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Vaccinations of Healthcare Workers

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Chelsea Emrit

on 11 September 2014

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Transcript of Vaccinations of Healthcare Workers

Chelsea Emrit,
Laura Borowski,
Stephanie Artusa,






* Test your flu IQ

*What's so bad about the flu?

*Vaccine Basics

*How can employers enhance vaccination compliance among healthcare workers?

*What is the current legal status of mandates?

* Pros and Cons of vaccination mandates

* Patient's perceptions

* Case Study
Enhancing Vaccination Compliance in Healthcare Workers
Legal Status of Mandates
CDC breaks down laws regarding vaccine mandates
Two types of laws
Offer law= A facility is required to offer or make available any vaccine to any healthcare worker or patient
Ensure law= A facility is required to arrange for the vaccination of, or make certain that any healthcare worker or patient has been vaccinated against, any vaccine-preventable disease unless a medical, religious, or philosophical exemption to the law is specified or the vaccination is refused
Patient's Opinion

With un-vaccinated health care workers:
*Patients cannot see HCWs faces & they hate it because they cannot see their expressions & it impedes effective communication.

*Patients may wonder why their nurse is wearing a mask & may automatically assume that they are sick.
Basic Facts
Impact of Influenza in the United States (1976-2003)
Types of Flu Vaccines
What's up about
Influenza is a single stranded RNA virus
3 types
A: moderate to severe illness, all age groups, humans and animals
B: milder illness, children, only humans
C: rarely reported in humans, no epidemics
Complications include pneumonia, Reye syndrome, myocarditis, and death
Reservoir= humans, animals
Transmission= airborne
Temporal pattern= peaks in December, lasts until March
Communicability= adults can spread flu 1 day before symptoms start until 5 days after symptoms start; children can transmit flu for 10 or more days after
The number of influenza-associated deaths varies substantially by year, influenza virus type and subtype, and age group
Annual influenza-associated deaths ranged from 3,349 (1985-86 season) to 48,614 (2003-04 season), with an average of 23,607 annual deaths
Persons 65 years of age and older account for approximately 90% of deaths
2.7 times more deaths occurred during seasons when a(H3N2) viruses were prominent
Highest rates of complications and hospitalization among young children and person > or =65 years
Average of >200,000 influenza-related excess hospitalizations
57% of hospitalizations among persons <65 years of age
Greater number of hospitalizations during type A (H3N2) epidemics
1. Trivalent inactivated influenza vaccination (TIV)
IM/intradermal: inactive versions of type A (H1N1), type A (H3N2), and type B
Grown in chicken eggs
2. Live attenuated influenza Vaccine (LAIV)
Same 3 viruses as TIV, intranasal
State Rulings
Offer law= California, Illinois, Maine, Maryland, Massachusetts, Nebraska, Oklahoma, Rhode Island, Tennessee
Ensure law= Alabama, New Hampshire
Arguments Against Federal/State Mandates
.Loss of autonomy
Healthcare workers cannot deny the vaccine based on religion, doubt of effectiveness, or personal beliefs
Healthcare workers would lose the right to choose their own health care decisions
Mandate healthcare workers to receive the flu vaccine
Blythdale Children's Hospital in NY
Held educational sessions on influenza disease and vaccine for each unit
Information given to employees with pay checks
Vaccination services were timed during employee work hours, including night shifts
Provided vaccination services using rolling carts on all units, during some staff meetings, and direct to administrative and support staff in their offices
Employees accepting vaccination were given free pens
Participation in program is voluntary; declination form required
Employer covers costs of program
73% vaccination rate
Community Hospital of the Monterey Peninsula
Provided information about the program via posters, webpage, online module.
Vaccine nurse floated daily with rolling cart to units for one month.
Added drop-in clinics near cafeteria and in infection control office.
Employees fearful of shots were seated in a “comfy” chair while a second nurse talked with them about their best vacation (distraction technique) and offered TLC.
Infection control staff available at clinics to provide factual information to counter myths.
Participation in program is voluntary; no declination form required.
Will be adding declination form for the 2008-09 program.
Employer covered costs of program
61% vaccination rate
Virginia Mason Medical Center in Seattle, Washington
Uses incentive system
Campaign kick-off“tailgate” party with the NFL’s Seattle Seahawks; activities included photos withplayers, autographs, t-shirts, buttons, bracelets
Partnered with Tully’s Coffee to promote the “double shot” campaign
Promoted a “Name the campaign” contest; winning slogan,“Save Lives – Immunize” was printed on bracelets and lanyards and given to staff to provide a visual cue of vaccinated employee
99% vaccination rate
Center for Disease Control. (2012, February 28).
Vaccines & immunizations. Retrieved from http://www2a.cdc.gov/nip/statevaccapp/statevaccsapp/AdminbyVaccineandPatientType.asp?PatientTypetmp=Hospital Employees&Vaccinetmp=Influenza

Tan, L. J. (2012, October 12). National influenza vaccine summit. Retrieved from

Occupational Safety and Health Administration. (2013). Seasonal Flu. Retrieved from http://www.osha.gov/dts/guidance/flu/healthcare.html

Steckel, C. (2007). Mandatory influenza immunization for health care workers: An ethical discussion. American Association of Occupational Health Nurses. 55(1). 34-39.

Centers for Disease Control and Prevention. (2012). Vaccine ingredients. Retrieved from: http://www.cdc.gov/vaccines/parents/vaccine-decision/ingredients.html.

Hamdan, A. (n.d.). Vaccines: a religious contention. Retrieved from http://www.vaccineriskawareness.com/Vaccines-A-Religious-Contention-

LaHoda, D. (2011). Requiring masks for healthcare workers. Briefings on Infection Control.
Retrieved from: http://blogs.hcpro.com/osha/2011/11/requiring-masks-for-healthcare-workers/.

Van Delden, J.J.M., Ashcroft, R., Dawson, A., Marckmann, G., Upshur, R., & Verweij, M.F. (2008). The ethics of mandatory vaccination against influenza for health care workers. Vaccine, 26(44). Retrieved from: http://www.sciencedirect.com.proxy.binghamton.edu
- 60% less likely to need treatment for the flu by a healthcare provider.

- If do get flu: reduces illness, antibiotic use, time lost from work, hospitalizations, and deaths.

- two weeks after vaccination for antibodies to develop in the body and provide protection
* get vaccinated early in the fall
Vaccine Facts
Mild: last 1-2days

Soreness, redness, and swelling at the injection site
Fainting, mainly in adolescents
Severe: begin within minutes. – hours

Difficulty breathing High Fever
Hoarseness Behavior Changes
Hives Dizziness
Swelling of eyes or lips Racing Heart
Vaccination Side Effects
A severe allergy to chicken eggs

A history of severe reaction to a flu vaccination

Infants, pregnant women, immunocomromised

A moderate-to-severe illness with a fever (you should wait until you are better to get the vaccine)

A hx of Guillain-Barre Syndrome
Immune system damages nerve cells --> a severe paralytic illness.

Some cases develop after flu vaccine (1976)
Those who shouldn't
get Vaccinated
- Might be respiratory virus

- Exposure shortly before or during two week period after vaccination

- Exposed to flu virus very different from one vaccination designed to protect against

- Doesn’t always provide adequate protection

- More likely if have weakened immune system or >65 yo
What about those who get vaccinated and still get sick with flu-like symptoms?

Occurs when a critical portion of community immunized. 
Most members are protected because there is little opportunity for outbreak
Community Immunity/"Herd" Immunity
Discussion Questions

Encouraging sick workers to stay at home;

Emphasizing hand hygiene and cough etiquette;

using airborne infection isolation rooms;

ensuring proper functioning of the heating, ventilation, and air conditioning (HVAC) system in patient rooms, procedure rooms, and examination rooms;

limiting the transport of infectious patients throughout the healthcare facility;

limiting the number of healthcare staff who come in contact with flu patients; and

Giving proper personal protective equipment (PPE) (gloves, gowns, surgical masks, respirators) to healthcare staff and ensuring that it is used and discarded correctly.

Develop a policy for Ill workers and consider additional medical surveillance and screening
Reducing Exposure to the Flu
- CDC recommends Priority groups receive the Flu Vaccine
*Highly effective, minimal side effects, benefits outweigh risks
- Morbidity and mortality rates have increased over last 10 years
* Vulnerable populations are in the hospital
* Not uncommon for nurses to continue to work even if sick
* Nurses may pass the virus to others before they are even aware they are infected
* Mortality rates are higher in hospitals with lower percentage of vaccinated health care employees

Goal = safeguard population at large
- freedom of workers to make decisions regarding own health should carry less weight than well-being of people who depend on them for their care
Saves Money
Every $1000 spent on flu vaccinations, $1600 decrease in health care costs
Lost work hours factored in potentially $4700 in savings
Vaccine Efficacy

* Well Matched: Prevents 70-90% of adults < 65 yo
* Not well matched (2003-2004): 52% effective

Vaccinated = 28% fewer
lost workdays
Whats Your Flu IQ???

This year it became mandatory for all Decker students to get vaccinated against the flu.
How did you feel about this?
Did anyone here choose not to get vaccinated?
What are some incentive programs hospitals can use to improve vaccination rates of employees?
What are some ways hospitals can educate about ways to protect yourself against the flu if you are not vaccinated??
Do you think all healthcare settings should mandate flu vaccinations and why?
How do you address personal, religious, cultural attitudes against receiving the flu vaccine?
Arguments against mandatory vaccination
Lack of Autonomy for Healthcare Workers
* Major freedom of choice issue because it infringes over one's autonomy.

*Generally, the prevention of harm to others is considered a legitimate cause for constraints on autonomy. However, is it enough harm to render a constraint on autonomy?
Questionable Ingredients
Hospitals do not want patients to think they are allowing a worker who is sick to care for them.
Case Study
Two Nurses Fired For Refusing To Take Flu Shot
Religious Factors
Christianity: The bible teaches that there are unclean animals and that we are not to put the "unclean" into our bodies.

Mormonism: Because some vaccines contain human diploid cells cultured from aborted fetuses, this is considered a contradiction of their faith.

Jehovah's Witnesses: "As vaccination is a direct injection of animal matter in the blood stream, vaccination is a direct violation of the law of Jehovah God." (The Golden Age publication)

Judaism: Vaccines for people may be made with animal parts that are not kosher.

Islam: Those that are Muslim believe that the body is created in perfection and immunizations are not needed to improve it.
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