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Two medical societies back mandatory flu vaccination for health care workers
Talbot TR. Infect Control Hosp Epidemiol. 2010;31:882-890.
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The Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA) this week endorsed mandatory vaccination policies for all health care workers to reduce risk of infection among patients and employees.
“SHEA views influenza vaccination of [health care personnel] as a core patient and [health care personnel] safety practice with which noncompliance should not be tolerated,” wrote researchers representing SHEA. “It is the professional and ethical responsibility of [health care personnel] and the institutions within which they work to prevent the spread of infectious pathogens to their patients through evidence-based infection prevention practices, including influenza vaccination.”
The only exceptions, the two organizations noted, should include people with medical contraindications for receipt of the vaccine.
The researchers noted that vaccinating health care workers can:
- Prevent disease spread from health care workers to patients.
- Decrease health care workers’ risk of infection.
- Create herd immunity.
- Prevent health care worker absenteeism during outbreaks.
- Set an example by showing the importance of vaccination.
In several studies, results indicated that a 100% vaccination rate among health care personnel in acute care settings triggered a 43% decline in risk of influenza among patients. This decrease appeared even higher — 60% — among nursing home patients, the panel wrote. Furthermore, other study data highlighted the cost-effectiveness of health care worker vaccination as a prevention strategy.
Two new studies also add to the research on increased vaccination in long-term care facilities, said the researchers. A rise in health care provider vaccination rates — even in facilities where vaccine uptake was already high — correlated with reductions in patient mortality, influenza-like illness and hospitalizations for influenza-like illness.
“The scientific evidence shows significant reductions in the risk of influenza in both acute and long-term care settings as a result of strong immunization policies and programs,” Richard Whitley, MD, president of IDSA, said in a press release. “Vaccination of health care personnel saves patients’ lives and reduces illness. It also protects individual workers from falling ill during influenza outbreaks and from missing work, which further impacts patient care.”
However, these benefits have not inspired health care professionals to receive the influenza vaccine, according to the researchers. A report conducted by the RAND Corporation in 2009 indicated that only 53% had been vaccinated during the 2008-2009 season, and 39% expressed no intention of getting vaccinated.
Implementation of mandatory policies
In 2004, the Virginia Mason Medical Center (VMMC) in Seattle became the first facility to institute a mandatory influenza vaccination policy. Officials only allowed declinations in the case of medical contraindications. The program initially faced resistance but eventually led to vaccination rates that have remained above 98% since its implementation.
Other hospitals followed suit, including BJC Healthcare in St. Louis, where vaccination rates reached 98.4% after the policy’s implementation. Similarly, Hospital Corporation of America boasted a 96.4% vaccination rate after introducing the policy during the 2009-2010 season.
In 2009, during the influenza A (H1N1) pandemic, New York became the first state to implement a statewide requirement of influenza vaccination for health care workers. Vaccine shortages put the policy on hold, but the State of New York Department of Health plans to make influenza vaccination a permanent condition of employment for health care personnel.
In the position paper, the researchers also addressed strategies that could be used for the successful introduction of a mandatory influenza vaccination policy. Including vaccination rates as measures of a facility’s quality and safety and requiring unvaccinated personnel to wear masks while in close contact with patients were among the strategies discussed.
Requiring signed declinations might also reinforce the risk associated with refusing vaccination, said the researchers, although the effect of this policy may vary among facilities.
Controversy
While research suggests that many health care professionals accept mandatory influenza vaccination policies, agreement with the stipulation often depends on how long the policy has existed. Mandatory hepatitis B vaccination, for example, appears more widely accepted than influenza vaccination.
Other health care workers, however, have expressed their belief that mandatory influenza vaccination policies are “coercive and negatively impact the employee-employer relationship,” said the researchers. Some also find the regulation troublesome because the influenza vaccine requires annual administration.
The panel noted that ethics and legality are of concern to some health care workers who believe that the relationship between mandatory health care personnel vaccination and better patient outcomes has not been adequately investigated.
People who support mandatory programs, however, said that influenza vaccination is one of the ethical responsibilities of a health care provider.
“The transmission of influenza in health care settings is a substantial safety concern for both patients and health care personnel and deserves our attention and action,” Neil Fishman, MD, president of SHEA said in the press release. “Health care providers are ethically obligated to take measures proven to keep patients from acquiring influenza in health care settings.”
Although important, mandatory vaccination should only be one aspect of a comprehensive influenza prevention program, according to the researchers. Practicing good hand hygiene, cough etiquette, isolating infected patients and restricting ill visitors or health care workers in a facility are also necessary.
To have a successful program and overcome challenges to its implementation, strong leadership, up-to-date knowledge and adequate funding and resources are also required, the researchers said.