More hos­pi­tals re­quire work­ers to get flu shots, but re­sis­tance per­sists

Modern Healthcare - - PUBLIC HEALTH - By An­dis Robeznieks

The gen­eral public may have won­dered why it was worth an­nounc­ing last week that Kaiser Per­ma­nente and 105,000 of its union em­ploy­ees had agreed that staff would ei­ther get a flu shot or wear sur­gi­cal masks in pa­tient­care ar­eas dur­ing flu sea­son.

But it’s not a given that healthcare work­ers will get flu shots, even as providers and public health of­fi­cials be­come in­creas­ingly vo­cal about en­cour­ag­ing pa­tients to get them.

Kaiser’s agree­ment with its unions re­flects an “evolv­ing norm,” ac­cord­ing to Dr. Matthew Wy­nia, di­rec­tor of the Cen­ter for Bioethics and Hu­man­i­ties at the Univer­sity of Colorado An­schutz Med­i­cal Cam­pus, Aurora. The over­all vac­ci­na­tion rate for healthcare work­ers has reached 77% and it sur­passed 90% for hos­pi­tals. Ac­cord­ing to the Cen­ters for Dis­ease Con­trol and Preven­tion, the av­er­age vac­ci­na­tion rate is just 44% at fa­cil­i­ties where it’s not re­quired, pro­moted or of­fered on-site.

A grow­ing num­ber of hos­pi­tals and health sys­tems re­quire vac­ci­na­tions for their em­ploy­ees, typ­i­cally al­low­ing those with re­li­gious ob­jec­tions to wear masks in­stead. Bron­son Methodist Hos­pi­tal in Kala­ma­zoo, Mich., was one of the first to adopt the pol­icy 10 years ago. Richard Van Enk, Bron­son’s di­rec­tor of in­fec­tion preven­tion, says flu shots are now seen as an em­ployee ben­e­fit and work­ers “would scream bloody mur­der” if the im­mu­niza­tions ended.

Still, re­sis­tance per­sists. Op­po­nents ar­gue that the ev­i­dence be­hind manda­tory vac­ci­na­tion is not as solid as por­trayed. They also note risks that in­clude ad­verse re­ac­tions to the vac­cine, and a ten­dency among im­mu­nized work­ers to be­come lax in other pre­cau­tions, such as hand-wash­ing.

Oth­ers ar­gue it’s a mat­ter of civil lib­er­ties. Sak­ile Chen­zira sued Cincinnati Chil­dren’s Hos­pi­tal in De­cem­ber 2011 when she lost her job af­ter re­fus­ing to be vac­ci­nated based on her re­li­gious be­liefs as a ve­gan. Chen­zira, a for­mer cus­tomer ser­vice rep­re­sen­ta­tive, said she lived a ve­gan lifestyle and op­posed the con­sump­tion of an­i­mal prod­ucts; flu vac­cines are de­vel­oped in eggs. (The case was set­tled for undis­closed terms.)

Many provider or­ga­ni­za­tions have en­dorsed manda­tory vac­ci­na­tions, but nurses unions and as­so­ci­a­tions have gen­er­ally op­posed them—of­ten in court. The Na­tional Nurses United, while rec­om­mend­ing mem­bers get vac­ci­nated, has vig­or­ously ob­jected to poli­cies that com­pel them, ar­gu­ing that vac­ci­na­tions should be an in­di­vid­ual choice.

Amid measles out­breaks this past sum­mer, how­ever, the Amer­i­can Nurses As­so­ci­a­tion up­dated its pol­icy to call for all nurses to get im­mu­nized against all pre­ventable dis­eases un­less they can doc­u­ment re­li­gious or med­i­cal rea­sons for re­fus­ing them.

Wy­nia said it’s in­cum­bent upon healthcare em­ploy­ers to make it easy for their em­ploy­ees. “Healthcare work­ers don’t want to put peo­ple at risk in­ten­tion­ally,” he said, “and not get­ting vac­ci­nated is putting peo­ple at risk.”

Vac­ci­nat­ing the healthcare work­force

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