New York State’s New HCW Flu Vaccination Policy

Photo Credit – CDC PHIL

 

 

# 7620

 

Four years ago (2009), with the specter of the H1N1 pandemic looming, the state of New York attempted to mandate that all health care workers (HCWs) receive a yearly flu shot.

 

But due to a shortage of pandemic H1N1 vaccine that fall, and vigorous protests (and threats of legal action) by employees, in October of 2009 we saw New York Rescind Mandatory Flu Shots For HCWs.

 

Since that time, the debate over mandatory flu vaccinations for HCWs has raged. While the CDC only recommends the flu shot, many professional medical organizations have adopted policies calling for mandatory vaccination of health care workers.

 

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 many infection control experts see this as a long overdue step in patient and co-worker protection, some HCWs see this as an infringement of their rights to decide what will be injected into their bodies (see HCWs: Refusing To Bare Arms & HCWs: Developing a Different Kind Of Resistance).

 

In July of this year, the CDC reported – after seeing increases in the update of flu vaccines by HCWs over the past few years – that last year (2012-13) saw little improvement over the previous year (see CDC: Uptake Of Flu Vaccine By HCWs).

 

• Available as PDF  [627 KB, 15 pages]

 

In recent years a growing number of medical facilities have implemented mandatory flu vaccination as a condition of employment, including Seattle’s Virginia Mason Medical Center and BJC Healthcare of St. Louis, Missouri  (see here and here).

 

Some states have begun to consider laws requiring HCW immunization, including last October when Rhode Island Adopts New Flu Vaccination Requirements For HCPs.

 

Earlier this month, New York state quietly passed a regulation that would require – once flu season begins – for all health care workers either to be vaccinated against influenza, or `wear a surgical or procedure mask while in areas where patients or residents may be present’.

 

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.

The entire regulation may be read at this link.

 

Critics point out that we really don’t know just how effective masks are in preventing the transmission of influenza to patients. The assumption is, by helping to contain respiratory secretions, they would help reduce transmission. 

 

But by how much?  No one knows.

 

Of course, flu vaccines aren’t close to being 100% effective either.

 

Most years (see CIDRAP: The Need For `Game Changing’ Flu Vaccines), protection from the flu shot runs under 60% for healthy adults, and probably even less for those over 65 or with weakened immune systems.

 

While admittedly imperfect solutions - given the increased risk to patients of serious illness or death from influenza - reasonable measures that can reduce the spread of the flu in the healthcare environment are increasingly being considered. 

 

Love the idea or hate it – short of an overturn in the courts – the requirement for annual flu vaccinations in HCWs appears to be gaining traction across the country.

CMAJ On Mandatory Flu Shot For HCWs

Photo Credit – CDC PHIL

# 6676

 

In an editorial today, the CMAJ (Canadian Medical Association Journal) endorsed requiring HCWs (Health Care Workers) to get a seasonal flu shot, thus joining a growing list of medical associations around the world calling for similar policies.

 

First, the press release followed by a link to the editorial, then I’ll return with more.

 

Canadian Medical Association Journal

Mandatory flu vaccine for health care workers to protect patients

All health care workers in health care institutions should be vaccinated with the annual influenza vaccine to protect patients, argues an editorial in CMAJ (Canadian Medical Association Journal).

 

Each season, 20% of health care workers get influenza, and 28% of young healthy adults who get it have asymptomatic or subclinical infections," writes Dr. Ken Flegel, Senior Associate Editor, CMAJ. "Some of them may shed virus up to a day before symptoms appear. It is time that all people who work in a health care institution be vaccinated."

 

In Canada, there are approximately 20 000 hospital admissions related to influenza and an estimated 4000 to 8000 deaths attributed to the illness. However, 55%% of physicians do not get vaccinated against the flu and are putting patients at risk of illness and death.

 

Dr. Flegel argues that flu vaccination for health workers must be compulsory, although there could be exemptions for medical or religious reasons. A vaccination rate above 90% is required to prevent outbreaks in hospitals. Mandatory programs for health care workers in many US institutions have resulted in participation rates of about 95%.

 

"Our schools have shown us the way. During measles outbreaks, access to schools has been successfully denied to nonvaccinated children and staff. The time has come for health care institutions to demand that all health care workers be vaccinated. Our patients' lives depend on this change," Dr. Flegel concludes.

 

You can read the entire editorial at this link:

 

EDITORIAL

Health care workers must protect patients from influenza by taking the annual vaccine

October 29, 2012

We know that health care workers import and transmit seasonal influenza to patients. We know that many patients get seriously ill from it and that some die. We know that the annual influenza vaccine can interrupt most of this imposed disease burden. It is time that we act on our knowledge and require all health care workers to be vaccinated. 

Full article

 

 

Despite vocal resistance from some HCWs and their unions, calls for mandatory flu vaccination for health care workers have been coming from many professional organizations for several years.

 

A few earlier blogs on these 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

 

In 2011, the following editorial opinion appeared in The Lancet.

 

The Lancet, Volume 378, Issue 9788, Pages 310 - 311, 23 July 2011

doi:10.1016/S0140-6736(11)61156-2

Time to mandate influenza vaccination in health-care workers

 

This perspective was penned by Arthur Caplan, Ph.D., who is director of the Center for Bioethics at the University of Pennsylvania, and addresses the ethics of mandating yearly influenza vaccination for Health Care Workers (HCWs).

 

Caplan argues that the evidence overwhelmingly shows that vaccinating HCWs helps to protect patients from infection (and possible death), and that the influenza vaccine is both safe and effective.

 

Citing language common to all oaths sworn by health care professionals (Doctors, Nurses, Techs, etc.), he points out the universal concept that the interests of the patient must come first, and that all HCWs must honor the core medical principal of, “First, do no harm.”

 

Both tenets, he argued, are violated when HCWs fail to accept a yearly flu vaccination.

 

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.

 

And earlier this month we saw Rhode Island Adopts New Flu Vaccination Requirements For HCPs.

 

Although many infection control experts see this as a long overdue step in patient and employee protection, compulsory vaccination remains 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 some of the HCW’s objections to forced flu shots in the past, including:

 

HCWs: Refusing To Bare Arms

HCWs: Developing a Different Kind Of Resistance

 

While their concerns over the vaccine’s safety may be overblown, one of their arguments that does carry some weight is the relative effectiveness of the flu vaccine.

 

It simply isn’t as good as with other vaccines.

 

Most years (see CIDRAP: The Need For `Game Changing’ Flu Vaccines), protection from the flu shot runs under 60% for healthy adults, and probably even less for those over 65 or with weakened immune systems.

 

Having a better flu vaccine would remove at least one of the objections that many HCWs have voiced.

 

Popular with HCWs or not, hospitals are increasingly looking at this as both a liability and an economic issue. Unless the courts intervene, the momentum increasingly appears to be moving towards mandating yearly flu shots for many Health Care Workers down the road.

Rhode Island Adopts New Flu Vaccination Requirements For HCPs

 

HCW Flu Vaccine Survey – Credit MMWR

 

# 6611

 

Last week (Sept 28th) the CDC’s MMWR carried a report on the level of seasonal flu vaccination among Health Care Personnel (HCPs) based on a pair of relatively small Internet Surveys.

 

Influenza Vaccination Coverage Among Health-Care Personnel — 2011–12 Influenza Season, United States

(Excerpt)

. . .  overall, 66.9% of HCP reported having had an influenza vaccination for the 2011–12 season. By occupation, vaccination coverage was 85.6% among physicians, 77.9% among nurses, and 62.8% among all other HCP participating in the survey. Vaccination coverage was 76.9% among HCP working in hospitals, 67.7% among those in physician offices, and 52.4% among those in long-term care facilities (LTCFs). Among HCP working in hospitals that required influenza vaccination, coverage was 95.2%; among HCP in hospitals not requiring vaccination, coverage was 68.2%.

 

 

While the numbers are considerably higher than we’ve seen in previous years, this survey was subject to a number of limitations and may overstate the percentage of HCPs who actually accepted the flu shot last year.

 

It recruited its small sampling (n=2348) via emails and pop up ads from two websites (Medscape & SurveySpot) – so this was not a random sampling.

 

Additionally, the responses were based on self-reporting, and were not verified by employee records.

 

Still, this survey indicated fully 1/3rd of health care workers refused the flu shot last year.  According to this survey, the top three reasons for doing so were:

 

1) a belief that they did not need it (28.1%)

2) concern about vaccination effectiveness (26.4%)

3) concern about side effects (25.1%).

 

Regardless of the exact percentage, millions of health care workers in the U.S. choose not to be vaccinated against influenza each year, a number that worries many infectious disease specialists.

 

While strongly advocating influenza vaccination for HCPs, the CDC has stopped short of mandating them. I blogged on this back in June of 2010 (see CDC: Proposed Influenza Infection Control Guidance).

 

Many professional medical organizations have taken a stronger stance, adopting policies calling for mandatory vaccination of health care workers (HCWs).  A few earlier blogs on this 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

 

 

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 flu virus – such as improved vaccination rates and better infection control measures - are vital areas that many healthcare facilities need to review and improve.

 

Some facilities are offering employees an alternative to taking the vaccine. This from a July 2011 edition of Infection Control and Hospital Epidemiology.

 

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.

 

 

 

Which brings us to a press release from Rhode Island’s Department of Health, announcing the mandating (with some exemptions) seasonal flu vaccinations for all health care workers, students, trainees and volunteers who are likely to have direct contact with patients in a healthcare facility.

 

 

HEALTH Adopts Regulations to Require Flu Shots for Healthcare Workers in Rhode Island

Release date: 10-05-2012

PROVIDENCE – The Rhode Island Department of Health (HEALTH) has announced that it has adopted new amendments to its Rules and Regulations for Immunization and Testing For Healthcare Workers that will make flu immunizations mandatory for all workers, students, trainees and volunteers who may have routinely anticipated face-to-face interaction, also known as "direct contact," with patients at a healthcare facility.

 

"HEALTH listened closely to all stakeholders and used that feedback to craft amendments that addressed the concerns of healthcare workers and volunteers, while protecting patients from the threat of influenza," said Michael Fine, MD, director of HEALTH.

 

Healthcare workers and volunteers who have a medical reason for not getting a flu shot may obtain a medical exemption from their doctor, licensed physician's assistant or licensed nurse practitioner. This exemption must be renewed annually and submitted to the employing facility by December 15 each year.

 

Healthcare workers and volunteers who are opposed to having a flu shot but are not medically exempt must submit a form annually by December 15 that states their refusal to be immunized against influenza and indicates their understanding that they are obligated to wear a surgical face mask during each routinely anticipated direct patient contact during any declared period in which the flu is widespread. That determination will be made by the Director of Health, and healthcare facilities will notify all workers that "a period in which flu is widespread" has been declared for the facility.

 

"Those who care for and interact with patients in a healthcare setting have a duty to protect the health and safety of those for whom they care," said Michael Fine, MD, director of HEALTH. "A flu shot for all those who interact with patients as part of their employment or volunteer efforts at a healthcare facility is the best way to prevent the spread of influenza to some of our state's most vulnerable populations."

 

These regulations do not apply to patient family members or to friends who visit or otherwise assist in the care of that patient in a healthcare facility.

 

To read the newly-amended rules and regulations, visit

http://sos.ri.gov/documents/archives/regdocs/released/pdf/DOH/7083.pdf

 

 

While this move will likely be applauded by many infectious disease specialists, many HCP will be less than pleased.  Mandatory flu shots have evoked a contentious debate among health care workers for years.

 

According to an AP article RI health workers now required to get flu shots by Erika Niedowski last night, union officials opposed to mandatory vaccination are already considering how they will respond to this requirement.

 

New York State, you may recall, attempted to require vaccination as a requirement to work as a HCW in 2009, but legal challenges and vaccine shortages forced them to abandon – at least temporarily – that mandate  (see New York Rescinds Mandatory Flu Shots For HCWs).

 

In recent years an increasing number of hospitals have moved aggressively towards implementing mandatory flu vaccinations, including Seattle’s Virginia Mason Medical Center and BJC Heathcare of St. Louis, Missouri  (see here and here).

 

The Immunization Action Coalition (IAC) maintains a terrific website with extensive information on vaccines, and includes a growing `Honor Roll’ of organizations and practices that have adopted a mandatory flu shot policy (some exemptions may apply).

 

Of course, legal challenges still lie ahead.

Hospitals increasingly are looking at this as both a liability and an economic issue, on top of their concerns over patient welfare.

 

Love the idea or hate it – short of an overturn in the courts – the requirement for annual flu vaccinations in HCPs appears to be gaining traction across the country.

Lancet Perspective: Mandatory Flu Vaccination For HCWs

 

 

Photo Credit – CDC PHIL

# 5709

 

 

A perspective appears today in The Lancet by Arthur Caplan, Ph.D., who is director of the Center for Bioethics at the University of Pennsylvania, on the ethics of mandating yearly influenza vaccination for Health Care Workers (HCWs).

 

Arthur Caplan is the author and/or editor of nearly 25 books, and more than 500 journal articles. He writes a regular column on bioethics for MSNBC.com, and is a frequent guest commentator on NPR, CNN, MSNBC, and for major newspaper outlets, including the New York Times and Washington Post.

 

In 2008, Discover Magazine named him one of the 10 most influential people in science.

 

Not known for mincing words (see Arthur Caplan On `Flunking The Swine Flu Test’ for an earlier example), Caplan states that: “Vaccination is a duty that one assumes in becoming a health-care provider.”

 

He argues that the evidence overwhelmingly shows that vaccinating HCWs helps to protect patients from infection (and possible death), and that the influenza vaccine is both safe and effective.

 

Citing language common to all oaths sworn by health care professionals (Doctors, Nurses, Techs, etc.), he points out the universal concept that the interests of the patient must come first, and that all HCWs must honor the core medical principal of, “First, do no harm.”

 

Both tenets, he argues, are violated when HCWs fail to accept a yearly flu vaccination.

 

Yet every year, despite awareness campaigns and the endorsement by many medical organizations, less than half of all healthcare providers in the United States and the UK voluntarily agree to take the vaccine.

 

You can read the entire piece at the link below, after which I’ll return with more.

 

The Lancet, Volume 378, Issue 9788, Pages 310 - 311, 23 July 2011

doi:10.1016/S0140-6736(11)61156-2

Time to mandate influenza vaccination in health-care 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.

 

Numerous professional medical organizations have adopted policies calling for mandatory vaccination of HCWs, however.  A few earlier blogs on that 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 many infection control experts see this as a long overdue step in patient and co-worker protection, 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: Refusing To Bare Arms

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 an increasing number of 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).

 

 

The Immunization Action Coalition (IAC) maintains a terrific website with extensive information on vaccines, and includes a growing `Honor Roll’ of organizations and practices that have adopted a mandatory flu shot policy (some exemptions may apply).

 

As we saw last month in SHEA: Improving HCW Flu Vaccine Uptake, some facilities are offering employees an alternative to taking the vaccine. This from a recent edition of Infection Control and Hospital Epidemiology.

 

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.

 

 

Increasingly, hospitals are looking at this as both a liability and an economic issue, on top of their concerns over patient welfare. 

 

Of course, legal challenges still lie ahead.

 

But love the idea, or hate it, the momentum appears to be moving in the direction of mandatory influenza vaccinations for Health Care Workers.

SHEA: Improving HCW Flu Vaccine Uptake

 

 

# 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: Refusing To Bare Arms

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. 

APIC Calls For Mandatory Flu Vaccination For HCWs

 

 

# 5282

 

 

APIC (the Association for Professionals in Infection Control and Epidemiology, Inc.) has joined the chorus of other professional infection control and medical organizations (including SHEA, IDSA, & AAP) who are calling for mandatory yearly flu vaccinations for healthcare workers (HCWs).

 

If this story sounds a bit like Deja Flu, you probably recall that in October of 2008 APIC released a similar statement (see APIC Seeking Mandatory Flu Shot For HCWs), but in that case provided for an informed `opt out clause’ if HCWs signed a declination form saying they understood the risks to patients.

 

The new statement eliminates that escape clause, recommending that that hospitals, nursing homes, and other facilities employing HCWs:

 

“require influenza immunization as a condition of employment unless there are compelling medical contraindications."

 

You can read the entire 4-page position paper, outlining their recommendations and rationale behind them, on the APIC home page.

 

APIC Position Paper:  Influenza Vaccination Should Be a Condition of Employment for Healthcare Personnel, Unless Medically Contraindicated

 

The paper also calls for those who are exempted for medical reasons to:

 

“. . .  be educated on the importance of careful adherence to all of the non-vaccine related HICPAC prevention strategies, including hand hygiene and cough etiquette.

Further, they may be  required to wear a surgical mask when contact with patients or susceptible employees is likely. “ 

 

Over the past year several other professional medical organizations have made similar calls for mandatory vaccinations.

 

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.

 

Similarly, a UK Department of Health report issued in June 2010 called Learning The Lessons From the H1N1 Vaccination Campaign For Healthcare Workers  – while not mandating vaccination – stresses the `professional duty’ of all HCWs to get the vaccine.

 

New York State attempted to require vaccination as a requirement to work as a HCW in 2009, but legal challenges and vaccine shortages forced them to abandon – at least temporarily – that mandate  (see New York Rescinds Mandatory Flu Shots For HCWs).

 

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.

 

There will almost certainly be legal challenges, and possibly labor disputes as well. I’ve covered HCW’s objections to forced flu shots in the past, including:

 

HCWs: Refusing To Bare Arms

HCWs: Developing a Different Kind Of Resistance

 

 

Only a few large hospitals have thus far managed to implement mandatory flu vaccinations, including Seattle’s Virginia Mason Medical Center and BJC Heathcare of St. Louis, Missouri  which I blogged about here

.

Details on how Virginia Mason Medical Center implemented mandatory HCW vaccinations can be read in the following  PDF.

 

 

Over the past 5 years Virginia Mason MC has maintained a 98% vaccination rate, and has vigorously promoted the uptake of flu shots not only in the workplace, but the greater community as well.

 

An abstract from a study that appeared in the August 2010 Infection Control and Hospital Epidemiology journal concludes that a policy of mandatory HCW vaccination is feasible, sustainable, and effective.

 

DOI: 10.1086/656210

Mandatory Influenza Vaccination of Healthcare Workers: A 5‐Year Study

Robert M. Rakita, MD; Beverly A. Hagar, BSN, COHNS; Patricia Crome, MN; Joyce K. Lammert, MD, PhD

(EXCERPT)

Results.

In the first year of the program, there were a total of 4,703 HCWs, of whom 4,588 (97.6%) were vaccinated, and influenza vaccination rates of more than 98% were sustained over the subsequent 4 years of our study. Less than 0.7% of HCWs were granted an accommodation for medical or religious reasons and were required to wear a mask at work during influenza season, and less than 0.2% of HCWs refused vaccination and left Virginia Mason Medical Center.

 

Impressive results. 

 

And, when combined with increased calls from infection control organizations to adopt similar practices, likely to inspire other facilities to follow suit.

Mandatory HCW Vaccinations: The Survey Says . . .

 

 

# 4961

 

 

One of the most contentious subjects among Health Care Workers (HCWs) today is the growing move towards making annual seasonal influenza vaccinations a requirement for employment.

 

 

Over the past two years several infection control and medical professional organizations have come forth in support of the idea, including APIC, SHEA, IDSA, and most recently the AAP (American Academy of Pediatrics).  

 

A few of my recent blogs on the subject include:

 

AAP: Recommends Mandatory Flu Vaccinations For HCWs

SHEA: Mandatory Vaccination Of Health Care Workers

IDSA Urges Mandatory Flu Vaccinations For Healthcare Workers

 

Despite this recent push towards mandatory vaccination for HCWs, only a handful of large hospitals have managed to implement mandatory flu vaccinations, including Seattle’s Virginia Mason Medical Center and BJC Healthcare of St. Louis, Missouri  which I blogged about here.

 

Details on how Virginia Mason Medical Center implemented mandatory HCW vaccinations can be read in the following  PDF.

 

Earlier this week CIDRAP reported on several Health Care Facilities in and around Chattanooga that are now requiring annual vaccinations.

 

More health facilities require flu immunization for staff

Two health systems and a hospital near Chattanooga, Tenn., are now requiring flu vaccination for healthcare workers, the Chattanooga Times Free Press reported today.

 

While strongly advocating HCW influenza vaccination, the CDC has stopped short of mandating them. I blogged on this back on June 23rd in  CDC: Proposed Influenza Infection Control Guidance.

 

Similarly, a UK Department of Health report issued in June called Learning The Lessons From the H1N1 Vaccination Campaign For Healthcare Workers  – while not mandating vaccination – stresses the `professional duty’ of all HCWs to get the vaccine.

 

New York State attempted to require vaccination as a requirement to work as a HCW in 2009, but legal challenges and vaccine shortages forced them to abandon – at least temporarily – that mandate  (see New York Rescinds Mandatory Flu Shots For HCWs).

 

Although viewed as an important patient safety, infection control, and liability issue by management, many HCWs see this as an infringement upon their rights to decide what they will have injected into their bodies.

 

I’ve covered HCW’s objections to forced flu shots in the past, including:

 

HCWs: Refusing To Bare Arms

HCWs: Developing a Different Kind Of Resistance

 

All of which brings us to today’s report on a survey of Infection Control professionals working in Health Care Facilities across the country on their views on requiring mandatory flu vaccinations for HCWs.

 

 

Infect Control Hosp Epidemiol 2010;31:1063–1065

© 2010 by The Society for Healthcare Epidemiology of America. All rights reserved.

0899-823X/2010/3110-0012$15.00

DOI: 10.1086/656382

 

Results of a National Survey of Infectious Diseases Specialists regarding Influenza Vaccination Programs for Healthcare Workers

Philip M. Polgreen, MD, MPH; Edward Septimus, MD; Thomas R. Talbot, MD, MPH; Susan E. Beekmann, RN, MPH; Charles Helms, MD, PhD

 

A minority of infectious diseases consultants currently work in healthcare institutions requiring influenza vaccination for healthcare workers, and in approximately half of these institutions, the healthcare workers who refuse vaccination do not face substantial consequences for their refusal.

 

Although true mandatory policies are not common, a majority of infectious diseases consultants support such policies.

 

The IDSA sent a 14 question survey to 1326 members of their Emerging Infections Network in December of 2009, followed by a couple of email reminders. 

 

Roughly half of the members responded.

 

Among the respondents, 80% agreed or strongly agreed that HCWs should be required to get a yearly flu vaccination and that HCWs refusing vaccination should be required to sign a declination statement.

 

The survey showed that 74% agreed or strongly agreed that influenza vaccination rates should be reported publicly as a measure of patient safety.

 

Only 37% reported that their healthcare institutions currently required influenza vaccination of HCWs. Of the remaining 63% that did not require vaccination, roughly half (51%) stated they were considering implementing a mandatory vaccination policy.

 

Among those hospitals requiring vaccination, most (91%) allowed exceptions including medical contraindication [84%], religious beliefs [47%], and personal beliefs  [37%].

 

 

While mandatory, serious consequences for refusing vaccination were rarely reported.  The survey indicated that 54% of respondents reported no consequences while 22% were unsure that consequences existed. 

 

Only 3% required that unvaccinated HCWs wear masks during patient care; and 2% reported that job evaluations were affected. Termination or suspension was reported by only 9% of respondents.

 

 

The authors point out that this survey, from a scientific viewpoint, has some limitations; it was not a population-based survey and the response rate may have been higher among those whose facilities have instituted mandatory vaccination programs.

 

Still this gives us a pretty good sense of the mood among infection control physicians across the country, and the growing move towards `mandatory’ vaccination for health care workers.

 

Despite the early success of a few mandatory vaccination policies across the country, the ultimate goal of achieving near-universal vaccination of HCWs in America and reducing the burden of influenza in health care facilities remains elusive.

 

The  authors sum up the situation with this closing paragraph:

 

. . .  given that the meaning of “mandatory” appears to have different interpretations in different institutions, the success of mandatory influenza vaccination programs may depend largely on the enforcement mechanisms implemented and the consequences for HCWs refusing influenza vaccination.

 

 

Whether accidental or intentional, I was surprised (and delighted) to find that a link to the entire PDF comes up at the top of a Google search on the study’s title. [PDF] Results of a National Survey of Infectious Diseases Specialists ...

AAP: Recommends Mandatory Flu Vaccinations For HCWs

 

 

# 4887

 

The American Academy of Pediatrics is the latest professional medical organization to embrace the idea of making yearly influenza vaccinations a requirement for HCWs (Health Care Workers).

 

The AAP – which boasts a membership of roughly 60,000 pediatricians – released the following statement yesterday (slightly reparagraphed for readability).

  

 

AAP Recommends Mandatory Flu Vaccine for All Health Care Workers

---

For Immediate Release:

Health-care associated influenza outbreaks are a common and serious public health problem that contribute significantly to patient morbidity and mortality and create a financial burden on health care systems.

 

In a new policy statement, the American Academy of Pediatrics (AAP) recommends that all health care personnel should be required to receive an annual influenza vaccine. The policy, "Recommendation for Mandatory Influenza Immunization of All Health Care Personnel," published in the October 2010 print issue of Pediatrics (published online Sept. 13), states that "despite the efforts of many organizations to improve influenza immunization rates with the use of voluntary campaigns, influenza coverage among health care personnel remains unacceptably low."

(Continue . . . )

 

While there remains a good deal of opposition among the rank and file of HCWs to mandatory flu vaccinations, over the past year or two the idea has gained increasing support among professional organizations such as SHEA, IDSA, and APIC.

 

Earlier this summer the CDC released their proposed infection control guidelines, where they strongly urged – but did not mandate – flu vaccinations for HCWs.

 

In response to what many felt was a tepid policy, Richard Whitley, MD president of the Infectious Diseases Society of America (IDSA), wrote an open letter to CDC  director Thomas Frieden urging that these guidelines include mandatory influenza vaccination.

 

Less than two-weeks ago SHEA (Society for Healthcare Epidemiology of America) released a similar position paper (see SHEA: Mandatory Vaccination Of Health Care Workers).

 

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.

 

There will almost certainly be legal challenges, and possibly labor disputes as well.

 

Last year New York State attempted to require vaccination as a requirement to work as a HCW, but lawsuits and vaccine shortages forced them to abandon – at least temporarily – that mandate  (see New York Rescinds Mandatory Flu Shots For HCWs). 

 

I’ve covered HCW’s objections to forced flu shots in the past, including:

 

HCWs: Refusing To Bare Arms

HCWs: Developing a Different Kind Of Resistance

 

Only a handful of large hospitals have managed to implement mandatory flu vaccinations, including Seattle’s Virginia Mason Medical Center and BJC Heathcare of St. Louis, Missouri  which I blogged about here.

 

Details on how Virginia Mason Medical Center implemented mandatory HCW vaccinations can be read in the following  PDF.

 

 

 

The backing of AAP, IDSA, SHEA and APIC most certainly adds gravitas to the movement - but without government regulatory backing – it remains to be seen just how many health care facilities are going to be willing to pioneer these sorts of policies on their own.

 

But love the idea or hate it, this is an issue that isn’t going to be going away anytime soon.

SHEA: Mandatory Vaccination Of Health Care Workers

 

 

 

# 4855

 

 

The vaccination rate among health care workers (HCWs) against seasonal influenza runs abysmally under 50%, and in recent years there have been multiple calls to make yearly vaccination a requirement of employment.

 

For infection control professionals, the advantages are obvious.  Influenza exacts a heavy burden on patients, their families, and co-workers.  Requiring vaccination would undoubtedly save lives, and reduce costs.

 

But for many HCWs, the issues are more about personal rights to decide what they will inject into their bodies. And that has left this hot-potato issue in the wings.

 

Earlier this summer the CDC released their proposed infection control guidelines, where they strongly urged – but did not mandate – flu vaccinations for HCWs.

 

Here is the passage from the proposed guidance:

 

Strategies to improve HCP vaccination rates include providing incentives, providing vaccine at no cost to HCP, improving access (e.g., offering vaccination at work and during work hours), and requiring personnel to sign declination forms to acknowledge that they have been educated about the benefits and risks of vaccination.

 

While some have mandated influenza vaccination for all HCP who do not have a Contraindication, it should be noted that mandatory vaccination of HCP remains a controversial issue.

 

In response to what many felt was a tepid policy, Richard Whitley, MD president of the Infectious Diseases Society of America (IDSA), wrote an open letter to CDC  director Thomas Frieden urging that these guidelines include mandatory influenza vaccination.

 

You can read the letter off the IDSA website from the link below.  

 

IDSA Letter to CDC Director Tom Frieden on Draft Guidance “Prevention Strategies for Seasonal Influenza in Healthcare Settings”  07/15/2010

 

 

As you can imagine, this is a hot button issue.
 

Last year New York State attempted to require vaccination as a requirement to work as a HCW, but legal challenges and vaccine shortages forced them to abandon – at least temporarily – that mandate  (see New York Rescinds Mandatory Flu Shots For HCWs).

 

• Some hospitals around the nation have adopted mandatory vaccination – or require the wearing of masks by unvaccinated workers during flu season.
• APIC (Association for Professionals in Infection Control and Epidemiology) has been promoting the idea of mandatory flu shots for HCWs for two years (see APIC Seeking Mandatory Flu Shot For HCWs)
• In the UK, the Department of Health  – while not mandating vaccination – stresses the `professional duty’ of all HCWs to get the vaccine.

 

 

Which brings us to a press release and a positions paper from SHEA (Society for Healthcare Epidemiology of America), – endorsed by the IDSA -  that calls for the mandatory vaccination of all HCWs against seasonal flu each year.

 

First an excerpt from the press release, followed by a link to the position paper.

 

NATION’S LEADING INFECTIOUS DISEASES EXPERTS CALL FOR MANDATORY FLU VACCINE FOR ALL HEALTHCARE PERSONNEL

Vaccination Should Be Requirement for Continued Employment for Healthcare Personnel, Epidemiologists and Infectious Disease Physicians Say

(Arlington, VA)— Influenza vaccination of healthcare personnel is a professional and ethical responsibility and non-compliance with healthcare facility policies regarding vaccination should not be tolerated, according to a position paper released today by the Society for Healthcare Epidemiology of America (SHEA). The paper, published in this month’s Infection Control and Healthcare Epidemiology journal and endorsed by the Infectious Diseases Society of America (IDSA), stresses influenza vaccination of healthcare personnel as a core patient safety practice that should be a condition of both initial and continued employment in healthcare facilities.

 

According to SHEA, their recommendations apply to all healthcare professionals in all healthcare settings, regardless of whether the professional has direct patient contact or whether he or she is directly employed by the facility. The policy also applies to students, volunteers, and contract workers. The only exemptions, say the epidemiologists and infectious disease physicians, should be in cases of medical contraindications.

(Continue . . . )

 

 

SHEA Position Paper: Influenza Vaccination of Healthcare Personnel

An update of an original SHEA statement issued in 2005, this paper states that influenza vaccination is the professional and ethical responsibility of healthcare professionals and that non-compliance with healthcare facility policies regarding vaccination should not be tolerated. It is endorsed by IDSA.

 

SHEA Position Paper

 

 

 

Hospitals are looking at this as both a liability and an economic issue, on top of their concerns for patient welfare.  So this movement has `legs’.

 

Of course, legal challenges still lie ahead, but the momentum is clearly moving in the direction of mandatory vaccinations for Health Care Workers.

Study: Mandatory Flu Vaccination Of HCWs

 

# 4781

 

 

Although some HCWs (Health Care Workers) object strenuously to such policies, the idea of mandating yearly flu vaccinations for professional care givers isn’t going away. 

 

Over the last decade, the percentage of HCWs who voluntarily get the seasonal flu vaccine in the United States and Canada has languished disappointingly between 30% and 40%.

 

Many infection control organizations (IDSA, APIC, SHEA) support the idea of requiring yearly vaccination of HCWs, and last month the IDSA published an open letter to Thomas Frieden, Director of the CDC, in support of such a mandate.

 

While strongly advocating HCW influenza vaccination, the CDC has stopped short of mandating them. I blogged on this back on June 23rd in CDC: Proposed Influenza Infection Control Guidance.

 

Similarly, a UK Department of Health report issued in June called Learning The Lessons From the H1N1 Vaccination Campaign For Healthcare Workers  – while not mandating vaccination – stresses the `professional duty’ of all HCWs to get the vaccine.

 

New York State attempted to require vaccination as a requirement to work as a HCW in 2009, but legal challenges and vaccine shortages forced them to abandon – at least temporarily – that mandate  (see New York Rescinds Mandatory Flu Shots For HCWs).

 

I’ve covered HCW’s objections to forced flu shots in the past, including:

 

HCWs: Refusing To Bare Arms

HCWs: Developing a Different Kind Of Resistance

 

A handful of large hospitals have managed to implement mandatory flu vaccinations, including Seattle’s Virginia Mason Medical Center and BJC Heathcare of St. Louis, Missouri  which I blogged about here.  

 

Details on how Virginia Mason Medical Center  implemented mandatory HCW vaccinations can be read in the following  PDF.

 

Over the past 5 years that facility has maintained a 98% vaccination rate, and has vigorously promoted the uptake of flu shots not only in the workplace, but the greater community as well.

 

We’ve an abstract of a study that appears in the current Infection Control and Hospital Epidemiology journal that concludes that a policy of mandatory HCW vaccination is feasible, sustainable, and effective.

 

 

DOI: 10.1086/656210

Mandatory Influenza Vaccination of Healthcare Workers: A 5‐Year Study

Robert M. Rakita, MD; Beverly A. Hagar, BSN, COHNS; Patricia Crome, MN; Joyce K. Lammert, MD, PhD

(EXCERPT)

Results.

In the first year of the program, there were a total of 4,703 HCWs, of whom 4,588 (97.6%) were vaccinated, and influenza vaccination rates of more than 98% were sustained over the subsequent 4 years of our study. Less than 0.7% of HCWs were granted an accommodation for medical or religious reasons and were required to wear a mask at work during influenza season, and less than 0.2% of HCWs refused vaccination and left Virginia Mason Medical Center.

 

Impressive results. 

 

And likely to inspire additional facilities to try to follow suit in the future.  

 

While some HCWs may decry such efforts as a violation of their rights, most infection control experts see this as an important step towards increasing patient and co-worker safety.

IDSA Urges Mandatory Flu Vaccinations For Healthcare Workers

 

# 4731

 

 

A little over 3 weeks ago the CDC published their draft revised influenza infection control guidelines and requested public comment on the changes.

 

I blogged on this back on June 23rd in CDC: Proposed Influenza Infection Control Guidance.

 

In addition to changes to their recommendations on the use of surgical masks and N95 respirators, the guidance also dealt with the issue of yearly vaccination of HCWs (Health Care Workers) against influenza.

 

While strongly advocating HCW influenza vaccination, the CDC has stopped short of mandating them.

 

Here is the passage from the proposed guidance:

 

Strategies to improve HCP vaccination rates include providing incentives, providing vaccine at no cost to HCP, improving access (e.g., offering vaccination at work and during work hours), and requiring personnel to sign declination forms to acknowledge that they have been educated about the benefits and risks of vaccination.

 

While some have mandated influenza vaccination for all HCP who do not have a Contraindication, it should be noted that mandatory vaccination of HCP remains a controversial issue.

 

As I pointed out at the time, not everyone was going to be happy with these guidelines.

 

Those advocating stricter infection control will see the vaccination recommendations as being tepid and short of the mark, while those concerned with individual rights will view this as a victory.

 

In response, Richard Whitley, MD president of the Infectious Diseases Society of America (IDSA), has written a letter to CDC  director Thomas Frieden urging that these guidelines include mandatory influenza vaccination.

 

You can read the letter off the IDSA website from the link below.   (Hat tip to Tetano on FluTrackers for posting this story)

 

IDSA Letter to CDC Director Tom Frieden on Draft Guidance “Prevention Strategies for Seasonal Influenza in Healthcare Settings”  07/15/2010

 

The `money quote’ from the letter appears on page two:

 

It is in one area, however, that IDSA feels the guidance does not go far enough. We feel the CDC should provide a definitive recommendation for mandatory influenza vaccination of healthcare providers. IDSA supports universal immunization of HCWs against seasonal influenza by health care institutions (inpatient and outpatient) through mandatory vaccination programs, as these programs are likely to be the most effective means to protect patients against the transmission of seasonal influenza by HCWs.

 

Employees who cannot be vaccinated due to medical contraindications, or because of vaccine supply shortages, or who sign a written declination choosing not to be vaccinated for religious reasons, should be required to wear masks or be re-assigned away from direct patient care. 

 

The letter goes on to outline the IDSA’s rationale for mandating vaccination.   By all means, read it in its entirety.

 

Last year New York State attempted to require vaccination as a requirement to work as a HCW, but in so doing aroused a hornet’s nest of protests.

 

Legal challenges and vaccine shortages forced them to abandon – at least temporarily – that mandate  (see New York Rescinds Mandatory Flu Shots For HCWs).

 

A few hospitals around the nation have adopted mandatory vaccination – or require the wearing of masks by unvaccinated workers during flu season.  But it remains voluntary in most facilities.  

 

And APIC (Association for Professionals in Infection Control and Epidemiology) has been promoting the idea of mandatory flu shots for HCWs for over a year (see APIC Seeking Mandatory Flu Shot For HCWs).

 

But among the rank and file of health care workers, this remains a contentious and divisive subject.

 

Whether this appeal from the IDSA produces any changes to this year’s guidance is hard to say, but one thing is certain: with two major infectious disease organizations behind it, this issue isn’t going to go away.

UK: HCWs `Professional Duty’ To Get Flu Jab

 

 

# 4702

 

There are few subjects that produce as much dissention and debate among healthcare workers as attempts to mandate vaccination of HCWs against influenza. 

 

To some, this seems purely a patient and co-worker safety and welfare issue, while to others this is all about the individual right to decide what they will or will not put into their bodies.

 

Given the controversial nature of this sort of edict, the  emphasis has been on `softer’ approaches.  

 

In the United States, Canada, and the UK  HCW (Healthcare Worker) flu vaccination rates most years run only about 40%.  

 

Some facilities, through hard fought promotional campaigns, have boosted that rate to 80% and 90%.

 

Last year New York State attempted to require vaccination as a requirement to work as a HCW, but legal challenges and vaccine shortages forced them to abandon – at least temporarily – that mandate  (see New York Rescinds Mandatory Flu Shots For HCWs).

 

• Some hospitals around the nation have adopted mandatory vaccination – or require the wearing of masks by unvaccinated workers during flu season.
• APIC (Association for Professionals in Infection Control and Epidemiology) has been promoting the idea of mandatory flu shots for HCWs for over a year (see APIC Seeking Mandatory Flu Shot For HCWs)
• And the New York State Health Department indicates that they will pursue mandatory vaccination again in 2010, assuming adequate vaccine supplies are available.

 

While strongly advocating HCW influenza vaccination, the CDC in its recently updated has stopped short of mandating them in its proposed guidance on influenza infection control

 

 

Similarly, a UK Department of Health report issued last week called Learning The Lessons From the H1N1 Vaccination Campaign For Healthcare Workers  – while not mandating vaccination – stresses the `professional duty’ of all HCWs to get the vaccine.

 

If fact, the word `Duty’ appears four times in the 31-page document.

 

Set out the expectation that is the professional duty of staff to protect their patients by taking the vaccine

 

“Strong clinical and director lead communications messages around staff receiving swine flu
vaccination as part of their professional duty and responsibility“ - Bradford Teaching Hospitals

 

Reminding clinical staff their duty to act professionally and give advice based on CMO and JCV1 information, not on personal opinion.

 

Continual emphasis on message that staff had a duty to receive the vaccine and would be demonstrating their professional responsibility by receiving it. 

 

The report outlines four major themes for a successful vaccination campaign.

 

• Flexible and accessible delivery approaches
• Visible leadership
• Effective communications strategy
• Attention to the basics of having a robust plan with clear governance arrangements and supported by sound project management

 

As the report reminds us, the new H1N1 virus is expected to be the major component of this fall’s flu season and continued vaccination efforts for frontline medical staff are urged to continue through the summer. 

 

We’ll have to wait to see if these motivational concepts prove effective in boosting the seasonal flu vaccination rates among UK HCWs this fall.