# 2844
The TimesOnline is reporting today that only 14% of the UK's frontline Health Care Workers (HCWs) received a flu shot before the 2008-09 flu season. This low vaccination rate, Health Authorities contend, puts vulnerable patients at risk.
Proving once again, that a hospital is no place to send a sick person.
Here in the United States the compliance rate is higher, but still only about 42% of our HCWs get an annual flu shot. In recent months, some health care facilities have taken steps to try to make getting the yearly jab mandatory.
I wrote about how one Alaskan hospital is confronting this issue in a December blog entitled: Ongoing Debate: Mandatory Flu Shots For Health Care Workers?
Their policy?
Either get the flu shot, or look for other employment.
Last October, APIC (Association for Professionals in Infection Control and Epidemiology) released a statement recommending mandatory flu shots for health care workers, which I blogged about in APIC Seeking Mandatory Flu Shot For HCWs.
I admit I'm not completely comfortable with the idea of a `mandatory' flu shot for HCW's, even though I believe that HCW's should get a flu shot every year. In the interest of full disclosure, I take an annual flu shot, and have done so for many years.
We find ourselves at the precarious intersection of a person's right to choose whether or not to take a vaccine, and a hospital's need to protect patients, and other employees, from potentially contagious individuals.
There are economic, moral, and liability issues involved here, and no easy answers.
Influenza kills thousands of people each year, and undoubtedly a fair number of those people contract the virus while in a hospital, doctor's office, or nursing home setting.
Unvaccinated HCW's are probably the cause of at least some of those deaths.
Of course, even vaccinated HCW's can spread the flu.
Even during years when the vaccine is a good match, it is generally only about 70% - 80% effective.
And HCW's can also spread the virus from patient to patient by failing to wash or sanitize their hands, or through inanimate objects (dinner trays, stethoscopes, long sleeves,etc.) that move about a hospital.
Obviously, you will never completely eliminate the nosocomial transmission of influenza. But the first tenant of medicine is, after all: Primum non nocere - "First, do no harm."
The question becomes, is it reasonable to mandate that health care workers take a flu vaccine every year? And how much liability does a hospital have if it allows unvaccinated HCW's to deal with patients?
Public Health Officials, hospital administrators, and infection control teams are increasingly finding themselves in the middle of a battle between individual employee's rights, and protecting their staff, patients, and the public.
In 2006, a U.S. District Court in Seattle ruled that the Virginia Mason Medical Center couldn't force nurses to take flu shots. Undoubtedly this ruling will be tested again in the future.
Now, after a particularly bad flu season in the UK, the debate over mandatory flu shots for NHS workers is front and center.
A hat tip to Carol@SC on the Flu Wiki for posting this report from the TimesOnline.
From The Times
February 28, 2009
Flu spread by unvaccinated NHS frontline staff
Most health workers ignored advice to have a flu vaccination, exacerbating infections in hospital
Sam Lister, Health Editor
Health workers have been blamed for putting vulnerable patients at risk and worsening the winter’s flu outbreak by refusing to have flu jabs.
Fewer than one in seven frontline NHS staff had a flu jab last year, The Times has learnt, despite a recommendation that they do so. The Royal College of General Practitioners called last night for hospital doctors, GPs, nurses, carers and other staff to have compulsory jabs or be banned from contact with patients other than in exceptional circumstances.
Figures to be published next week by the Department of Health will show that the vast majority of health professionals ignored government advice that everyone in direct contact with patients be immunised.
Of the hundreds of patients seriously affected by staff transmission of flu, some were infected while being treated in high-dependency wards.
The health department figures show that only 14 per cent of frontline workers had a flu jab before the 2008-09 season, despite warnings from Sir Liam Donaldson, the Chief Medical Officer for England, that immunisation rates had to improve.
The flu outbreak over Christmas and the new year was the worst for eight years, with more than 60 cases per 100,000 head of population. About 2,000 deaths are attributed to flu annually – although the number can rise to more than 10,000 in bad years. The number for this winter has not yet been released.
Some hospitals suffered serious flu outbreaks exacerbated by staff transmission of the highly contagious virus, while shortages of workers put pressure on accident and emergency departments. Anecdotal reports suggest that on occasion patients brought to hospital by ambulance had to wait for up to five hours because staff were so overstretched by absenteeism and higher admission rates caused by flu.
At Royal Liverpool University Hospital, nearly 100 patients caught flu, including on high-dependency wards treating blood diseases and kidney problems.
Low levels of vaccination among staff were identified by the Health Protection Agency as a significant factor in the outbreak. When health chiefs in Liverpool asked any unvaccinated staff to get a jab to help to control the outbreak, almost 1,300 came forward.
(Continue . . . )
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