Healthcare Worker Vaccination Still Key to Protecting Patients

By Kelly M. Pyrek

ICT spoke to William Schaffner, MD, chairman of the Department of Preventive Medicine at Vanderbilt Medical School in Nashville, Tenn., about lessons learned from the 2009 H1N1 influenza pandemic, non-compliance with flu-prevention measures, and other pertinent issues related to healthcare worker vaccination against seasonal influenza.

Q: What important lessons did the 2009 H1N1 influenza pandemic teach us?

A: Many lessons! Among them:

- The pandemic reminded us that global influenza pandemics can occur and can move around the globe with the speed of transcontinental jet planes.

- All pandemics are not alike. This one affected children and young adults predominantly very unusual.

- Vaccine remains the best preventive measure, but even with the best intentions, our current methods for the development, manufacturing and distribution of a new pandemic vaccine are too slow. All of these traditional methods need to be brought up to the opportunities provided by the 21st century.

- There is an important role for antiviral treatment, but we must be wary of the development of resistance to the antiviral drugs.

- The importance of the public health infrastructure at the local, state and national levels.

- The need for every healthcare facility to have developed and drilled its own pandemic preparedness plan.

Q: Do you have a sense that in the pandemic aftermath hospitals took a closer look at things like compliance with respiratory protection and healthcare worker vaccination?

A: The pandemic clearly directed attention to all aspects of prevention including how to triage and care for a sudden surge in patients, purchasing and use of appropriate personal protective equipment (including regular surgical masks as well as N-95 respirators) as well as healthcare worker vaccination. The trick will be to maintain and expand that interest to deal with the regular annual visitation of seasonal influenza.

Q: Is non-compliance with flu-prevention measures a knowledge gap or an implementation gap?

A: Non-compliance is the result of both a knowledge gap by some administrators and healthcare workers as well as an implementation gap, also on the part of both administrators and healthcare workers. Frankly, the still-inadequate acceptance of annual influenza immunization by healthcare workers remains very disturbing.

Q: Why do healthcare workers knowingly endanger themselves and their patients and how can infection preventionists start to change attitudes and behavior?

A: Those are both large questions for which there are no completely satisfying answers. First, many healthcare workers still do not completely understand that this is primarily a patient-safety issue. They can transmit influenza virus to their already-sick patients even though the healthcare worker may only be mildly ill. Indeed, they can transmit the virus during the day before they themselves develop any symptoms. Knowing this, there is no way that "Ill stay home when Im sick" can be effective vaccination of healthcare workers is the only coherent prevention strategy. Also, it is a flat-out myth that you can get flu from the flu vaccine. This is a pernicious misunderstanding that remains a substantial barrier to acceptance of vaccine in every survey of healthcare worker attitudes and intentions.

Q: What do you believe are the least successful and the most successful strategies for HCW respiratory protection and vaccination and why?

A: I will continue to be candid. Although a few healthcare facilities have successfully attained influenza vaccination rates approaching 90 percent on a voluntary basis, they are few indeed. Mandates are necessary and have been shown now by many institutions to be successful in achieving influenza vaccination rates of 95 percent. After the initial turmoil when mandates are first implemented, they become an accepted and routine aspect of institutional practice. Those facilities and all of their healthcare workers can then be proud that they have done the maximum to protect their patients.