Virginia Mason’s mandatory flu shot policy wins praise

Virginia Mason Medical Center’s program requiring all of its staff to be vaccinated against the flu is “another important first in the field of infection control and prevention,” writes two experts in hospital infection control commenting on a new paper describing the hospital’s influenza-control initiative.

Virginia Mason was the first hospital in the nation to implement such a policy.

Virginia Mason’s decision to implement a mandatory influenza vaccination program for its healthcare workers “has opened the door to a new approach to increasing patient safety as well as (healthcare worker) protection,” write Drs. Thomas Talbot and William Schaffner of Vanderbilt University School of Medicine.

The paper and the commentary appear in the September issue of the journal Infection Control and Hospital Epidemiology.

The lead author of the paper was Dr. Robert Rakita, who was at Virginia Mason but is now at the University of Washington. The senior author was Dr. Joyce Lammert, chief of medicine at Virginia Mason and leader of the immunization effort.

The paper describes the results of a 5-year-long initiative to get as many of the hospital’s staff vaccinated against the flu as possible.

Because they are often in contact with people coming into the hospital, clinics, and emergency departments, healthcare workers are at high risk both of contracting the flu and becoming ill and of passing the infection along to their patients, many of whom are frail, elderly, or have weakened immune systems and, thus, are particularly vulnerable to the virus.

For years, the U.S. Centers for Disease Control and Prevention (CDC) and other healthcare organizations have urged healthcare workers to get vaccinated against the flu, but less than half do.

To address this problem, write Dr. Rakita and his coworkers, Virginia Mason decided in 2004 to make an annual influenza vaccination a “fitness-for-duty” requirement for every employee in the medical center.

At the time only about half of the staff were getting the vaccine.

3-D model of flu virus Credit: Dan Higgins/CDC

Healthcare workers could ask to be made exempt for either medical or religious reasons.

The flu vaccine, for example, is made by growing virus in eggs and so can pose a danger to some people allergic to eggs.

However, when the policy was adopted, the Washington State Nurses Association (WSNA) filed a grievance on behalf of the unionized nurses working at the center, arguing that any new requirement for the nurses had to be negotiated as part of the union’s collective bargaining agreement.

An arbitrator agreed with the WSNA, nevertheless, 85.9 percent, 515 of the 599 unionized nurses chose to be vaccinated in the 2005-2006 flu season and 95.8 percent in the most recent 2009-2010 season.

The nurses that chose not to vaccinated were required to wear masks during the flu season.

This requirement, too, the WSNA challenged, but an administrative law judge ruled it was a permissible requirement as part of an infection control policy.

Relatively few healthcare workers refused to be vaccinated. Five left voluntarily and two were fired in 2005-2006,  and since then only two have left because of the requirement, Dr. Rakita and his coworkers report.

The plan hit a snag in its first year, when there was a national vaccine shortage.

But the following flu season, 97.6 percent of the staff were vaccinated and since then nearly 99 percent of the staff receive the vaccination.

To vaccinate the center’s staff of nearly 5,000 employees as well as visiting clinicians, students and others is time-consuming and expensive, the authors write. Purchase of the approximately 6,000 doses needed alone cost about $70,000.

Although a few healthcare workers left because of the program, the authors write, surveys find that the center’s employee satisfaction is high “and many (healthcare workers) say that they are proud to belong to a healthcare organization that puts patient safety first.”

The study did not look at whether the program affected influenza rates among the healthcare workers or patients, the authors write, but note that previous studies have shown that healthcare worker vaccination has reduced infections and deaths among patients.

In the future, influenza vaccination rates among a hospital’s employees may be publicly available, the authors note. If that comes to pass, consumer demand may force hospitals to adopt mandatory vaccination programs, they write: “After all, if you had a choice of where to receive your health care, would you rather go to a place where your caregivers had been vaccinated or to a place where they had not?”

To learn more:

• Read the paper and commentary in the journal Infection Control and Hospital Epidemiology (subscription or fee may be required).
• Visit the Washington State Nurses Association website where you can find material about the association’s concerns with the policy.

Tags: Infection Control, Influenza, Nursing, Virginia Mason

Category: Infections, Influenza, Provider News, Virginia Mason