Over to you: Wear a mask or a get a flu shot – should all care providers have to?

2013-01-29 Flu shot

Two weeks ago, it was the Fraser Health Authority in BC: Masks mandated at Fraser Health Authority to stop flu.

This week it was a hospital in Sudbury, Ontario: Wear face mask or get flu shot, hospital staff told

 

Virginia Mason Medical Center describes as a “defining moment” its decision in 2005 to require all employees to get a flu shot; it was the first facility in the US to do so. The policy came about after an employee participating in a Rapid Process Improvement Workshop (RPIW) wondered aloud: “If the patient really came first, shouldn’t everyone at Virginia Mason get a flu shot?”

According to the Globe and Mail’s public health reporter Andre Picard, health care workers should actually take pride in rolling up their sleeves.

Now it’s over to you:

Should everyone working in health care get a flu shot?

Should the health system, or health regions, be mandating immunizations for their employees?

What did you think of this post? Click below and let us know.

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9 Responses to “Over to you: Wear a mask or a get a flu shot – should all care providers have to?”

  1. amanda
    December 1, 2014 at 9:10 am #

    I am concerned on a deep level. If the flu shot is roughly 60% effective according to the government, why aren’t ALL healthcare workers wearing a mask? 40% of vaccinated workers are spreading the flu! I’m concern to see workers who are 60% covered shaming those who choose not to inject themselves with the flue shot. What is next? What direction is our country headed? We cannot allow our society to be micro-managed and controlled by our government.
    If they are truly concerned over those with compromised immune systems getting the flu, then EVERYBODY should be wearing a mask…everywhere? Think for yourselves! Historically many free thinking countries have been turned into countries of “sheep.” This step towards controlling society could lead to something serious and detrimental.

  2. Greg Basky
    Greg Basky
    February 4, 2013 at 9:04 am #

    Yesterday, USA Today ran 2 editorials on this topic: the newspaper’s editorial position (Flu vaccine mandate protects patients’ rights: Our view) and that of the National Nurses United (Forced flu shots provide no cure: Opposing view).

  3. Anonymous
    February 1, 2013 at 5:13 pm #

    Check out this article (and link) on the success achieved by VMMC

    Talbot T., Schaffner W. On Being the First: Virginia Mason Medical Center and Mandatory Influenza Vaccination of Healthcare Workers. Infect Control Hosp Epidemiol 2010; 31(9) – http://www.oehn.net/Fluvaccinecommentary.pdf

  4. Michael Myint
    February 1, 2013 at 3:47 pm #

    As medical epidemiologist at Virginia Mason, I don’t dispute many of the points that Steven Lewis discusses in his post. I would like to point out that the Cochrane review on influenza vaccinations in healthcare workers makes a very tightly worded conclusion with emphasis added by me.
    “We conclude that there is no evidence that only vaccinating healthcare workers prevents laboratory-proven influenza, pneumonia, and death from pneumonia in elderly residents in long-term care facilities. Other interventions such as hand washing, masks, early detection of influenza with nasal swabs, anti-virals, quarantine, restricting visitors and asking healthcare workers with an influenza-like illness not to attend work might protect individuals over 60 in long-term care facilities and high quality randomised controlled trials testing combinations of these interventions are needed.”
    At Virginia Mason, we believe in the value of our vaccination program for multiple reasons.
    1. Preventing one case of influenza for our staff with a low risk intervention shows respect for the health of the individual vaccinated, their work and non-work community, and to our patients.
    2. Let’s look at the analytical evidence from the Cochrane review for influenza vaccination, as imperfect as the evidence is. For 100 (low match year) vaccinations to prevent one infection, our numbers would show that by vaccinating our 5,000+ employees have now decreased 50 cases of employee influenza. By doing this we reduced the risk of transmitting this to their colleagues as well as transmitting to high risk patients at our hospital and clinics. We use a value called R0 for transmissibility, and though variable, usually is around 1-2 (but up to 10). This number reflects how many others are infected for every one case of influenza. Note that influenza is transmissible even without symptoms. So by immunization we have now potentially averted 50 x R0 transmitted cases, decreasing morbidity and mortality in at least 50-100 or more potentially high risk patients in our hospital and clinics. Yes, error-proof infection control practices would mitigate this, but luckily we live in a world where we can do both as successive safety steps.
    3. Our influenza program is consistent with all of our efforts to make Virginia Mason the safest place for patients and our employees. When we ask our high risk patients to get immunized, we lead by example.
    I am a huge believer in evidence based practice, but where there is lack of conclusive evidence, biological plausibility and historical models have value. The elimination by vaccination of smallpox was a sentinel world event and a triumph of medicine. I always love referring to this paper http://www.bmj.com/content/327/7429/1459 to remind myself some of the limitations of over-reliance on a narrow view of evidence based practice.
    And yes, I stopped ordering PSA’s for screening.

  5. Corinne Haack
    February 1, 2013 at 10:37 am #

    While I appreciate Heather’s comments, I have a child who too is at risk to such exposure, I am leaning more to identifying with what Steven has laid out. That is I don’t think there is enough evidence to warrant mandating the flu shot.

    It was exciting to see the transparency of posting handwashing audits throughout the ER at RUH when we visited yet again in December, yet disturbing to see the number “68%”. So for me things such as handwashing and wearing masks makes me feel better than knowing the staff had a flu shot. After all there are many things the flu shot can not cover.

    I also wonder what mandating flu shots means in terms of human rights for all people, both staff and patients/families. What about staff’s rights and beliefs? Can we say staff who comply with hand washing and wearing masks but don’t get the flu shot are less patient and family centered? What about other patients – will we mandate they get the flu shot as well to ensure they are not adding additional risk to other patients? What effect would mandating the flu shot have on other services such as Steven listed – would it then be necessary to eliminate mammograhpy screening?

    A lot of food for thought that doesn’t make it any simpler for me to know whether my thought is right or wrong. Maybe one day, I will regret my point of view to not mandate flu shots but for now I will continue to work on being brave and asking my healthcare providers “Did you wash your hands?”

    • Lisa S.
      February 1, 2013 at 11:53 am #

      Thanks for bringing this up. I tend to align more with Steven and Corinne. I’m curious how much is being spent on mass immunizations and who’s benefitting? I have not seen compelling evidence (unbiased) that shows this intervention is truly reducing sickness, death and related health-care costs.

      And the “don’t you care about vulnerable patients?” guilt trip is turning me off. Unless everyone in a facility gets immunized or wears a mask (including patients/residents, physicians, staff, volunteers, visitors, etc.) how do you really know the spread came from unimmunized health-care workers? And masks are only effective if people use them correctly.

      In the argument for immunization, I hear people say, “You should get a flu shot because you could be a carrier and not even know it.” But if influenza shots aren’t 100% effective, then can’t I still potentially be a carrier? I’m more worried about people not washing their hands.

      I would love to see what results those who require mandatory flu shots are getting. If it’s workinig, I would think they’d be seeing reduced sick time for staff, huge cost-savings within the system and, most importantly, less sickness and flu-related deaths. Is this happening? I haven’t seen a lot of data on it so I truly don’t know.

      And by the way, I did get a flu shot this year but if it becomes mandatory, I might choose to mask up instead (as a show of principle).

  6. Steven Lewis
    February 1, 2013 at 9:29 am #

    My answer is, it depends on your threshold for evidence. If you think a) the evidence in favour of flu shots is strong enough to warrant making it mandatory for employees, and b) stronger evidence about other health care interventions should therefore also warrant mandatory practices, you should then mandate:
    – the elimination of mammography screening
    – the elimination of PSA screening
    – a major reduction in bone density testing
    – a major reduction in knee arthroscopies
    – a major reduction in many forms of back surgery
    – adverse childhood events screening in primary care
    – automatic review of all patients on 5 or more drugs.

    The evidence for flu shots is very flimsy according to the most recent Cochrane Review. The highlights:
    1. For healthy adults, where the vaccine and the flu strain are well-matched, it takes 33 adult flu vaccinations to prevent one case of flu-like symptoms.
    2. For healthy adults, where the match is not very good (which is the case most of the time), it takes 100 vaccinations to prevent one case.
    3. For the elderly, the evidence of mass vaccination is inconclusive, although there does appear to be a drop in all-cause mortality.
    4. Immunizing health care workers does not, according to a 2006 review, reduce complications among people they care for.
    5. Hand-washing, masks, and isolation or quarantine are effective in containing pandemics.

    So the question is, of all the evidence-based measures that would, if implemented across the board, make health care safer and better, where would flu vaccines rate? I would say, really low. If you’ve got 100% compliance on hand-washing, well-designed facilities that reduce exposures, and readily available and used masks in higher risk conditions, outcomes will improve. If then you want to achieve small additional risk reductions, and you think it is cost-effective to do so, maybe mandatory flu shots will get you there.

  7. Heather Thiessen
    February 1, 2013 at 9:04 am #

    Kudo’s to Virginia Mason, absolutely staff should have a flu shot. As a patient who deals with staff regularily it is one less thing I would need to worry about if I knew the people caring for me respect my health ( immuno-suppressed )and others like me by having a flu shot!!

  8. Mike Sprouse, Virginia Mason Medical Center
    January 31, 2013 at 4:48 pm #

    Appreciate the post, Greg, and the link to the Virginia Mason Blog. We are proud of our work around flu shots, and it wasn’t an easy road — at least in the early days. Great topic!

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