Flu vaccine rate rises to 96% with mandate

Court ruling exempts unionized nurses

The nation's only hospital to mandate influenza vaccination of health care workers achieved a 96% vaccination rate, despite a court ruling that exempted unionized nurses from the "fitness for duty" requirement.

Even the nurses, who had challenged the rule at Virginia Mason Medical Center in Seattle, responded to the call for vaccination. More than 90% received the vaccine, the hospital reported.

"We're really proud of them," says Joyce Lammert, MD, PhD, the hospital's deputy chief of medicine. "We think they're upholding their moral and ethical obligation. They really care about patient safety."

Under the hospital's policy, all employees must receive the annual influenza vaccine as a "fitness for duty" condition of employment or receive an accommodation for medical or religious reasons. Those who receive accommodations must take either prophylactic antiviral medication or wear a mask during the active flu season (January through March). Most have chosen to wear a mask, Lammert says.

The Washington State Nurses Association asserted that the hospital could not unilaterally change a condition of employment for the 600 unionized registered nurses. An arbitrator agreed, in a decision that was upheld in January by the U.S. District Court. In accordance with that ruling, the vaccination mandate does not apply to them.

Less than 1% of about 5,000 other employees requested an accommodation, Lammert says. About 10 employees refused to receive the vaccine and were terminated, she says.

"We've always had an active immunization program," she says. "The highest we've ever gotten is the low 50 [percentages]. As of today, we're close to 100%. The proof is in the pudding. It clearly worked."

'Save Lives, Immunize'

Virginia Mason's flu policy originated from the work of the flu team, which included Lammert, managers, physicians, nurses, medical assistants, and customer service representatives. As they discussed preventing transmission to vulnerable patients and improving immunization rates, she recalls that one medical assistant commented, "I can't believe this isn't a requirement."

The hospital leadership supported a strong policy that would make influenza vaccination a condition of employment. But just as the hospital planned to implement the policy, in the 2004-2005 season, a vaccine shortage curtailed the vaccinations.

Last fall, the hospital began with focus groups and a contest for a campaign slogan. The winner: "Save Lives, Immunize."

The hospital placed a major emphasis on education. A vaccine expert and bioethicist spoke at educational forums. Employees attending programs were eligible for door prizes. The flu team produced a video on the benefits of flu vaccination for both employees and patients. It featured hospital employees and physicians, including a cardiac thoracic surgeon who had been sidelined for a week by the flu the year before.

"It probably won't get an Academy Award, but it was a great video that helped humanize what we were trying to do," Lammert says.

Clearly, some employees were angry about the new requirement, which encompasses independent practitioners (such as physicians), volunteers, and students. The nurses' union argued that education would be the most effective way to improve vaccination rates.

"We absolutely support nurses, and everyone, getting the flu vaccine," says Anne Tan Piazza, spokeswoman for the Washington State Nurses Association. "What we're opposed to is having that be a mandatory condition of employment."

Employees who didn't want the vaccine were counseled one-on-one, says Lammert. "We worked very, very hard with every single person," she says.

Elsewhere in the country, some employee health professionals and union leaders criticized the Virginia Mason policy as overly coercive. But the hospital received kudos from Greg Poland, MD, director of the Mayo Vaccine Research Group and president of the International Society for Vaccines.

"My prediction is that the time will come when Virginia Mason will get some kind of a gold medal for their thinking about quality of care," he says. "I think they're going to get accolades for this."