Nursing News

Mandatory Flu Vaccinations Boost Nurse Compliance with Guidelines

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By Debra Wood, RN, contributor 

September 2, 2011 - Focused on patient safety and heeding guidance from numerous professional organizations, hospitals are increasingly requiring nurses and other health care workers to receive the annual influenza vaccine; in those facilities requiring the vaccination, staff coverage was 98.1 percent, according to a recent Centers for Disease Control and Prevention (CDC) report.
“Flu is the number one cause of vaccine-preventable death,” said Jonathan B. Perlin, M.D, Ph.D., MSHA, FACP, FACMI, chief medical officer of HCA (Hospital Corporation of America). “We consider our policy for patient safety, which requires either a flu vaccine or wearing a mask near patients during flu season, to be an expression of our obligation to do no harm to those who entrust us with their lives. The policy is also an expression of the scientific evidence-based recommendations.”
The American Academy of Pediatrics, the American College of Physicians, the American Medical Directors Association, the American Public Health Association, the Association for Professionals in Infection Control and Epidemiology, the Infectious Diseases Society of America, the National Foundation for Infectious Diseases, the National Patient Safety Foundation, and the Society for Healthcare Epidemiology of America support requiring health care workers to receive the annual influenza vaccine, based on scientific evidence. 
Bioethicist Arthur Caplan, Ph.D., director of the Center for Bioethics at the University of Pennsylvania in Philadelphia, estimates that close to 100 percent vaccination rates among health care workers could cut patient death rates from flu by 40 percent, according to a statement released by the Immunization Action Coalition, an organization that works to increase vaccination rates.
“As health care providers, we are ethically obligated to take the necessary precautions to prevent the spread of viruses such as influenza and to keep our patients, fellow workers and ourselves safe from acquiring the virus in health care settings,” said Steve Gordon, M.D., president of SHEA, in a written statement. “The data from the CDC’s study demonstrates the effectiveness of policies that makes vaccination a requirement for employment.”
The CDC study found about 13 percent of the 1,931 health care workers it surveyed worked for an employer requiring the vaccine, up from 11 percent in 2009-2010.
HCA is the largest chain of hospitals to require influenza vaccination.
“Last year, we received very strong support from over 150,000 direct-care providers, with well over 90 percent choosing to get immunized and the remainder opting to wear masks when they are around patients, for 100 percent patient safety,” Perlin said.
Virginia Mason Medical Center in Seattle pioneered making annual immunization mandatory for employees, in 2004. It now achieves greater than 98 percent compliance, said John Gillespie, spokesman for Virginia Mason.
In 2009, Emory Healthcare in Atlanta began requiring employees, students and volunteers to receive the flu vaccine. Spokesman Lance Skelly said, “The feedback and compliance have been outstanding.” 
University of California, Davis Health System in Sacramento, Loyola University Health System in Chicago, and Moses Cone Health System in Greensboro, N.C., are among the 78 hospitals on the Immunization Action Coalition’s Honor Roll for Patient Safety because they have mandated flu vaccinations for employees.
The Maryland Health Care Commission reported in August 2011 that the seven hospitals with mandatory vaccination policies, which included consequences for noncompliance, increased their vaccination rates last year compared to 2009-2010. Several of the facilities, including Holy Cross Hospital and St. Mary’s Hospital, obtained 100-percent coverage. However, Fort Washington Medical Center and Civista Medical Center, without such requirements, also achieved 100 percent coverage. Overall, the state’s rate of health care worker vaccination coverage increased from 78.1 percent to more than 80 percent, with hospitals having mandatory policies coming in at more than 90 percent.
“We are seeing support increase for flu vaccination of health care workers,” said Theressa Lee, chief of hospital quality initiatives for the commission. “Vaccination rates at hospitals with mandatory policies increased significantly, and we encourage hospitals to consider it.”
Some hospitals would like to go mandatory, but cannot always pull it off. The University of Iowa Health Care in Iowa City attempted to require employees to accept annual flu vaccination, but the SEIU local filed a grievance and was successful in forcing the health system to revoke the policy, said spokesman Tom Moore. 
“We then instituted a mandatory response policy that required everyone to either accept the flu shot or acknowledge that they had been offered a flu shot but declined,” Moore said. “Ninety-nine percent of our staff complied with the policy, and 90 percent accepted the flu shot. Eleven out of 20 clinical departments achieved a 100 percent immunization rate.”
That rate is far above the national averages. Overall influenza vaccination coverage among health care personnel was 63.5 percent during the 2010-2011 influenza season, according to the CDC, far below the Healthy People 2020 target of 90 percent.
Starting in 2013, the Centers for Medicare & Medicaid Services might require hospitals to report health care personnel influenza vaccination coverage as part of its Hospital Inpatient Quality Reporting Program. Tracking vaccination coverage among health care personnel is needed as a measure of patient safety and to mark progress toward reaching the Healthy People 2020 target, the CDC report authors said.
The SEIU Nurse Alliance remains opposed to mandatory flu vaccination. Ingela Dahlgren, RN, executive director of the SEIU Nurse Alliance of California in Camarillo, explained, “We believe that with proper education and information that all health care workers that are able to be vaccinated will do so. We do not believe that employees should be forced to be vaccinated as a condition of employment.”
Dahlgren added that the union also objected to how the staff members who objected were treated.
“Nurses had to wear a yellow mask for 12 hours at all times, even in the nurses’ station where they interacted with the general population that flows through a hospital on any given day. It was a way of shaming and branding that person as being a noncaring dangerous person when in reality the staff might have been severely allergic. Several facilities also made it a condition of employment and threatened to fire staff for not obeying them.”
Dahlgren emphasized that the SEIU Nurse Alliance is not opposed to vaccinations, just making them a mandatory condition of employment. The American Nurses Association also opposed mandatory seasonal influenza vaccination policies.
However, with scientific evidence indicating vaccination of health care workers can protect patients from influenza, more hospitals will likely adopt such policies whenever possible.
“As similar patient safety programs are endorsed by the National Patient Safety Foundation and American Hospital Association, the question is beginning to change from, ‘Requiring health care workers to get flu shots?’ to ‘Why isn’t every hospital doing this?’” Perlin concluded.

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