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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

Flu mask policies: Patient safety or punitive measure?

As part of its mandatory flu vaccination policy, the Association for Professionals in Infection Control and Epidemiology recommends that health care workers that cannot be immunized should wear a surgical mask when caring for patients or working with susceptible staff. This practice, which is already in place at some hospitals, was singled out for criticism by worker union officials in comments to recent National Vaccine Advisory Committee (NVAC) recommendations on influenza. The committee did not take a position on such masking policies, as it did not specifically recommend the individual conditions that should be used by hospitals adopting mandatory policies. “The ‘vaccinate or mask’ option some hospitals and county health departments (including San Francisco, Sacramento and Yolo counties in California) are requiring is…not based on evidence of effectiveness,” stated Margaret Robbins, MPH, National Director of the Occupational Safety and Health Coalition of Kaiser Permanente Unions, in comments to NVAC. “There is no scientific evidence that the routine wearing of surgical masks by unvaccinated healthcare workers protects either patients or the wearer of the mask from getting the flu. We believe this practice is intended to coerce and intimidate workers into getting vaccinated, and is not grounded in thoughtful analysis of whether the practice of daily mask wearing protects anyone.”

Robbins coalition is comprised of 28 local unions representing some 95,000 frontline employees of the Kaiser Permanente health system. Since a recent study showed that the flu vaccine is typically only 59% effective in a given flu season, and since there are many influenza like illnesses (ILI) that cannot be prevented by the flu vaccine then many workers who are vaccinated can and will get the flu or other ILIs, Robbins argued. “The logic of the situation tells us that it is not ‘just’ unvaccinated workers who are at risk of being a pre-symptomatic case of ILI (one of the justification we’ve been given for such policies),” she said in the comments to NVAC. "Both vaccinated and unvaccinated HCW could be a pre-symptomatic ILI case. By this logic every health care worker should be masked every day during flu season. We are not claiming this is a path that should be followed, but this is the direction logic leads us if we accept that the vaccinate-or-mask policy makes sense. “ Robbins also expressed concern that the masking policies actually could contribute to transmission if a worker never changes the mask throughout the course of patient care. “We wish the report and recommendations had reviewed and commented upon the safety and appropriateness of this type of requirement for vaccine refusal,” she noted.