Should Hospital Workers Who Don’t Get a Flu Shot Be Required to Wear a Mask?

(Photo: Yasser Alghofily)

A few weeks ago, before the flu was national news, a reader who works at a hospital in Portland, Or., wrote to say: “The organization I work for just started this policy, I think it is very interesting and may push those who don’t want to get a flu shot for whatever reason to get a flu shot to avoid the stigma of wearing a mask. The employee comment section has ranged from HIPPA violations to discrimination for those who can’t have a flu shot based on egg allergies.”

Here’s the policy:

You may have heard by now: Flu season is ramping up in Oregon, with cases now starting to affect hospitalized patients in greater numbers. For individuals whose immune systems are compromised by other conditions, the flu can be life threatening.

To keep patients safe, a new Influenza Vaccination and Masking policy requires that workforce members do one of two things during flu season:

  • Get vaccinated. Free vaccinations are available through Occupational Health. If you’ve already gotten a vaccination somewhere other than Occupational Health — but haven’t been offered an official blue check mark sticker on your ID badge to reflect that fact — make sure you’ve filled out your attestation form.
  • Wear a mask. If the vaccine’s not for you or you just haven’t gotten it yet, policy requires that starting at 12 p.m. on Dec. 19 — and until the active implementation is lifted — yellow procedure masks must be worn within 6 feet of patients in patient care areas.

Remember: The official blue check mark sticker on your photo ID badge is the visual key used to determine who needs to wear a mask. Wearing the sticker is a choice, for those who have been vaccinated, but without it masks are required.

This doesn’t strike me as unreasonable. After all, hospitals are in the business of making sick people well, not making sick people sicker, and one thing a flu vaccine is meant to accomplish is to stop relatively healthy people from passing along a flu to more vulnerable people.

Your thoughts? 

 

Leave A Comment

Comments are moderated and generally will be posted if they are on-topic and not abusive.

 

COMMENTS: 100

View All Comments »
  1. Mike B says:

    Hidden due to low comment rating. Click here to see.

    Disliked! Like or Dislike: Thumb up 49 Thumb down 67
    • Martin says:

      Hidden due to low comment rating. Click here to see.

      Disliked! Like or Dislike: Thumb up 42 Thumb down 61
      • Rusty says:

        Have you ever thought about the nurses who have an allergen and can not receive the vaccine? Your ignorance and lack for others amazes me.

        Well-loved. Like or Dislike: Thumb up 47 Thumb down 20
      • Deb says:

        Not to forget to mention…have you even taken the time to look up what they put in the flu vaccine. I’m sorry, but I don’t particularily care to inoculate my body with thermosol, detergents, mercury, chicken and pig innerds and God knows what else. TVM.

        Well-loved. Like or Dislike: Thumb up 28 Thumb down 19
      • Seminymous Coward says:

        There is no evidence of thimerosal harming anyone, and it was removed from vaccines sent to developed countries long ago. However, your constant complaints are making it difficult to use in countries without readily available refrigeration where it’s vital to getting life-saving vaccines safely distributed. Your ignorant whining has effects tantamount to mass murder.

        There are generally surfactants in your toothpaste. There is no elemental mercury in vaccines. I’d like to see a citation for chicken and pig innards in a vaccine.

        Do you realize the people who make vaccines are vaccinated, as are their children? There’s no evil conspiracy here. If nothing else, all these random scary things you imagine are put into shots cost money, and there are far cheaper ways for some cartoon villain to mass murder; anti-vaccine advocacy springs to mind. How exactly do you think the big nasty corporations are profiting from contaminating vaccines? Keep in mind that if it were simple fraud they’d just put perfectly safe saline in the shots.

        Well-loved. Like or Dislike: Thumb up 28 Thumb down 20
    • Seminymous Coward says:

      Mike B definitely has the right policy for this issue. They are being reckless with their own healthcare, endangering patients, and opposing a cornerstone of modern medicine. If they can’t be trusted to apply evidence-based medicine to themselves, they can’t be trusted to do it for others.

      It’s a public health issue both directly and because it gives the anti-vaccination crowd more ammunition in their fight to break our herd immunity and negligently slay an untold multitude.

      The egg allergy thing was born of (entirely reasonable) caution, and it’s being worn away by the research. ( Source: http://www.cdc.gov/flu/professionals/vaccination/vax-summary.htm#EggAllergy ) If some hospital employees have such severe egg reactions as to necessitate avoiding the flu shot, then they should be amongst the mask-wearing exception with the other people at http://www.cdc.gov/flu/professionals/vaccination/vax-summary.htm#NotRecommended and only those people.

      Well-loved. Like or Dislike: Thumb up 39 Thumb down 24
    • Kathy says:

      Mike B, there are a couple of problems with your proposal to fire hospital workers who don’t get a flu shot.

      One issue is people who cannot get one for medical reasons (egg allergy being a big one). ADA says that you need to find a reasonable accommodation for those people, and wearing a mask is a reasonable accommodation.

      Another issue is that vaccines, while the greatest thing humans have ever invented, are not risk free. I’m sure hospital lawyers have nightmares about someone getting a flu shot to avoid being fired, ending up with a reaction, and suing the (bleep) out of the hospital. It wouldn’t look good to a jury when they were told that the hospital passed up the reasonable requirement of masks in favor of firing.

      Well-loved. Like or Dislike: Thumb up 43 Thumb down 18
      • Enter your name... says:

        A severe egg allergy (anaphylaxed and ended up in the emergency depatment, not just hives) might be a common reason for exemptions, but a severe, life-threatening reaction to the flu vaccine itself is an absolute contraindication. It’s also quite rare.

        Well-loved. Like or Dislike: Thumb up 14 Thumb down 9
      • Mike B says:

        Hidden due to low comment rating. Click here to see.

        Disliked! Like or Dislike: Thumb up 25 Thumb down 36
      • TexCIS says:

        The hospital could also be sued if a patient gets the flu and dies, and the family can prove the patient was cared for by a nurse who did NOT get the shot but came down with the flu while caring for the patient.

        Hot debate. What do you think? Thumb up 20 Thumb down 17
      • Jay says:

        Hidden due to low comment rating. Click here to see.

        Disliked! Like or Dislike: Thumb up 8 Thumb down 27
    • Enter your name... says:

      The more moderate stance is to reassign them to a duty that doesn’t have any patient contact, rather than firing them. So nurses end up doing paperwork rather than patient care, janitors get stuck cleaning the administrative offices, etc. If you offer these accommodations only to people who have a legitimate disability-related need for them (not those who are afraid of needles or don’t want a slightly sore arm), then it’s not much of a burden on the institution.

      Hot debate. What do you think? Thumb up 9 Thumb down 13
      • Seminymous Coward says:

        Infecting the other employees is also bad. It violates sensible herd-immunity-based precautions.

        Well-loved. Like or Dislike: Thumb up 22 Thumb down 8
      • Nick says:

        I don’t think it’s reasonable to expect hospitals to pay a skilled nurse’s salary to shuffle paperwork if they’re unwilling to vaccinate themselves to interact with patients.

        Well-loved. Like or Dislike: Thumb up 17 Thumb down 5
      • Enter your name... says:

        Nick, they’re already paying skilled nurses to shuffle paperwork. There is a lot of paperwork that is supposed to be done by nurses. They review patient care documentation and check for protocol compliance and so forth. (In fact, we have a relative who is an RN and has done exclusively this for her hospital for years, and as a result can work from home or while traveling.)

        There are frequently dozens of nurses doing paperwork in a large hospital. The only question here is which nurse is doing it.

        Thumb up 4 Thumb down 2
  2. YX says:

    Interesting… as at least some hospital require every employee get flu shot. Not sure if this apply to contractor though.

    Thumb up 3 Thumb down 2
    • Enter your name... says:

      I’ve never heard of an American hospital that requires flu shots for all nurses, much less all employees. Every time it comes up in contract negotiations, the nurses’ unions all say that flu shots are good, but their own hospital shouldn’t be the first one to require it for all nurses, and instead everyone should wait until there is a law requiring it for the whole state or whole country. Besides, it’s probably those poor janitors or food service employees, rather than skilled nurses who are so contagious anyway.

      The service employees then say that whereas the nurses don’t have to have the flu shot, despite sometimes spending hours in close contact with patients, then the cooks and janitors shouldn’t be required to have it either.

      Then all the unions go to the government and say that since no hospital requires it for anyone, then it is not at all normal or accepted in the industry and should not be required by law.

      Thumb up 5 Thumb down 1
  3. Joel Upchurch says:

    There is little indication that facemasks will slow down the spread of influenza, so this falls under the heading of medical theater.

    http://www.ncbi.nlm.nih.gov/pubmed/21103330

    Well-loved. Like or Dislike: Thumb up 15 Thumb down 10
    • Seminymous Coward says:

      The study you cite was cut off by their steering committee before it collected anywhere near enough data. Look at that confidence interval: “the difference between arms was 0.40% (95%CI: -10% to 11%, P?=?1.00)” . Read their own conclusion: “This study should be interpreted with caution since the lack of statistical power prevents us to draw formal conclusion regarding effectiveness of facemasks in the context of a seasonal epidemic.” The only real justification I could see for publishing it would be so the data could be collected by review articles.

      Based on http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/news/aug1209iom-jw.html and http://www.ncbi.nlm.nih.gov/pubmed/19797474 , it seems the debate is whether surgical masks are as good as dual-purpose surgical masks and respirators, not whether any mask at all is effective. The N95/P2 respirators seem to be ~75% effective at stopping confirmed flu infections based on those much larger, non-interrupted studies.

      Well-loved. Like or Dislike: Thumb up 15 Thumb down 0
      • Joel Upchurch says:

        You are asking the wrong question. The answers indicate not that the masks work, but how often do they fail. They don’t rely on surgical masks for really dangerous viruses. They have full biological containment to protect doctors and staff in those cases. When you are dealing with a virus then is only 120 nanometers, then there is no question that the masks will fail some of the time. The masks are mostly for preventing the spread of bacteria, not viruses.

        Thumb up 5 Thumb down 7
      • Seminymous Coward says:

        I’m not suggesting they rely on masks over vaccinations, as I’ve made clear in other comments.
        Beyond that, I’m not sure what you’re trying to say. Masks are better than nothing, and they do have an effect. They are also frequently used to slow or prevent the spread of influenza specifically. We aren’t discussing exotic hemorrhagic fevers.

        Well-loved. Like or Dislike: Thumb up 6 Thumb down 1
      • James says:

        “When you are dealing with a virus then is only 120 nanometers…”

        Except that transmission is not (according to current knowledge, anyway) spread by naked viruses, but by viruses contained in much larger droplets of fluid expelled when infected people sneeze or cough.

        Well-loved. Like or Dislike: Thumb up 12 Thumb down 0
      • Nick says:

        This recent summary of masks/respirators and their role in prevention of influenza in the NYT is timely for this discussion. )http://newoldage.blogs.nytimes.com/2013/01/16/in-flu-seasonuse-a-mask-but-which-one/)

        Thumb up 1 Thumb down 0
    • Dan says:

      But the theater is effective if it increases the number of employees who choose to get the vaccine

      Well-loved. Like or Dislike: Thumb up 27 Thumb down 5
  4. scott says:

    Hidden due to low comment rating. Click here to see.

    Disliked! Like or Dislike: Thumb up 13 Thumb down 19
    • Seminymous Coward says:

      “I am not sure that … flu shots are all that effective.” Would you care to cite some evidence for your assertion against the overwhelming body of research?

      Well-loved. Like or Dislike: Thumb up 15 Thumb down 5
      • scott says:

        60% effective is the number that I generally hear, but I am sure if you look hard enough you can find any number you want.

        Flu is not caused by one specific virus, but a number of different viruses. For a given flu season the vaccine used is based on the viruses that are expected to dominate that season. This leads to a number of issues;

        - for an idvidual I may catch a virus not covered by the vaccine
        - the estimates of which viruses are going to dominate may be wrong, reducing the overall effectiveness of the vaccine
        - a specific virus may mutate, to a form the vaccine is ineffective against

        I think even the CDC will agree that flu shots are not as effective as a lot of people may think.

        Well-loved. Like or Dislike: Thumb up 19 Thumb down 10
      • Seminymous Coward says:

        60% effective is pretty damn effective in my book. 60% of the 1918 pandemic would have been 30 million human lives. I’m going to repeat that now: the flu vaccine would have saved a minimum of 30 million living, breathing humans with names, faces, hopes, and dreams.

        Herd immunity is key; James beat me to the general idea, but here are some flu-specific thresholds: http://www.ncbi.nlm.nih.gov/pubmed/22414740 . A relevant chart showing herd immunity thresholds for viral reproduction number, vaccine effectiveness, and vaccination rates is contained within, and it can be viewed (annoyingly as a single-slide PowerPoint presentation) at http://services.elsevier.com/SDWebExport/export/figure/S0091743512000588/1-s2.0-S0091743512000588-gr2.jpg/ppt .

        There are other multiplier effects. Keeping 60% of healthcare workers up and working during outbreaks is also extremely valuable in and of itself. There’s also the benefit of the increased solidarity of message from the healthcare community.

        Well-loved. Like or Dislike: Thumb up 17 Thumb down 1
      • Kathryn says:

        Hidden due to low comment rating. Click here to see.

        Disliked! Like or Dislike: Thumb up 8 Thumb down 19
      • Seminymous Coward says:

        Kathryn: Here are roughly two dozen citations: http://en.wikipedia.org/wiki/Influenza_vaccine#Effectiveness_of_vaccine Wikipedia isn’t hard research or anything, obviously, but in this case its references are; most are double-blind controlled studies. As just one example, here’s one giant review: http://www.thelancet.com/journals/laninf/article/PIIS1473-3099%2811%2970295-X/abstract . I’m not sure how you could have missed the enormous amount of research data if you looked for even the briefest moment. Did you seriously imagine that vaccine effectiveness was just made up? Of course scientists have actually checked that vaccines work.

        Well-loved. Like or Dislike: Thumb up 15 Thumb down 2
    • James says:

      Look up herd immunity. Briefly, even though a vaccine may not be 100% effective for the individual getting it, getting a large fraction of the population vaccinated reduces the transmission rate of the virus to less than what is needed to sustain an epidemic.

      Well-loved. Like or Dislike: Thumb up 10 Thumb down 2
      • scott says:

        For a large population there might be benefits I hadn’t thought about. I guess I am stuck on the fact that I personally don’t bother with flu shots because as an individual I am basically flipping a coin and I don’t get sick often anyway.

        Thumb up 5 Thumb down 6
  5. Jaime says:

    Regarding the issue of egg allergies, this is the CDC’s (straight from their website) opinion on the matter:

    ———————————
    TIV should not be administered to the following:1

    People who have experienced a severe (life threatening) allergy to a prior dose of an seasonal influenza vaccine (TIV or LAIV)
    People who have a severe allergy to a component of the TIV vaccine. Package inserts should be consulted for components 3

    Recommendations for vaccinating egg allergic patients were updated in 2011 and are available in the MMWR.8 Generally, egg allergic patients can safely receive TIV. Individuals with a history of severe (life threatening) allergy to eating eggs should consult with a specialist with expertise allergy prior to receiving TIV.

    ————————

    Well-loved. Like or Dislike: Thumb up 10 Thumb down 0
  6. Speed says:

    People with egg allergies can be protected with the flu vaccine. First, the risk is vanishingly small and not well documented as simply egg related …

    Allergy to eggs must be distinguished from allergy to influenza vaccine. Severe allergic and anaphylactic reactions can occur in response to a number of influenza vaccine components, but such reactions are rare. A review of reports to the Vaccine Adverse Events Reporting System (VAERS) of adverse events in adults noted four reports of death caused by anaphylaxis following influenza vaccine during 1990–2005; the vaccine components potentially responsible for these reactions were not reported (20). A prior severe allergic reaction to influenza vaccine, regardless of the component suspected to be responsible for the reaction, is a contraindication to receipt of influenza vaccine.
    http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6033a3.htm

    Second, those who believe or suspect that they are allergic to eggs can receive the flu vaccine if special precautions are taken — detail at the above link.

    Thumb up 5 Thumb down 2
  7. Leah says:

    Tip of the ice burg……..

    I have worked in healthcare for 15 years, 11 of which in an institution that recommends but does not require the influenza vaccine. I guess I would like to see more institutions take a bold stance of employees protecting those who are under our care. Currently, there are signs posted all over the hospital I work at that differentiate the signs of a common cold with that of influenza. That being said, I have a number of colleges from housekeeping to physicians that come to work despite symptom burden suggesting influenza type illness. Although the “blue sticker” system above may seem invasive, it seems much more effective than a flyer campaign.

    I also have to wonder what the future of mandating vaccines will be given the choice that currently exists in vaccinating our pediatric population with our “standard” vaccines. That, however, is another conversation entirely.

    Well-loved. Like or Dislike: Thumb up 5 Thumb down 0
    • Enter your name... says:

      I think that the institutional response to a potentially contagious employee is more important than either. What happens if you call in sick? Do you get irritable comments about how inconvenient your illness is or how short-staffed they are? Do you get told that you can only have the day off if you find your own substitute?

      A lot of physicians seem to go to work when they’re plainly sick because there’s no one else available. I’ve never heard a good explanation for the lack of scheduling a backup in the hospital, or for why they can’t swap with whoever is taking all the phone calls.

      Well-loved. Like or Dislike: Thumb up 14 Thumb down 0
      • Another side . . . says:

        It seems that most responses are from the employee or patient POV. There is also the hospital as business side of the story.

        I managed an office that dealt directly with the public. Our peak busy season (the time during which we brought in the most money) coincided with flu season. Every year in the fall, I would suggest that my employees (commissioned or not) get flu shots (as well as follow other common sense hygienic procedures, such as hand washing, etc). The reason was to avoid being laid up during our biggest period. This had nothing to do with protecting the public. It was all about having as many “hands-on-deck” during our peak productive period, so they and the company could maximize profits.

        Thumb up 1 Thumb down 1
      • John says:

        It makes perfect sense then to require EVERY visitor to wear a mask when they enter the hospital. The people in the general public are much more susceptible to diseases then healthcare workers. We have to be vaccinated against everything and visitors get off scott free. All people on airplanes should also be required to wear masks too, if you follow the hospitals logic.

        It’s simply a way to publicly shame and harass people who don’t want to partake in the process. Not to say that vaccines don’t work…I believe that they do when they are appropriately given. But to command everyone to take them is folly.

        Thumb up 2 Thumb down 0
  8. Nick says:

    On average the influenza vaccine (the shot, not the mist) provides about 60% protection in young health adults (think healthcare workers) against getting medically attended influenza (http://www.thelancet.com/journals/laninf/article/PIIS1473-3099%2811%2970295-X/abstract). This was recently re-affirmed for this influenza season by the CDC (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm62e0111a1.htm). Its clear the influenza vaccine doesn’t work as well as public health wants it to, but its clearly the best tool we have to prevent influenza. Every HCW should be getting it to protect themselves and their patients, however we cant oversell the value of vaccination to meet policy goals (http://www.hhs.gov/ash/initiatives/hai/hcpflu.html).

    That being said even if you vaccinate 100 HCW against influenza, in a given year 40 of them will be at risk for getting influenza or giving it to their patients just like those not vaccinated. You cant identify these 40 either. Then you also have lots of other people who may or may not be vaccinated in your hospital, such as patients, family members, visitors, contractors, etc. They can spread influenza just as well, which is why there are visitor restrictions during bad flu years.

    Regarding using masks routinely if you’re not vaccinated, I question the evidence and purpose of that policy (http://www.massnurses.org/news-and-events/p/openItem/7998). I would also question why everyone is not masked if that’s your policy, since you cant identify those vaccinated but still at risk.

    Well-loved. Like or Dislike: Thumb up 12 Thumb down 0
    • TK says:

      Exactly correct and 60% is meaningless in terms of effectiveness, because to get a true number every person with flu like illness would have to be tested to verify whether they had a strain that was included in the coverage of the vaccine and document whether that person had the vaccine. No such study has ever been done.

      Thumb up 2 Thumb down 2