Should flu vaccines be mandatory for healthcare workers? Thats the question raised this week in the British Medical Journal to two healthcare providers, including Penn Medicines Amy J. Behrman, MD, in a Head to Head piece that argues both sides of the debate.
Behrman, the medical director of Occupational Medicine Services at the Hospital of the University of Pennsylvania and associate professor of Emergency Medicine in the Perelman School of Medicine at Penn, believes that mandatory vaccination is needed to protect vulnerable patients, while an emergency department nurse from Vancouver General Hospital in Canada argues that evidence on effectiveness is not sufficient to over-ride health care workers right to choose.
Both authors cite past studies and raise ethical issues to make their case.
Influenza vaccines are not only estimated to prevent thousands of hospital admissions and millions of illnesses annually, but they are also safe and have the greatest protective effect in healthy non-elderly adults, precisely the demographic of most healthcare workers, Behrman states.
For this reason, vaccinating hospital staff can improve patient safety, as well as protecting healthcare workers. Mandatory staff vaccination help protect patients who are at the highest risk for influenza complications and most likely to be in a hospital setting: elderly people, infants, patients with heart and lung disease, and patients with compromised immune systems.
Healthcare institutions should maximize the use and benefit of a vaccine that is moderately effective, extremely safe, and logically likely to reduce the risk of healthcare-acquired influenza for vulnerable patients as well as decrease illness among healthcare workers, Behrman writes. First do no harm.
Ideally, workers will take individual responsibility for being fully immunized, but when that does not occur, healthcare institutions have an ethical obligation to intervene, just as they do to optimize handwashing and minimize surgical site errors, she says.
In 2009, the University of Pennsylvania Health System approved a mandatory policy for all staff, after extensive efforts to improve voluntary immunization rates were insufficient, and after an internal survey on attitudes toward immunization mandates found overwhelming medical staff support.
Will Offley, the healthcare provider from Vancouver General Hospital, on the other hand, argues that vaccinating healthcare workers has not been shown to reduce the transmission of influenza to patients by rigorous criteria. A recent Cochrane review of five studies found no evidence that vaccinating healthcare workers prevents influenza or its complications in individuals in long-term care, and thus no evidence to mandate compulsory vaccination, he states.
He also notes that the vaccine often only imparts partial immunity and may last for less than the entire flu season. Healthcare workers, according to him, should protect patients from influenza by isolating people with symptoms of respiratory infection, improving infection control, covering coughs, washing hands, and staying home when sick. For him, influenza vaccination should remain a personal decision until there is more persuasive evidence.
The full article, Should influenza vaccination be mandatory for healthcare workers?," can be found HERE.
Source: Perelman School of Medicine at the University of Pennsylvania