Nurse Flu Shot Compliance Reverberates Through Community

For every 15 healthcare providers who receive the influenza vaccination, one fewer person in the community will contract an influenza-like illness, research shows.

There's been an ongoing debate about whether healthcare workers should be required to get flu vaccines. Often the focus of that debate has been the rights and responsibilities of nurses.

But a new study suggests that when healthcare workers do get vaccinated, the consequences go beyond the hospital and reach into the larger community.

The study, presented over the weekend at the Association for Professionals in Infection Control and Epidemiology's (APIC) 41st Annual Conference, shows that for every 15 healthcare providers who receive the influenza vaccination, one fewer person in the community will contract an influenza-like illness.

"Healthcare personnel vaccination extends beyond the walls of the hospital," the study author, James Marx, PhD, RN, CIC, infection preventionist consultant at Broad Street Solutions in San Diego, told me via email.

Marx analyzed archival data from the California Department of Public Health from between 2009-2012 for the study. A correlation design study determined the relationship between vaccination of hospital healthcare personnel and influenza-like illness in the community; hospitalization due to respiratory infection; and death from pneumonia or influenza. 1 in 3

1 in 3 Healthcare Workers Skip Flu Shots

According to the abstract, "There was an inverse relationship between vaccination rates of health care personnel and influenza morbidity as measured by influenza-like illness when three consecutive years of data were combined and analyzed."

Little seems to raise the ire of this column's readers than the topic of mandatory vaccines for healthcare workers. They take to the comments section (scroll down the page) to debate the ethics of such policies and the efficacy of the vaccines themselves.

According to the CDC, the efficacy of the influenza vaccine varies from season to season, but it does cite numerous studies showing its overall effectiveness. For instance, one study showed that flu vaccination reduced children's risk of flu-related pediatric intensive care unit admission by 74% during flu seasons from 2010–2012.

Another showed that flu vaccination was associated with a 71% reduction in flu-related hospitalizations among adults of all ages and a 77% reduction among adults 50 years of age and older during the 2011-2012 flu season.

The CDC and other organizations are also urging healthcare workers to get vaccinated against the flu. The coverage rate for healthcare workers was estimated at 72% for the 2012–13 season, representing an increase from 66.9% in the 2011–12 season and 63.5% in the 2010–11 season, the CDC reports.

However, voluntary flu vaccination doesn't seem to raise the rates enough, and many healthcare organizations have been reluctant to make getting flu vaccines a condition of employment. Some have taken that step, though, including University of North Carolina Health Care and Johns Hopkins.

One of the first to implement such as mandate was Loyola University Medical Center. A four-year study of the mandatory flu vaccination program there found that it did not lead to excessive voluntary termination.

It reports that "in the first year of the mandatory policy (2009–2010 season), 99.2% of employees received the vaccine, 0.7% were exempted for religious/medical reasons, and 0.1% refused vaccination and chose to terminate employment.

The results have been sustained: In 2012, 98.7% were vaccinated, 1.2% were exempted and 0.06% refused vaccination… Over the course of four years, fewer than 15 staff members (including volunteers) out of approximately 8,000 total chose termination over vaccination."

Whether or not a healthcare organization chooses to mandate the flu vaccine, Marx says it's still up to a hospital and its leadership to increase vaccination rates among employees.

"Vaccination rates vary widely based on leadership commitment," he says. Therefore, nurse and other leaders should role model annual influenza vaccination, and healthcare organizations should provide free vaccines and convenient access to them; doing so will make flu vaccination a "cultural expectation."

Marx also adds that hospitals should publicize vaccination campaigns with senior leadership, and "include the patient. They need to know what the hospital does to keep them safe."