Should Flu Vaccinations Be Mandated for all Hospital Staff?

As influenza season ramps up, how are hospital directors and RT department managers ensuring proper vaccination coverage for their staff in order to prevent the spread of the virus?

By Lisa Spear

Influenza can spread quickly in a hospital setting. It can be dangerous and even fatal. A simple shot can help stop the spread of the flu, so it’s not surprising that most, if not all, hospitals throughout the country have policies that either mandate that their healthcare workers get vaccinated as a term of employment or strongly encourage inoculation. Some launch aggressive educational campaigns to inform staff of the risks of not getting the shot.

Flu carts are dispatched throughout the halls in Texas Children’s Hospital in Houston. In Oregon, all healthcare workers at OHSU Hospital are required to wear a sticker on their identification badges to alert managers that they received their flu vaccine. In California, Lucile Packard Children’s Hospital Stanford actually hires additional staff during flu season just to administer flu shots.

All these measures seem to be paying off. Flu vaccination coverage among healthcare personnel in hospitals throughout the country topped off at 91.9% during the 2016–17 season, according to data¹ from the Centers for Disease Control and Prevention. Many hospitals have rates even higher than that. In North Carolina, at the UNC Hospitals, compliance rates for this season are between 96% and 97%, with the hospital allowing a small percentage of staff members to opt out because of medical contraindications or religious reasons.

“Their job is conditional on getting the flu vaccine,” said David Weber, MD, MPH, medical director of hospital epidemiology and occupational health. He attributes the hospital’s high compliance rates to a strict policy. All staff members, aside from those in the two exclusion groups, must get vaccinated 10 days before Thanksgiving.

Lee Evey, MHA, RRT, director of respiratory care and ECMO (extracorporeal membrane oxygenation) services at Texas Children’s Hospital, said that administrators have found that they can get high compliance rates of more than 90% without making the vaccine mandatory.

Part of Texas Children’s Hospital’s strategy is making it as easy as possible for healthcare workers to get the vaccine. Aside from flu carts that travel throughout the hospital, there is also an occupational health center, where staff members can drop in during most work hours to get inoculated. All flu shots delivered onsite are free to healthcare employees who work at the hospital, said Evey.

At Lucile Packard Children’s Hospital Stanford, there are also multiple sites set up in central locations throughout the facility, where employees can stop in for their shots. “It is a very convenient setup for the employees. They have multiple opportunities to get vaccinated,” said Roshni Mathew, MD, associate medical director for the hospital’s infection and prevention control program and a pediatric infectious disease physician.

Every flu season, Texas Children’s Hospital disperses educational material to staff through email. These materials may include compelling personal stories of those who contracted the flu in the hospital. “Just putting a face on why you are doing this is one of the more important aspects,” said Evey.

It’s also essential that hospital management stays informed of local and state’s laws regarding vaccinations. The Santa Clara Department of Public Health² in California mandates that health workers who are not vaccinated wear masks around patients during flu season. On the other hand, the state of Oregon restricts mandatory immunizations for any reason, said Misti Powell, MBA, occupational health manager at OHSU Hospital in Portland, Oregon.

OHSU still manages to get high compliance rates. During last year’s flu season, by February, 95% of all OHSU staff had been vaccinated against the flu, according to Powell.

The hospital uses an online tool that’s accessible to all employees, managers and departments to assess vaccination compliance. The tool allows managers to see what is required for each staff member and when expiration dates are approaching, Powell said.

OHSU also sends automated notifications to employees. If the employee does not take action, the system sends the notification to that person’s manager one week before the deadline date. If still incomplete on the date it is due, the manager’s manager will then be notified. If requirements are not met after that date, employees are placed on unpaid leave or removed from patient care until requirements are complete,
said Powell.

Those who are not yet vaccinated are required to wear a mask when they are within six feet of a patient or working in a patient care building. “It is very rare that individuals violate this policy as our workforce understands and respects the importance of protecting our patients,” said Powell.

Flu prevention doesn’t stop with vaccination. Many facilities take other precautions too. OHSU offers rapid flu testing since many cases of influenza are asymptomatic. Healthcare providers at any of the UNC Hospitals are required to stay home at any sign of a fever and a respiratory infection. If workers have a cough or any other symptoms, but no fever, they are allowed to work, but must wear a mask around patients, said Weber.

If healthcare workers at Lucile Packard Children’s Hospital Stanford decline the flu vaccination, they are then required to participate in an educational module to understand the risk, said Mathew. “Everybody comes to work with very good intentions and that is to help the patient in front of you, and so just having that knowledge that you can potentially help protect very vulnerable patients by getting vaccinated is important.” RT

Lisa Spear is associate editor of RT Magazine. For more information, contact [email protected].