infection Control Geisinger Health System "Healthcare workers are critical to limiting the spread of influenza since they are exposed to numerous sick patients and can readily spread the infection from patient to patient."
To increase vaccination rates among staff, some hospitals have embraced a mandatory approach – get vaccinated or lose your job. However, Geisinger Health System chose a slightly different approach. The 14,000-employee system decided to allow staff members to opt out of receiving the flu vaccine for ethical or medical reasons, but required that those who did opt out would need to wear a facemask for the entire flu season, extending from November 1 to March 31. All vaccinated employees were known by a campaign sticker placed on their identification badge – no sticker meant the employee needed to wear a mask whenever they were within five or six feet of any other person throughout the entire day.
"We're proud of the success we had and the team building it inspired, encouraging each unit to act as a team to achieve full vaccination." said Dr. Esolen.
This idea is one I actually wrote about (and advocated) during the pandemic as being a reasonable compromise to mandatory vaccination (see Public Support For Mandatory HCW Vaccination).
Although some HCWs may consider wearing a mask as onerous, they should help reduce in-hospital influenza transmission, while being a considerably less draconian solution than mandating employees either accept the flu vaccine or risk losing their jobs.
It’s not a perfect solution (neither are vaccines, btw), but compromises rarely are.
