Absenteeism may hit hospitals this flu season

One-third reported flu-linked shortages last year

Brace yourself for a tough flu season. Absenteeism could become an issue for many hospitals as unvaccinated employees with respiratory symptoms miss days of work.

Health care worker influenza vaccination rates typically are dismal, with only 38% receiving the vaccine, according to the National Health Interview Survey. No one knows how many health care workers will be vaccinated nationally this year, but the rates likely will vary widely based on the vaccine supply available to individual hospitals.

With fewer people immunized in the general population, unvaccinated health care workers could be more vulnerable to the illness, employee health experts say. The result may be significant staffing shortages.

"We, of course, are concerned about the quality and intensity of flu this year because that will influence our absenteeism," stresses William Schaffner, MD, chair of the department of preventive medicine at Vanderbilt University in Nashville, TN, which had ordered from Chiron Corp. of Emeryville, CA, and found itself scrambling for available doses.

"Our fingers are crossed that we’ll have a milder than usual flu season. If that’s true, we’ll get through this OK," he says.

Many hospitals had planned campaigns to increase their employee vaccinations — only to discover they had little or no vaccine. Even those with adequate supply are following recommendations of the Centers for Disease Control and Prevention (CDC) and limiting vaccination to health care workers in direct patient care or with other risk factors, such as chronic illness.

Last year, a CDC survey found that 35% of health care facilities reported staffing shortages due to influenza. The greatest impact was in the western United States, where 47% of health care facilities reported shortages. Those facilities actually had reported higher than average vaccination rates, with an average of 53%. The CDC will conduct a similar survey this year to determine the impact of the vaccine shortage.

"We have never been well-positioned to prevent absenteeism because of the low rates of vaccination among health care workers," says Raymond Strikas, MD, medical officer in the CDC National Immunization Program. "So hospitals have dealt with this in the past."

Sick HCWs and a flood of patients

This was to be the year for a major push for health care worker vaccination. The CDC made vaccination of health care workers a priority, as did the Association for Professionals in Infection Control and Epidemiology (APIC). Hospitals created slogans and strategies to get the shots to employees.

With those campaigns now cut short, hospitals will need to rely on other methods to minimize the risk of nosocomial spread of influenza.

Health care workers with a cold or cough will be expected to follow respiratory hygiene: using alcohol-based hand rubs or washing hands frequently, wearing a mask if there are respiratory symptoms, and coughing into a tissue. Health care workers also should wear surgical masks if they have close contact with patients with respiratory symptoms, according to CDC recommendations.

But here’s a worst-case scenario: limited vaccination with virulent flu in the community. You won’t want your health care workers to come to work if they have symptoms, but you need as many as possible to report for duty to care for patients.

You also don’t want health care workers staying home every time they get a runny nose. "How do you define sick?" Schaffner asks.

The presence of a fever is a key factor, as it may indicate that the worker is contagious. "Once they’re afebrile, they can probably go back to work," Strikas adds. "For most people, that should be two or three or four days."

Using antivirals to treat infected health care workers can shorten the course of illness if they’re used within two days of onset. Because the medications have potential adverse effects, employees would need a health screening, Schaffner says. In fact, concern about adverse effects may make employee health professionals reluctant to use antivirals among this otherwise healthy population, he adds.

If there already is an influenza outbreak in the facility, the CDC recommends the prophylactic use of antivirals among health care workers who care for patients at high risk of complications from influenza, such as HIV/AIDS patients. (Vaccinated workers only would need the antivirals for two weeks after receiving the vaccine.) Health care facilities can consider using antivirals as chemoprophylaxis in health care workers who have direct patient care responsibilities and have been unable to obtain the vaccine, the CDC says.1

If influenza is spreading throughout the community, your hospital likely will feel the impact even with vaccine and antivirals. If the situation becomes severe, you may want to initiate parts of your pandemic influenza plan to cope with an onslaught of patients and staffing shortages due to influenza-stricken workers.

That is what Vanderbilt did last year when the emergency department was overwhelmed with influenza patients, Schaffner notes. Physicians assessed patients and determined which ones could be safely discharged.

That opened up enough beds to handle the overflow, and the hospital didn’t need to move to Phase 2 of the plan, which would have included curtailing some elective procedures, he says.

Not everyone is struggling to vaccinate health care workers this year. Ironically, for those hospitals with adequate supply, the shortage may raise the demand and inspire better vaccination rates among health care workers with direct patient care. In fact, the shortage may help hospitals raise their vaccination rates next year.

"Four years ago, when there was never a shortage, we had a hard time giving it away," explains JoAnn Shea, MSN, ARNP, director of employee health and wellness at Tampa (FL) General Hospital. She had ordered extra doses from Aventis Pasteur and had started her Flu Challenge program in mid-September, a few weeks before the Chiron news broke.

The Flu Challenge targeted high-risk units, such as the burn unit, transplant, critical care, and intensive care, to raise their health care worker vaccination rates by 20%. If they succeeded, the staff won wellness prizes, including a chair massage.

Employees began to respond to the challenge. For example, the cardiac surgery unit went from seven employees vaccinated last year to 32. There are 71 employees in the unit.

But even with a full order of vaccine, the hospital ran out. Physicians and medical residents who usually received the vaccine elsewhere got it from Tampa General. The hospital also followed the CDC recommendations and limited the vaccine to health care workers with direct patient care and to high-risk groups.

"Without a doubt, we have a lot of people who still want it," Shea points out. "If we were able to do our Flu Challenge program like we had planned, I think we would have well surpassed these numbers."

And even with better vaccination rates, Shea is wary about the flu impact on her employees — and staffing. "A shortage is going to affect everybody because you’re going to have more chance of exposure in the community," she says.

With so much publicity and concern about the flu and the flu vaccine, Shea hopes employees will be more receptive to vaccination in the future. "All it takes is to get the flu once, and people will become flu vaccine believers."


1. Centers for Disease Control and Prevention. Influenza antiviral medications: 2004-05 Interim chemoprophylaxis and treatment guidelines. Nov. 3, 2004. Web site: www.cdc.gov/flu/professionals/treatment/0405antiviralguide.htm.