Fran Lowry

June 17, 2013

FORT LAUDERDALE, Florida — When given a choice between being vaccinated against influenza and being terminated from their jobs, the vast majority of healthcare workers chose vaccination.

Mandatory flu vaccination as a condition of employment did not lead to excessive voluntary termination, according to a 4-year analysis of vaccination rates at the Loyola University Medical Center (LUMC) in Maywood, Illinois.

Dr. Jorge Parada

"Vaccination is the most effective way of preventing infection. We, as healthcare workers, should do everything we can to prevent our patients from becoming ill," Jorge Parada, MD, from Loyola University Chicago Stritch School of Medicine, told Medscape Medical News.

"Healthcare workers are at higher risk for the flu. We have a responsibility because we know we are going to have a greater exposure risk," Dr. Parada said here at the Association for Professionals in Infection Control and Epidemiology (APIC) 2013 Annual Meeting.

Although annual influenza vaccination is recommended for all healthcare workers, the national average is only 64%.

Take It or Leave It

Four years ago, Dr. Parada and his colleagues at LUMC decided to make vaccination mandatory for all healthcare staff, with a few exemptions for well-documented religious or medical reasons.

"We made it clear that if they don't get vaccinated, they are not working here anymore. It was either get vaccinated or get an official exemption. We wanted 100% participation," he said.

To get an official exemption for medical reasons, the healthcare worker had to get a letter from his or her physician, which would then be reviewed by a special panel.

"It wasn't enough to say 'I have an egg allergy.' We wanted it on a letter from a doctor on letterhead. We also reserved the right to request additional information from the physician if we felt the explanation was insufficient. In addition, if the justification for no vaccination was an allergy, we reserved the right to do skin and allergy testing," he explained.

Before this stringent measure was enacted, many healthcare workers used egg allergy as an excuse not to get vaccinated, Dr. Parada said.

Miraculously, hundreds and hundreds of egg allergies disappeared in our healthcare workers.

"As soon as we required proof from the doctor and reserved the right to do allergy testing, miraculously, hundreds and hundreds of egg allergies disappeared in our healthcare workers," he said.

There was a similar high bar for religious exemptions.

"We wanted a letter from the pastor, priest, rabbi, guru, whoever it was, and we wanted a phone number so that we could contact that person if we wanted to discuss the exemption further," Dr. Parada said.

Vaccination Rate Now Almost 100%

In the 3 years before vaccination became mandatory, the average vaccination rate was 65%. Since it became mandatory in 2009, the vaccination rate is close to 99%, with the rest being exempted.

In addition to hospital staff, volunteers, medical students, and nursing students must be vaccinated, Dr. Parada said.

LUMC has not tracked whether mandatory immunization has resulted in better outcomes for patients, so that remains unclear. However, he noted that mandatory immunization has reduced flu-related absenteeism among hospital staff.

"Getting vaccinated is not about you, it's about the people you take care of. That is what we want to get across to our healthcare workers, and that is the main shift in thinking that has to occur. Most healthcare workers are relatively young and healthy, and not as affected by the flu as more vulnerable people are, so they think they don't need to be vaccinated. But it's not about them," he said.

Marcia Patrick

Marcia Patrick, RN, an infection preventionist from Tacoma, Washington, and a member of the APIC practice guidance committee, noted that flu is just one of several communicable diseases for which vaccination is mandated for healthcare workers.

"The Centers for Disease Control and Prevention recommends that healthcare workers be immune to mumps, measles, rubella, chicken pox, and more recently pertussis. Mandatory vaccinations or proof of immunity as a condition of employment in healthcare is not a new concept, and vaccination against flu is just a new addition," Patrick, who was not part of the study, told Medscape Medical News.

She recounted a similar experience with mandatory vaccinations at institutions in Tacoma.

"The first year we instituted mandatory vaccination there were 6 or so people who chose to terminate rather than be vaccinated. Thereafter, each year there were 1 or 2, which is always going to happen," she said.

Getting all the institutions in a community to have the same mandatory vaccination policy is key to success, Patrick explained.

"If all the facilities in the community go to the same standard, it increases the motivation to get vaccinated because staff who refuse can't just go down the street and get another job. It's a community effort, and it's about getting healthcare workers to understand how important flu vaccination is. We don't have a right, as healthcare workers, to jeopardize our patients' safety, and vaccination makes a very big difference," she said. "It really does."

Dr. Parada and Ms. Patrick have disclosed no relevant financial relationships.

Association for Professionals in Infection Control and Epidemiology (APIC) 2013 Annual Meeting: Abstract 12. Presented June 9, 2013.


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