Hospital considers rule for mandatory flu vaccination

Voluntary program isn’t working, expert says

If you could reduce absenteeism, protect vulnerable patients, and keep employees healthier with one yearly shot, what would you do?

To Gregory Poland, MD, director of the Vaccine Research Group at the Mayo Clinic in Rochester, MN, the answer is obvious. You would make it mandatory for employees with patient care duties.

The shot is the influenza vaccine. And though many Americans think of the flu as just a little worse than the common cold, influenza causes thousands of complications and deaths every year. Children, older people, and those with chronic illnesses are most at risk.

"In an average year, 36,000 Americans die of a disease that’s preventable. That is exactly that same number as if we had a World Trade disaster every month, month after month," says Poland.

The Mayo Clinic is considering whether to become the first acute care facility to require the vaccine for those who work with vulnerable patients, such as in the intensive care unit.

Maryland, New York, and North Carolina already require the flu vaccine for employees of long-term care facilities.

This year, several organizations have launched campaigns to improve immunization of health care workers, including the Centers for Disease Control and Prevention (CDC), the Association for Professionals in Infection Control and Epidemiology, and the National Foundation for Infectious Diseases (NFID).

Only about 36% of health care workers receive the annual vaccine, according to data from the National Health Interview Survey.

"It’s immensely frustrating that we say we’ll highly recommend it.’ That’s fine," says Poland. "More than four decades of data disprove the notion or the hypothesis that a voluntary program for health care workers is going to work."

Poland has become a national advocate for mandatory influenza vaccination. Health care workers who do not receive the vaccine should be required to sign a declination, as they do with the hepatitis B vaccine, Poland says.

"All of us physicians made a promise, we took an oath to protect out patients," he says. "I intend that we live up to that promise."

The failure of health care workers to get the flu vaccine has grabbed national attention. Earlier this year, after a flu season marked by strong public demand for the vaccine, the news media picked up on this paradoxical story that a minority of health care workers received it.

"There were many surprised comments by lay persons that this was not routine," says William Schaffner, MD, chair of the department of preventive medicine at Vanderbilt University School of Medicine and a board member the National Foundation for Infectious Diseases.

Schaffner says he is intrigued by the idea of a mandatory program. "We will be looking at [Mayo’s] program to see how well it indeed works. Hospitals and other health care facilities will learn from it. If it’s successful, [they will] adopt it in whole or in part in order to increase their own vaccination rates." But he also thinks there’s room for progress even without a mandate. For example, if surveyors from the Joint Commission on Accreditation of Healthcare Organizations began asking about influenza vaccination programs, hospitals would respond, Schaffner says.

The NFID recently released a "Call to Action" and a list of strategies for improving immunization of health care workers. That includes debunking a number of myths, he adds, including:

I’ll get the flu from the vaccine. "The myth that you can get flu from flu vaccine is alive and well in the nursing population," says Schaffner. "We need to address that in a reassuring, positive way. That has two bad impacts. Many nurses won’t get vaccinated because of that myth. If they believe it, they are not going to be strong advocates for flu vaccination among their patients."

I never get the flu. They aren’t just getting the vaccine to protect themselves from sickness. They are doing it to protect their patients, he says. About 30% to 50% of people with influenza may be asymptomatic, but they still can transmit the illness, the NFID says.

I don’t have enough time. The goal of influenza vaccination programs should be to make them as convenient as possible, Schaffner says. For example, Mayo has a peer vaccination program, in which nurses on a unit vaccinate each other.

I don’t like shots. A surprising number of nurses are themselves afraid of needles. The CDC recently issued guidelines that allow health care workers to use the new nasal-administered vaccine, unless they work with "severely immunosuppressed" patients.

(Editor’s note: More information on the NFID Call to Action and strategies for increasing immunization of health care workers is available at