Vaccinations for Healthcare Workers

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Do unvaccinated healthcare professionals pose a risk to their patients?

The urging of the medical field has always been to “Do no harm.” Originally, it meant to have the best interest of the patient in mind. Today, however, sometimes the best interests of the patient has to take a backseat. The Hippocratic Oath points out the importance of maintaining the health of the healthcare workforce, especially to avoid easily preventable diseases (such as influenza) that could cause unnecessary harm to patients.

A significant question throughout this revolution in healthcare from reactionary medicine to preventive medicine is whether or not to make it mandatory for all healthcare workers to have vaccinations. Common sense advises society to prevent as much illness as possible, and the Centers for Disease Control (CDC) recommends it. For healthcare professionals, does refusing a vaccination put one’s own best interests above those of vulnerable patients?1

This is the issue that has been raised on the local, state and even federal levels to ensure that individual rights and the right for public safety are not at odds. Solutions to immunizing healthcare staff have been met with mixed reviews from the healthcare administration, healthcare providers and patients. Many solutions that have been tried have had limited success, and the issue remains.

Mandatory Vaccinations by Facility Policy

Most ambulatory, hospital and long-term healthcare facilities recognize the need to protect their patient population by educating and requiring their employees to be vaccinated. According to Pozgar (2016),2 hospital-borne infections are the highest cause of patient injury within healthcare facilities. Most facilities have instituted a mandatory vaccination policy (for some diseases), which can be enforced up to the point of written warnings and even terminations in some cases. The battle over attempting to get all healthcare workers vaccinated has escalated from the individual to federal intercession, however, due to litigation over individual healthcare workers’ rights. Wiener reported3 that a group within the Massachusetts Nurses Association at Boston’s Brigham and Women’s hospital has filed a suit in regards to mandatory flu vaccinations.

“The matter is complicated because rules about vaccinations are either determined by the states or not addressed at all. Three states—AL, NH and RI—require all healthcare workers to be vaccinated against the flu yearly,” wrote Wiener. In this case, the Unions are arguing the point of employment practices for this group of nurses based on the requirement of obtaining the flu vaccines to keep their jobs. Also, this is a case in which local groups have gone to the state government in order to get clarification on mandatory vaccination for healthcare workers.3

table 1What if this was an at-will state with a group of non-unionized healthcare workers? In this same case, Wiener pointed out that the CDC is implementing a program called “Healthy People 2020,” which will demand 90% of all healthcare workers to be immunized against influenza as opposed to 75% two season ago.3 The solution presented in this case was that the majority of unvaccinated healthcare workers would be required to wear masks if they were to stay within their present job duties to prevent transmission of the flu to others.

Based on appearance of illness and the discomfort from the heat and humidity from wearing it during long work shifts, some healthcare workers still dispute the facial mask. The question of masks being a “true” safeguard from transmitting the flu virus is questionable as well—it may only be a temporary fix until that healthcare professional is not being exposed to patients. Transmitting the influenza virus from healthcare worker to patient would be no different. In this instance, the factors involved would be individual negligence due to refusing to get the vaccination and, subsequently, exposing a patient to a preventable disease. If the patient died, the malpractice suit would extend to the facility itself for not enforcing any policies to prevent transmissible diseases.

“During last year’s flu season, which was equally challenging, there was one suspected case of a patient at the University of Chicago Medicine getting the flu from a healthcare worker who had respiratory symptoms but no fever, so the infection control team decided to implement a temporary policy of mandatory influenza testing for all such employees,” wrote Wood.4

table 2

Duty to care is, above all, to protect the patient. If the healthcare worker is in health, it can compromise the health of the patient. The breach of care would begin with the individual healthcare worker not recognizing they were ill. The CDC (2016) reported5 that a person can be infected with influenza and not see symptoms appear for up to seven days. If that is the case, then the reasonable solution is to be proactive and prevent exposure by obtaining the flu vaccine before any exposure.

The damage would be incurred by the patient either acquiring the influenza or an opportunistic infection from exposure to the flu. The causation would be evident in the respiratory infections seen in the patient and the documented refusal of the flu vaccine by the healthcare worker that exposed the patient. “Unvaccinated health care staffers are second only to unvaccinated adults living with kids in their likelihood of coming down with the flu,” wrote Harmon.1 The opportunity for harm and exposure is there, as well as the ability for prevention, so malpractice and damages to the patient are both a concern.

Vaccination for Influenza among healthcare professionals is, in part, their duty to uphold the Hippocratic Oath of “Doing no harm.” For individuals that refuse to do so, it may be a matter of simple education to clarify the potential risks and benefits of protection for themselves and their patients. Healthcare workers are among the least recognized and hardest working professions, and they do not have the luxury of taking a “sick” day because they are the ones caring for the sick. Caring for those that care for others and showing some appreciation for the healthcare workers taking on the responsibility of patient care by protecting themselves with the flu vaccine may be the best solution to satisfy administrators, providers and the public at large.


References

  1. Centers for Disease Control and Prevention. (2013). 2013-14 Flu Season. Washington D.C.: Centers for Disease Control and Prevention.Centers for Disease Control and Prevention. (2015). See also : Cases and Outbreaks. Atlanta: National Center for Immunization and Respiratory Diseases, Division of Viral Diseases. Department of Health & Human Service. (2013, 12 30). www.vaccineeducationonline.org.
  2. Pozgar, G. D. (2016). Legal Aspects of Health Care Administration. Burlington: Jones & Bartlett Learning.
  3. Wiener, L. J. (2014). Hospitals Battle Unions Over Mandatory Flu. Health Leaders Media, 4.
  4. Wood, M. (2015). Health care workers and the flu: When checking for a fever isn’t enough to decide who stays home from work. Science Life-In at the Bedside, 2.
  5. Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older — United States, (2016) WeeklyFebruary 5.
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About Author

David Plaut
David Plaut

Chemist and statistician in Plano, TX, and frequent contributor to ADVANCE. He also writes a blog. Off the Cuff, found on our website.

Celia McDonald

Celia McDonald is a veteran in the clinical laboratory community and frequent contributor with ADVANCE.

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