Physician viewpoint: Hospital leaders should mandate vaccination among staff

Misperceptions about vaccines are the same in hospitals and long-term care as the rest of the world

It would be easy to assume that in a healthcare setting there is a high level of understanding and acceptance of vaccines. The reality is hospital employees live in the same communities and are exposed to the same social media, arguments and concerns that have driven vaccine skepticism in the rest of the population.

Just like the general public, some healthcare workers incorrectly worry that the flu shot gives them the flu, or they assume if they felt bad after one vaccination, they will have a bad reaction every time.

But the stakes are higher among healthcare workers. One unvaccinated worker exposed to the flu or another preventable illness can infect dozens of coworkers and patients before that worker even knows they are ill. Research has shown that many health workers will continue to come to work once symptoms appear, even in violation of workplace polices, increasing the exposure to patients and co-workers.

While gains in vaccination rates have generally improved for healthcare workers in recent years in hospitals and long-term care settings, the rates remain too low to protect workers, employers and, most importantly, vulnerable patients. In the 2017-2018 flu season, 78.4 percent of healthcare personnel were vaccinated, according to the CDC. While that rate is similar to the 79% vaccinated in the 2015-16 flu season, it is not enough, and the vaccination rates are even lower in long-term care facilities.

Healthcare workers with the most medical education are most likely to be onboard with vaccinations. In the 2017-2018 flu season, CDC data showed physicians were vaccinated at the highest rate (96.1 percent), followed closely by pharmacists and nurses. Vaccination rates were lowest (under 73 percent) among aides and non-clinical healthcare personnel.

The goal should be above 98 percent vaccination rate, accounting for the small portion of people with allergies or compromised immune systems who should not be vaccinated. Getting to this level of vaccination requires leadership, listening, education, easy access and mandates.

Strategies for increasing vaccination rates

Among strategies for increasing vaccination rates in hospitals and long-term care settings, mandates are by far the most successful. One study found that long term care facilities that had mandatory vaccination requirements resulted in 89.3 percent of employees vaccinated. In hospitals, that percentage rose to 96.6 percent.  

But imposed with a heavy hand, mandates are increasingly meeting resistance. Mandates must be accompanied by strong leadership, which includes clear and persistent communication from the top, and the right message: We are keeping healthcare workers safe so they can keep their patients safe.

Listening is an important element of success. Vaccination requirements are most readily accepted when unions and workforce leaders are engaged in the discussion before requirements for employment are changed. Vaccination compliance rates also go up when vaccinations are included as quality indicators, and when vaccinations are free and easy for workers to access, such as through programs that bring vaccination carts to workers on multiple days and times to accommodate shifts.

Workers should know that the risk they put themselves in with vaccinations is minimal, and yet they put patients' lives at risk if they avoid that responsibility.

Not just for the flu

While the flu shots get a lot of notice because the vaccine changes with each flu season, it is important that healthcare workers are protected from other highly contagious but preventable diseases. The recent resurgence in measles demonstrates the need to ensure that the measles, mumps and rubella vaccinations are current in health workers who are too young to have contracted measles as children.  Tetanus, diphtheria and pertussis is recommended, especially due to the danger pertussis poses to young patients. A generation is just coming into the workforce that had little exposure to chickenpox, making varicella another vaccine to check. The CDC also recommends healthcare workers are vaccinated for hepatitis B and, in some cases, meningitis.

Healthcare workers want to take care of their patients and don't want to make them ill by spreading preventable diseases. The right policies and support can protect both healthcare workers and patients form dangerous preventable illnesses.

The evidence is strong and consistent: Vaccinating nearly all healthcare providers keeps healthcare workers safe, reduces patient mortality and reduces complications that lead to extended length of stay. Vaccination adds another element of patient safety by helping facilities maintain staffing levels during disease outbreaks.

Dr. Babcock is president of the Society of Healthcare Epidemiology of America and Dr. Kaye is a professor of medicine in the Division of Infectious Diseases at the University of Michigan Medical School in Ann Arbor.


More articles on clinical leadership and infection control:

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Trump signs exec order on flu shot development

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