Should Hospitals Mandate Employee Flu Shots?

Lisa, who is a nurse, says she is “not one to accept most immunizations due to various health concerns.”  This year, when she and other hospital employees were asked to get a flu shot, she declined, as usual. “I’m one of those people who takes very good care of my health, and use elderberry extract to reduce/prevent viral replication and other complementary/alternative treatments.”

But, unlike previous years, Lisa was told if she didn’t get a flu shot she would have to wear a surgical mask.

“The rule of thumb is if we are to be within six feet of another person, we must don a mask,” she explains. “We had been using the normal hand and respiratory hygiene of cover, muffle and sanitize for coughs and sneezes and the rule of thumb had been three feet.”

Mandating, instead of just recommending, employee flu shots is a growing trend among hospitals around the country, including in Maine. The consequences of refusing vary from hospital to hospital.

Examples of flu shot mandates nationwide

  • Banner Health, a system of hospitals in several states, requires all healthcare workers, students, and volunteers, as well as clerical, dietary, janitorial, and laboratory staff to receive influenza vaccine or face dismissal.
  • Dartmouth Hitchcock Medical Center, in Lebanon, NH also requires healthcare workers and volunteers, as well as clerical, dietary, janitorial, and laboratory staff, to receive influenza vaccine or face dismissal. Exemption to immunization is only allowed for valid medical contraindications and religious reasons.
  • Children’s Hospital Boston requires all employees, medical staff, volunteers, and associated personnel who enter patient care areas to receive the vaccine as a condition of employment, unless they receive a certified medical exemption (allergy to vaccine, severe egg allergy, or history of Guillain-Barre syndrome).
  • Henry Ford Health System in Michigan requires all healthcare workers and volunteers, as well as clerical, dietary, janitorial, and laboratory staff who don’t get a flu shot to wear a mask in patient-care areas while at work during influenza season.

At Eastern Maine Health System, which includes Eastern Maine Medical Center in Bangor, employees must either get a flu shot or sign a special declination form by December 31st or be suspended from work.

MaineHealth, a system that includes Maine Medical Center in Portland, requires employees who opt out to wear a surgical mask when working within six (6) feet of patients in all patient care areas/departments during the influenza season. Employees had until December 1st to comply.

David Dickison, DO, MaineHealth’s Medical Director of Employee Health, says, “The care and safety of patients is our top priority. Flu shots, masking, and practicing good hand hygiene are all proven steps to prevent the spread of germs that cause flu and other illnesses. Many patients in health care facilities have weakened immune systems, and it’s important that we take every possible precaution to protect them.”

Mid Coast Hospital in Brunswick does not have an employee mandate, says Steve Trockman, director of community relations and outreach. “Staff who decline vaccination are asked to share their reasons why, and we use that information for education purposes. All declining staff have the opportunity to attend a discussion with our infectious disease physician. So far that approach has been successful, and in last year’s flu season we achieved a 90% vaccination rate.”

The approach earned Mid Coast a Maine CDC award recently, “for consistently high rates of employee influenza vaccination.”

Different strategies work for different hospitals, says State Epidemiologist, Dr. Stephen Sears. “An intensive education program and interactions with employees tend to work better in smaller facilities,” he contends. “In larger facilities with thousands of employees, it becomes more difficult.”

According to a survey of 808 hospitals that was was published in the journal Clinical Infectious Disease, only about 40% of health care workers received a seasonal flu shot last year, even though it was required in more than half of all hospitals. Increasing the percentage of health care workers who get annual flu shots to 90% is one of the goals of Healthy People 2020.

“The primary goal of requiring annual flu shots,” explains Dr. Sears, “is to prevent health care workers from spreading the disease to high risk individuals. It’s important to remember that people start shedding the virus a day or two before they start getting sick. One strategy is if you get sick, you go home. The problem is you may have already spread the disease at that point.”

Individuals and health care providers may support getting an annual flu shot, but mandating them has some folks up in arms.

  • A critical care nurse in Chicago believes it is her right to make her own health care choices and says she will refuse a flu shot even if it means her job.
  • More than 150 employees signed a petition against a Tennessee hospital mandate. In a letter to hospital leaders, the employee who started the campaign said,  “I am writing to you out of concern for the new mandate that all employees receive the influenza vaccination as a condition of employment. I believe that vaccines [the hospital] feels are important should be offered, but not forced upon their employees.”
  • The Occupational Safety and Health Administration (OSHA) has stated that it “is strongly supportive of efforts to increase influenza vaccination rates among healthcare workers in accordance with the Healthy People 2020 goals. However, at this time, OSHA believes there is insufficient scientific evidence for the federal government to promote mandatory influenza vaccination programs that do not have an option for the health care provider to decline for medical, religious and/or personal philosophical reasons.”

As for Lisa, she says she is “a little bit steamed that the hospital has initiated a new policy.” She also question why it doesn’t require visitors or patients to wear masks as well.

Dr. Sears says the Centers for Disease Control and Prevention (CDC) does not tell hospitals what to do, but believes that vaccinating health care workers is an important strategy. “The strategy is one that is very similar to any other patient safety strategy,” he says, “which is to avoid getting their patients sick from something they do. A lot of people think of the vaccination of health care workers in the same way as washing your hands — you’re supposed to wash your hands before you see a patient because you don’t want to transmit illness. An annual flu shot is part of a strategy to prevent the transmission of influenza.”

What do you think? Should hospitals mandate employee flu shots?