Johns Hopkins' senior hospital epidemiologist and flu
expert is calling for mandatory vaccination of all health
care workers as the best means of protecting patients and
hospital staff from widespread outbreaks of the viral
illness.
Studies by other U. S. researchers show that voluntary
vaccination programs don't do the job and that each year
nearly 40,000 Americans die from influenza, many of them
elderly or ill, with weakened immune systems that cannot
readily fend off the disease.
In an editorial published in the journal Infection
Control and Hospital Epidemiology online Nov. 9, Trish
Perl concludes that mass vaccination policies are required
to prevent patients from accidentally contracting the virus
directly from an infected medical staff worker or
indirectly from other patients or visitors via medical
staff.
Previous research from Johns Hopkins showed that
annual flu shots have been almost 88 percent effective at
reducing the risk of flu infection and that they reduced by
one-half the number of deaths among hospital patients from
the disease.
Perl's view, which is likely to inform further debate
on the subject of voluntary vs. mandatory worker
vaccination programs, is based on research showing that
despite free and ready access to the vaccine, only 40
percent of all health care workers actually get a flu
shot.
"We have gone as far as possible with vaccination
programs emphasizing education and health promotion," says
Perl, an associate professor of
medicine and
pathology at the
School of Medicine. "It's now time to go the extra step,
requiring active declination or even making vaccination a
mandatory part of the job, linked to patient safety, along
with such tasks as keeping hands clean and getting
mandatory TB tests."
Neither state nor federal law requires workers to
provide medical details when they call in sick, so it is
difficult to precisely link seasonal hospital absenteeism
and high rates of nonvaccination, she notes.
"We need to close the very serious gap between
knowledge and behavior that exists among health care
workers," Perl argues, and it can be done, she says. In
2003, her team, along with Occupational Health Services at
Johns Hopkins, vaccinated more than 70 percent of 10,000
hospital staff. "But we can do better, and ideally, at
Hopkins and other hospitals, our objective would be to
consistently have more than 90 percent of staff vaccinated
each year."
According to Perl, numerous staff surveys from other
hospitals have shown that the most common reason cited for
not getting a vaccination is a lack of time (47 percent).
Surprisingly, a remarkably high number of staff, more than
30 percent, believed they could catch influenza from the
vaccine itself, which is false. Perl also notes that
surveys show that relying on people's self-awareness is not
sufficient to prevent the flu from spreading. "One-half of
infected health care workers have no idea when they are
infected with influenza, often having few if any signs and
symptoms and making it impossible to ask all staff to stay
home when they are feeling ill to prevent other people from
catching their infection," she says.
Still other studies have found that education
campaigns can be effective at increasing vaccination rates
among health care workers by as much as 60 percent. And to
the surprise of those conducting these surveys, the reason
most likely to motivate health care workers to get the shot
is that it benefits patients, not themselves.
However, in the editorial Perl concludes that
"shifting the message from self-interest to altruism in
protecting patients may improve vaccination rates, but it
won't fix the problem. From a hospital policy standpoint,
this is a real patient safety issue, and vaccination can be
viewed as a means of protecting patients from influenza
exposure and the related mortality seen among vulnerable
populations. Vaccination should be presented as such to
both health care workers and every hospital's
leadership."
Perl notes that even without mandatory vaccination
policies, other potential barriers to widespread
vaccination can be helpful and should be implemented
nationwide. Among her recommendations are free shots for
all staff, easy access to flu shot clinics on site,
flexible vaccination hours, emphasis on patient safety
aspects of the program, education to counter beliefs that
the shots can make you sick and encouragement from hospital
leaders to get the vaccine.
The next step, Perl says, is for health care
professional associations, such as the Infectious Disease
Society of America and the U.S. Joint Commission of
Accreditation on Healthcare Organizations, to endorse
mandatory flu shots. One group, the Society for Health Care
Epidemiology, last month endorsed just such a plan.
However, she acknowledges that current federal workers'
rights regulations prevent employers from making
vaccinations a requirement.
Perl says her proposal is open to discussion at Johns
Hopkins. "Ultimately, we want to make vaccination as
mandatory for workers as the law allows in order to
effectively accomplish what we cannot enforce," she
says.