Posted on PediatricSuperSite.com September 2, 2010
Two medical societies back mandatory flu vaccination for health care
workers
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.
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