ED Accreditation Update

Mandatory immunizations: Do they make any sense?

In light of the importance of having health care workers immunized against influenza, some facilities have instituted mandatory vaccination programs. For a few years, Virginia Mason Medical Center in Seattle stood alone with a mandatory influenza vaccination policy that enabled the hospital to vaccinate 98% of its employees, but other hospitals have quietly moved toward mandatory vaccination in an effort to reach the highest levels of coverage.

Yet several experts question that approach. "First of all, it is not currently recommended by the [Centers for Disease Control and Prevention], and our standards are based on scientific guidelines," says Louise Kuhny, RN, MPH, MBA, CIC, senior associate director, standards interpretation, for The Joint Commission. "We have no guidelines on which to base or recommend that practice."

David Ross, DO, an emergency physician at Penrose Hospital in Colorado Springs, CO, says, "I think immunization rates can be raised without a mandatory system, and I don't favor that approach. People should be able to opt out." He says his hospital allows staff to opt out.

Ross adds that if he had knowledge that an epidemic was a certainty and that morbidity and mortality rates were going to be substantial, it might be a different story, "but in our current environment, we are better off not trying to force it on people," he says. Not only is it "draconian" in nature, Ross says, but there could be a liability issue if staff members who have been immunized subsequently develop vague symptoms such as a numbness and tingling in their legs, and decide to sue.

Ken Braxton, JD, a health care attorney and partner in the Dallas law firm of Stewart Stimmel, says, "I agree with him; there's always a potential for that. Every hospital has to weigh the risks vs. the benefits, the potential side effects vs. having all your employees have flu shots." One of the key considerations, he adds, is the level of risk for flu infection in a given locale.