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Mandatory Flu Vaccination of Healthcare Workers: A Patient Safety Imperative


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A discussion about the rights of the individual versus the rights of the patient was something Virginia Mason Medical Center welcomed the WSNA to have, and Lammert says it becomes a very simple issue when everyone at a healthcare institution understands why they are there and to whom they have an obligation. “If you consider that we are here for our patients and that patient safety is paramount, it makes the discussion a lot easier, and it makes the right thing to do much clearer,” she says. “It’s important to note that the WSNA’s objection was not that their nurses shouldn’t be immunized but that it should be something that was negotiated through their contract. The nurses in general believe they should get immunized and the first year 86 percent did, and last year 96 percent did. We are hoping that blocking implementation by unions is not going to be inevitable.”

Absent union negotiations and legal challenges, healthcare institutions also could be challenged by resources and funding in their quest to replicate VMMC’s success.  As Rakita, et al. (2010) note, “A significant amount of human and financial resources are required for this effort, including employee time and cost of vaccine and supplies.” The researchers report that the vaccination program required more than 500 hours of nursing and medical assistant time alone, and that the facility spent approximately $70,000 for the approximately 6,000 doses of influenza vaccine needed.

It’s an undertaking that Lammert says she wishes all facilities will attempt. “We really hope that the work we have done will help inspire other people to see that it is possible to drive compliance rates upward and that it is something they can do too,” Lammert says. “Most healthcare institutions already have some sort of immunization program, and I think almost any size facility can raise their vaccination rates because they are already going through the motions of administering vaccinations. The bottom line is, dare to do it. The first year there were some challenges and barriers but the second year was much easier and now it’s just something that everyone in our organization assumes we will be doing each fall. Last year we did both seasonal and H1N1 immunization so it was double the work and it was amazingly smooth.”

Lammert continues, “The No. 1 thing is having the support of institutional leadership – in our organization we began at the top with our CEO saying, ‘This is really important for our patients,’ and turning it upside down – it’s not about the staff, it’s about the patients. When you change the conversation to placing focus on the patients I think that makes a significant difference. When you talk about safety you develop a mindset, a culture that safety is a benefit both to patients and to staff, as the two groups are absolutely connected.”

Among those lauding VMMC for its efforts are Thomas Talbot, MD, MPH, and William Schaffner, MD, from the Departments of Medicine and Preventive Medicine at Vanderbilt University School of Medicine in Nashville, Tenn., who write in an editorial, “This forthright and novel decision by VMMC leaders and vaccination program champions to emphatically emphasize the importance of influenza vaccination of healthcare workers has opened the door to a new approach to increasing patient safety as well as healthcare worker protection.” Talbot and Schaffner (2010) add, “With the growing interest in implementing similar programs, the healthcare worker influenza vaccination program, after years of extensive efforts that resulted in only a modest increase in coverage, now may follow the effective course taken by childhood vaccination programs and school entry requirements. Low healthcare worker influenza vaccination rates can no longer be tolerated, because our patients and our coworkers are at risk. Combining a mandatory healthcare worker influenza vaccination policy with a multifaceted infection control program -- which includes early identification of infected patients, source control, use of isolation precautions and personal protective equipment, restriction of ill healthcare workers and visitors, and other environmental controls -- can reduce transmission of influenza in healthcare settings and represents a new model of influenza infection control. For effectively implementing a mandatory healthcare worker influenza vaccination program, we can applaud the role that VMMC has played in pioneering another important infection control ‘first.’”

As Talbot and Schaffner (2010) allude in their editorial, numerous healthcare systems healthcare institutions in the United States have followed VMMC’s lead, and that “Arguably, many of these organizations would not have taken this step if they had not had the successful example of VMMC to emulate.”

“As the Vanderbilt folks pointed out, several large organizations have followed our lead and in fact 203 institutions required flu immunization last year,” Lammert says. “I am hoping it will be much higher this year. Even in a mild flu year, 36,000 people in the U.S. die from influenza, and globally half a million people die, so in a non-pandemic year it is still a huge public health problem. It’s so important to continue to raise people’s awareness about flu mortality.”

Professional societies pushing for mandatory vaccination of healthcare workers include the Society for Healthcare Epidemiology of America (SHEA), which provided comment to the Department of Health and Human Services (HHS) on its “Updated Guidance: Prevention Strategies for Seasonal Influenza in Healthcare Settings.” In a letter to the HHS, SHEA wrote, “Regardless of precautions applied in the prevention of influenza transmission, the best preventive measure is use of a safe and effective influenza vaccine. The importance of annual vaccination is stated, but only in terms of achieving high rates and improved levels of coverage. Now would be an appropriate time for a direct and unequivocal statement that every healthcare professional without a valid medical contraindication to receiving influenza vaccine should receive an annual vaccination; if not as a mandate, then as a professional obligation not dissimilar to the responsibility to apply hand hygiene and the other standard measures recommended in this guidance to prevent influenza.” The letter adds, “SHEA views influenza vaccination of healthcare professionals as a core patient and healthcare professional safety practice with which non-compliance should not be tolerated. The Society believes that it is the professional and ethical responsibility of healthcare professionals and the institutions within which they work to prevent the spread of infectious pathogens to their patients through evidence-based infection prevention practices including influenza vaccination. SHEA endorses a policy in which annual influenza vaccination is a condition of both initial and continued healthcare professional employment and/or professional privileges for the safety of both patients and healthcare professionals.”


Rakita RM, Hagar BA, Crome P and Lammert JK. Mandatory influenza vaccination of healthcare workers: A 5 ‐ year study. Infect Control Hosp Epidemiol. 2010;31:881-888.

Talbot TR, Schaffner W. On being first: Virginia Mason Medical Center and mandatory influenza vaccination of healthcare workers. Infect Control Hosp Epidemiol. 2010 Sep;31(9).



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