IDSA Pushes for Mandatory Vaccination of Healthcare Workers in CDC Flu Guidance

July 16, 2010

Richard Whitley, MD, FIDSA, president of the Infectious Diseases Society of America (IDSA), has written a letter to CDC director Thomas Frieden relating to the draft guidance, "Prevention Strategies for Seasonal Influenza in Healthcare Settings." The IDSA says it supports the CDCs draft guidance concerning infection prevention and control measures that should be implemented in response to seasonal and H1N1 influenza, but notes the guidance should also support mandatory influenza immunization of healthcare workers.

In the letter Whitley notes, "IDSA welcomes the proposed update, which replaces the previous seasonal influenza guidance and the Interim Guidance on Infection Control Measures for 2009 H1N1 Influenza in Healthcare Settings, to recommend that healthcare workers (HCWs) wear face masks around patients with confirmed or suspected influenza, wear respirator devices during aerosol-generating procedures and utilize negative pressure rooms, when available, during higher-risk procedures. While IDSA took issue with the 2009 federal guidance on the use of N95 respirator devices, we appreciate the remedial action that CDC is proposing, which responds in large part to our concerns and the concerns of other experts. The proposed revisions on personal protective equipment (PPE) for HCWs are more closely aligned with the safety precautions supported by IDSA members and othersprecautions that are evidence-based and supported by the best available science. IDSA welcomes future opportunities to work closely with the U.S. Department of Health and Human Services (HHS), CDC, and Occupational Safety and Health Administration (OSHA) to ensure that all decisions affecting HCWs and patient safety are science-based. In July and November 2009 joint letters, IDSA, the Society for Healthcare Epidemiology of America (SHEA) and the Association for Professionals in Infection Control and Epidemiology (APIC) outlined control measures for use in healthcare facilities during care of patients with suspected or confirmed novel H1N1 influenza infection and expressed concern with the federal PPE guidance issued last year. Our primary goal continues to be the effective delivery of patient care while protecting both HCWs and patients from acquiring influenza in healthcare settings."

In the letter, the IDSA says it endorses the following principles: "Early recognition and identification of suspected seasonal and novel H1N1 influenza-infected patients upon presentation to a healthcare setting; Placing surgical masks on patients with suspected or confirmed seasonal or pandemic H1N1 influenza infection at the point of entry into any healthcare setting; Using surgical masks to cover the HCWs nose and mouth to prevent acquisition of influenza virus by droplets or hand contact during routine patient care activities; Placing patients with suspected or confirmed seasonal or pandemic H1N1 influenza infection in a single room, if available, or cohorting them with other patients infected with the same influenza virus; Strict adherence to hand hygiene, respiratory hygiene and cough etiquette; and Restricting visitors and HCWs with acute respiratory illnesses."

The IDSA adds that it believes it is crucial that guidance keeps pace with science and, as such, supports the CDCs current efforts: "It is in one area, however, that IDSA feels the guidance does not go far enough. We feel the CDC should provide a definitive recommendation for mandatory influenza vaccination of healthcare providers. IDSA supports universal immunization of HCWs against seasonal influenza by healthcare institutions (inpatient and outpatient) through mandatory vaccination programs, as these programs are likely to be the most effective means to protect patients against the transmission of seasonal influenza by HCWs. Employees who cannot be vaccinated due to medical contraindications, or because of vaccine supply shortages, or who sign a written declination choosing not to be vaccinated for religious reasons, should be required to wear masks or be re-assigned away from direct patient care. IDSA also is supportive of comprehensive educational efforts that inform HCWs about the benefits and risks of influenza immunization to both patients and HCWs. The rationale for this policy is as follows: The most recent data, including the CDCs April 2, 2010 Morbidity and Mortality Weekly Report, 59(12); 357-362 (enclosed), shows that organizations with a mandatory vaccination policy in place have a much higher immunization rate than those who have a voluntary program or no program at all. Several studies demonstrate that immunizing HCWs against influenza protects patients against acquiring the virus from HCWs, reducing both morbidity and mortality. Thus, universal immunization of HCWs against seasonal influenza is a critical patient safety issue. Immunizing HCWs against influenza also protects the individual HCW from falling ill, thus both protecting the HCW from potentially serious illness while maintaining an adequate workforce, which further protects patients. Decades of scientific data demonstrate Food and Drug Administration-approved influenza vaccines to be safe, effective, and cost-saving. Educational programs, declination policies and easy access to influenza immunization have resulted in modest improvements in coverage in many healthcare systems in recent years, but generally have not achieved acceptable levels of coverage. Despite extensive and sophisticated efforts, most successful educational programs still average only 40 percent to 70 percent rates of influenza vaccine coverage."

To read the rest of the letter on the IDSA Web site, CLICK HERE.