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

Masking the Unvaccinated Healthcare Worker: Science or Stigma?

By Gary Evans, AHC Media Senior Staff Writer

As flu shots are increasingly mandated for healthcare workers, some states, health departments and individual hospitals are requiring those who decline vaccination to wear a surgical or exam mask during patient care. Is this a scientifically valid approach or a social stigma akin to a "Scarlet Letter?"

Ostensibly, masking the non-immunized is based on the concern that healthcare workers with early-stage, asymptomatic flu infection may transmit the virus to vulnerable patients. However, the approach has been also criticized for inducing a kind of stigma that increases pressure on healthcare workers to be vaccinated. Even vaccine advocates question whether it is really effective, given that masks were not really designed to prevent flu transmission and the established lack of compliance with all manner of personal protective equipment in healthcare. Those who call for flu vaccination mandates as a condition of employment see the policies as a way to dodge immunization. Others see healthcare workers who may have a valid reason for not being vaccinated branded by a punitive policy.

Typically, mandated flu shot policies have a declination clause for those citing a medical or religious reason not to be vaccinated. According to the CDC, 11 states permit medical exemptions for vaccination requirements, four states permit religious exemptions, and ten states permit philosophical exemptions.

Healthcare settings vary on how they handle these requests for exemption, with some allowing those not vaccinated to continue working if they wear a surgical mask during patient care activities. Three states (Colorado, New York, and Rhode Island) require hospital healthcare workers to wear surgical masks during flu season if they have been exempted from or declined vaccination, the CDC reports.

California state law requires employees to be offered vaccines free of charge and to sign a declination form if they choose not to be vaccinated. However, each local health department has the authority to issue requirements that apply to facilities within their jurisdiction only, which include in some cases that unvaccinated workers wear masks for patient care.

For example, the policy posted on the state health department website for Tuolumne County CA, openly acknowledges that one of the benefits of a masking policy is increased immunization, suggesting it is as much a pressure tactic as a valid accommodation: “HCWs who decline to receive a seasonal influenza vaccination, will be required to wear a surgical mask while working in patient care areas during influenza season, between November 1 and March 31 each year. … In addition to protecting the wearer from transmitting the influenza virus, masking requirements have strongly and consistently raised vaccination rates among healthcare workers.”

For more on this story see the December 2016 issue of Hospital Employee Health.

Gary Evans has written about infectious diseases, infection control and other healthcare issues for more than 25 years. His writing and reporting have been honored with five awards from the National Press Club in Washington, DC.