Mandatory Immunizations for Clinicians, Staff, IDSA Says

Laurie Barclay, MD

December 10, 2013

The Infectious Diseases Society of America (IDSA), the Society for Healthcare Epidemiology of America, and the Pediatric Infectious Diseases Society recommend that all healthcare employers (HCEs) require universal immunizations recommended by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC), according to a policy statement. Included with the mandated immunizations are those against measles, mumps, and hepatitis B.

"Although some voluntary [healthcare provider (HCP)] vaccination programs have been effective when combined with strong institutional leadership and robust educational campaigns, mandatory immunization programs are the most effective way to increase HCP vaccination rates," the statement authors write in a news release. "As such, when voluntary programs fail to achieve immunization of at least 90% of HCP, the Societies support HCE policies that require HCP documentation of immunity or receipt of ACIP-recommended vaccinations as a condition of employment, unpaid service, or receipt of professional privileges."

HCPs include all paid and volunteer persons working in the healthcare setting who have the potential for exposure to patients and/or to infectious materials.

The policy statement recommends that HCEs should consider, on a case-by-case basis, the need for administrative and/or infection control measures to reduce risk for disease transmission among HCP who cannot be vaccinated because of medical contraindications or vaccine supply shortages. Such measures may include use of surgical masks during influenza season or reassignment away from direct patient contact.

In addition, the policy statement recommends comprehensive educational programs to instruct HCPs regarding the benefits of immunization and the risks of not following vaccination guidelines.

Underlying Rationale for Universal HCP Immunization

  1. Immunization of HCP against vaccine-preventable diseases protects patients as well as HCP from morbidity and mortality related to these diseases.

  2. HCP immunization also reduces work absence during outbreaks, which would further compromise patient care.

  3. HCPs continue to have low vaccination rates for ACIP-recommended vaccines, despite recent outbreaks of measles and influenza among patients.

  4. When voluntary programs are insufficient to maintain adequate HCP vaccination rates, mandatory vaccination programs are needed.

  5. The safety, efficacy, and cost-effectiveness of ACIP-recommended vaccines are well documented and proven.

  6. Although educational campaigns improve HCP compliance with immunization programs, they are inconsistent in effecting ,adequate vaccine coverage levels when used alone.

  7. Providing free vaccinations in the occupational setting improves HCP immunization compliance.

  8. On the basis of the Hippocratic Oath, physicians and other HCPs have an ethical moral obligation to prevent transmission of infectious diseases to their patients, because they have pledged "to do good or to do no harm."

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