In this paper we outline the seven primary truths supporting the call for requiring inﬂuenza immunization of all health care workers. We view this as a serious patient safety issue, given the clear and compelling data regarding the frequency and severity of inﬂuenza infection. In addition, clear-cut safety, efﬁcacy, economic, legal, and ethical platforms support the use of inﬂuenza vaccine. Unfortunately health care workers have demonstrated, over almost 25 years that they are unwilling to comply with voluntary inﬂuenza immunization programs utilizing a variety of education and incentive programs, at rates sufﬁcient to protect the patients in their care. We suggest that an annual inﬂuenza immunization should be required for every health care worker with direct patient contact, unless a medical contraindication or religious objection exists, or an informed declination is signed by the health care worker. High rates of health care worker immunization will beneﬁt patients, health care workers, their families and employers, and the communities within which they work and live.
The ﬁrst truth: inﬂuenza infection is a seriousFact: Most cases are subclinical (no symptoms) and the vast majority of deaths that do occur, occur occur in people who are extremely frail and would not live much longer even if they did not develop the flu.
illness causing signiﬁcant morbidity and mortality
adversely affecting the public health on an annual
The second truth: inﬂuenza-infected health careFact: There is no reliable evidence that they do so, particularly if they do not come to work coughing or sneezing, which is how the disease is transmitted
workers can transmit this deadly virus to their
The third truth: inﬂuenza vaccination of healthFact: It may help employers
care workers saves money for employees and
employers and prevents workplace disruption
The fourth truth: inﬂuenza vaccination of healthFact: CDC's flu vaccine recommendations are not science-based, as shown earlier in this blog. "Standard of care" is a medico-legal term that suggests a particular practice is "standard." Since less than 50% of HCWs got yearly flu vaccines, it could not be considered a standard.
care workers is already recommended by the CDC
and is the standard of care
The ﬁfth truth: immunization requirements areFact: Requirements are effective at increasing vaccination rates, but there is no evidence they are effective at reducing mortality or morbidity in patients, which is the supposed reason they are being mandated.
effective and work in increasing vaccination rates
The sixth truth: health care workers and healthFact: HCWs have an obligation to protect patients, which is why frequent handwashing, and staying home from work when contagious, are important and proven measures to protect patients. If/when a truly safe and highly effective flu vaccine is developed, it might be reasonable to require HCW vaccinations. But for now, in the absence of an excellent and fully-tested flu vaccine, that is not the case.
care systems have an ethical and moral duty to
protect vulnerable patients from transmissible
The seventh truth: the health care system willAs I noted in a previous post, this "truth" is spin. Are HCWs to be blamed for the many failings of the healthcare system? Why not focus instead on the 44,000-98,000 Americans who die in hospitals each year from adverse drug reactions? A well-read 1999 report by the Institute of Medicine (TO ERR IS HUMAN: BUILDING A SAFER HEALTH SYSTEM) said:
either lead or be lambasted
Among the problems that commonly occur during the course of providing health care
are adverse drug events and improper transfusions, surgical injuries and
wrong-site surgery, suicides, restraint-related injuries or death, falls, burns,
pressure ulcers, and mistaken patient identities. High error rates with serious
consequences are most likely to occur in intensive care units, operating rooms,
and emergency departments.
Beyond their cost in human lives, preventable medical errors exactTellingly, influenza deaths are not even mentioned. IOM pointed out the areas where the healthcare system has to lead. Remember: flu deaths in the elderly have not fallen since 1980, when only 15% of seniors were vaccinated, till today, when 65% get yearly flu vaccines.
other significant tolls. They have been estimated to result in total costs (in
cluding the expense of additional care necessitated by the errors, lost income
and household productivity, and disability) of between $17 billion and $29
billion per year in hospitals nationwide.