More Than Half of U.S. Hospitals Don't Require Employees to Get Flu Vaccine

Turns out healthcare workers don't like being told what to do, either.

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Many people have gotten their shots in preparation for flu season, which is officially in full swing. But one unlikely group of people who may or may not be vaccinated? Hospital workers.

According to a November 2015 paper published in Infection Control & Hospital Epidemiology, more than half of U.S. hospitals do not require their employees to get vaccinated against the flu. Out of the 386 hospitals that responded to the survey, only 42 percent had a company policy that made the flu vaccination mandatory for their employees.

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And the rate at Veterans Affairs (VA) hospitals was much lower — only 1 percent of VA hospitals require employees to get the flu shot. (It is worth noting, however, that this survey was conducted in 2013, so hospitals that instituted mandatory vaccinations the following flu season were not counted.)

"Vaccination of healthcare workers has been shown to significantly reduce patients' risk of influenza and its complications, including pneumonia and death, compared with vaccination of patients alone," senior study author Sanjay Saint, MD, MPH, professor of internal medicine at University of Michigan and chief of medicine at the VA Ann Arbor, said in a press release. "To put it bluntly, American hospitals have a lot of work to do."

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As part of its Healthy People 2020 initiative, the U.S. Department of Health and Human Services has stated a goal to have 90 percent of healthcare workers receiving vaccinations by 2020, and making the flu shot mandatory at work may be one of the best ways to do that. According to the paper, when hospitals require vaccination, nearly 98 percent of workers get the shot, whereas when hospitals don't require nor promote vaccination, only about 48 percent of employees at get the shot.

Why Requiring the Flu Shot Is Rejected

"The issue of a mandatory flu shot in a hospital system is fairly controversial," says Paul Terpeluk, DO, medical director of employee health services at the Cleveland Clinic. "Generally speaking, people don't like to be told to do things, like take vaccines."

Dr. Terpeluk explains that while many people are against vaccinations overall, some are against the flu vaccination in particular. One reason: They haven't always worked. "Some years there hasn't been a good correlation between the vaccination and the flu bug," he says. "Other years, it's been right on. It does protect people, but not 100 percent of the time."

"Generally speaking, people don't like to be told to do things, like take vaccines."

There's also the ongoing chatter about potential side effects. "There are occasional complications from the flu vaccine, but they are rare," he says. "And it's hard to overcome a lot of the myths, like you can get the flu from the flu vaccine."

Terpeluk adds that the Cleveland Clinic moved toward a mandatory flu program for two main reasons. "One, obviously patient safety because you don't want to spread the flu among your patients," he says. "And two, employee health, because you don't want your caregivers to be sick and out of work."

The Debate Goes On

While every hospital enforces their flu regulations differently – some will require non-vaccinated employees to wear a facemask, others will threaten termination — there are two exceptions to the rule: employers with religious or medical exemptions; however, making the flu shot mandatory within a hospital setting has become a hot — even litigious— topic.

Back in 2013, at least 15 nurses and other hospital staffers in four states were fired for refusing the vaccine, as reported by CBS News. And in June 2014, a New Jersey court ruled in the favor of a nurse who was denied unemployment benefits after she was fired for refusing the flu shot.

"My opinion is that we should encourage vaccination, but not mandate it," says Michael B. Edmond, MD, chief quality officer and associate chief medical officer at University of Iowa Hospitals & Clinics. "I also think that hospitals should work harder to prevent presenteeism (sick people coming to work)."

"I second Dr. Edmond's comments and add that we need to invest more resources into developing improved vaccines that have activity beyond one year," says colleague Eli Perencevich, MD, professor of internal medicine at University of Iowa Carver College of Medicine. "It strains hospital resources to undertake vaccination programs every year."

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