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? 


Mike B

Here's an about Hospital workers who don't get a flu shot get fired.


Mike - you hit it on the head. Someone who does not understand how immunization works should not be a health care professional. Nurses who refuse to get flu shots should have their licenses revoked. How could someone that lacking in basic scientific knowledge function in the medical field?


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

Enter your name...

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.


Joel Upchurch

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

Seminymous Coward

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 and , 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.



In terms of modifying behaviour the policy may be effective.

In terms of preventing flu the policy seems questionable. I am not sure that masks and flu shots are all that effective.

Seminymous Coward

"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?


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.


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.



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.

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.



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.


Enter your name...

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.


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 ( This was recently re-affirmed for this influenza season by the CDC ( 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 (

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 ( I would also question why everyone is not masked if that’s your policy, since you cant identify those vaccinated but still at risk.


Andrew B

I am a physician and totally in favor of the flu shot, and it is fairly effective, as others have noted, but not perfect in preventing disease (almost nothing ever is). That being said I am a little uncomfortable forcing people to get shots- is not even the minor thing of sticking someone with a needle considered assault if we are forcing it against their will? Patients of sound mind nowadays are given their free choice to refuse any medical care they wish, even needle sticking, so how can we force others to do so? Would like to hear an ACLU type attorney make an educated comment about this.