Archive for: Pandemic Influenza
A study appearing in Infection Control and Hospital Epidemiology looks at how and why healthcare workers in non-hospital settings differ in their acceptance of influenza vaccination, and in particular the vaccination for H1N1.
While training as doctors during the 2009 H1N1 pandemic, residents in four healthcare facilities showed a lack of knowledge about PPE use and when not to report to work because of illness, according to a study in the American Journal of Infection Control.
The issue of mandatory flu shots for healthcare workers continues to be a hot topic, with federal vaccination-expert panels making recommendations and professional healthcare associations opining in on both side of the argument. Below is a thoughtful article from HealthLeaders Media weighing voluntary versus mandatory vaccinations.
How to sidestep hospital flu shot mandates
Alexandra Wilson Pecci, for HealthLeaders Media, February 14, 201
Should vaccinations against influenza be mandatory for healthcare workers?
A debate is currently raging about whether the decision to get a flu shot should be made by a nurse, or by his or her employer. In Massachusetts, one in five employees at acute care hospitals declined to be vaccinated last fall.
Last week, the National Vaccine Advisory Committee (NVAC) recommended that hospitals, physician practices, and other healthcare organizations “strongly consider” imposing a flu shot mandate among employees if they fail to achieve 90% voluntary immunization.
Organizations such as the American Hospital Association and American Academy of Family Physicians support mandatory flu vaccines for healthcare workers, with exceptions in the case of health or religious opposition. But nurses have provided some of the most vocal opposition to such mandates; just read some of the individual comments and the summary of public comments about the issue.
Although the nurses’ union National Nurses United “maintains the position that every RN should be vaccinated against the flu,” it opposes vaccine mandates, saying that such programs “engender distrust and resistance among employees; offer a disincentive to providing vaccination education to employees, and raise ethical and legal questions about the personal employment rights of employees.”
The union also argues that “issues such as vaccination supply and efficacy make it such that the vaccine cannot be relied upon to exclusively provide adequate protection from the flu virus.”
In its written policy provided to HealthLeaders Media, the American Nurses Association “urges all registered nurses to get vaccinated every year to protect themselves, their families, and the patients they serve.” However, it “does not support mandatory influenza vaccination requirements for healthcare workers unless they adhere to certain guidelines to ensure they are fair, equitable and nondiscriminatory.”
The ANA believes a mandate should be implemented only if:
- The mandatory policy comes from the highest level of legal authority, ideally state government
- Suitable exemptions, such as for those allergic to components of the vaccine, are included
- Discriminating against or disciplining nurses who choose not to participate is prohibited
- The policy is part of a comprehensive infection control program that includes personal protective equipment, such as N95 respirators, to increase safety
- Vaccinations are free and provided at convenient times and locations to foster compliance
- The employer negotiates with worker union representatives to resolve any differences when the policy is implemented at a health care facility
But voluntary measures don’t seem to work as well. According to the CDC, “during the 2010-2011 influenza season, coverage for influenza vaccination among healthcare workers was estimated at 63.5%.” However, “coverage was 98.1% among healthcare workers who had an employer requirement for vaccination.”
I personally feel very conflicted about this issue. On one hand, I totally understand nurses’ resistance to vaccine mandates as a condition of employment. Something seems very wrong with being forced to inject something into your body.
But I’m also the mom of a little girl who had surgery twice before she was five months old. It was late autumn, and the hospital was heavily restricting visitors because of a local flu outbreak. Only immediate family—and absolutely no kids—could visit my daughter after her surgery.
Our pediatrician vehemently insisted that I, my husband, our parents, and any other adult who came into contact with her be vaccinated against the flu. I personally harangued my relatives—who had no health or religious reasons for not getting the vaccine—until they complied. Not only was I worried about her surgical complications, I was worried that my unvaccinated infant would be exposed to a flu outbreak.
I knew that the flu vaccine would not be 100% effective, but I still felt better about having that extra level of protection. A heavy padlock might not keep a determined intruder out of your home for long, but locking the door is safer than leaving it open.
At the end of the day, no one should be forced to get a flu vaccine as a condition of employment; there are too many legal and ethical problems with doing so. However, mandates with provisions and conditions such as those outlined by the ANA seem warranted.
In the meantime, healthcare groups that oppose a mandate, but support vaccinations should take much stronger action to achieve higher voluntary vaccination rates.
Source: HealthLeaders Media
Healthcare workers giving lots flu shots in clinics during a pandemic are at higher risk of experiencing needlestick injuries, according to a study published in the American Journal of Infection, February 2.
“Needlestick injury surveillance during mass vaccination clinics” looked at needlestick injuries to healthcare workers in the Denver Metropolitan region health department clinics during the H1N1 pandemic. The study found that the injury rate was 4.9 times the mean rate compared that of non-pandemic vaccination clinics from 2003 to 2009.
The study also found an increased trend in needlestick injuries with vaccination inexperience.
“These findings can be used to improve future mass vaccination clinic safety,” the study included.
A federal panel of vaccine advisors proposed recommendations that could lead to mandatory influenza vaccinations for healthcare workers.
The National Vaccine Advisory Committee (NVAC) received a report on February 7 from the Health Care Personnel Influenza Vaccination Subgroup following the publishing of draft recommendations and the public comment period beginning last November, according to CIDRAP News.
Recommendations approved by the majority of the working group say that healthcare facilities should continue to establish among workers flu prevention education, integrated vaccination programs, and standardized vaccination rate reporting, according to CIDRAP.
The report also says that facilities failing to achieve and maintain a 90% worker vaccination rate with voluntary measures “should strongly consider requiring mandatory flu vaccination,” reports CIDRAP.
The NVAC recommendations now go to the Department of Health and Human Services.
The Immunization Action Coalition (IAC) has added 28 healthcare institutions to its Honor Roll for Patient Safety.
The recognition, honors hospitals, medical practices, professional organizations, and government entities that require mandatory influenza vaccination policies for healthcare workers.
The Colorado State Board of Health will vote next month on whether to mandate flu shots for healthcare workers.
The board is considering a recommendation by state health officials requiring influenza immunizations “for nearly all hospital and nursing-home employees, with no religious or other personal exemptions, saying patient protections outweigh individual choice,” reports The Denver Post, January 26.
The proposed rule would work in concert with state and national goals to increase healthcare worker influenza immunizations to 90% by 2014.
High-risk facilities that did not reach required immunization rates would have to switch to a mandatory flu shot policy, according to the Post. Lower risk businesses, such as assisted living and home health, would have more leeway on establishing flu shot policies for workers.
The rule would not affect medical and dental practices since the state does not license those types of healthcare facilities, the Post reports.
What can’t Google do?
A study appearing in January 8 issue of Clinical Infectious Diseases has good things to say about Google Flu Trends (GFT).
Google’s internet surveillance system uses queries on search engines to estimate influenza activity in near real time.
GFT shows strong correlation, especially at the city level, with number of flu cases and emergency department visits for influenza-like-illnesses, according to the study. This makes it a valid surveillance tool, the study added.
The CDC posted infection prevention strategies for healthcare settings for a seasonal flu variant on December 23.
Influenza A(H3N2) variant [A(H3N2)v] is a virus containing genes from human, avian and swine origins, and has been detected in 12 persons since July 2011, according to Prevention Strategies for Seasonal and Influenza A(H3N2)v in Health Care Settings.
The US Department of Health and Human Services (HHS) is asking for comments on a draft guidance for achieving a 90% influenza immunization rate for healthcare workers by 2020.
The guidance document is from the National Vaccine Advisory Committee (NVAC), and the request for comments appeared in the Federal Register, December 19.
In brief, the five recommendations for healthcare employers (HCE) are:
A free, five-minute video makes a compelling case for nurses to receive the influenza vaccination.
The Immunization Action Coalition has selected “Nurse-to-Nurse Influenza Vaccine Safety Video” as its video of the week.
In case you hadn’t noticed, The Joint Commission (TJC) revised the infection control standard for influenza vaccinations for staff and independent practitioners in accredited hospitals, critical access hospitals and long-term care facilities. If you are not sure about the specifics of the revision, I suggest you spend 30 minutes viewing TJC’s online presentation.
Standard IC.02.04.01 Influenza Vaccination for Licensed Independent Practitioners and Staff for CAH, HAP, and LTC Accreditation Programs covers the rationale for the revision and the specific requirements of the standard, including the nine elements of performance.
TJC has had an influenza vaccination standard since 2006 and approved the revised Standard IC.02.04.01 September 21, 2011.
The rational being: