The Clip.

What you need to know as a nurse in this modern world.

Should hospitals require flu vaccines for nurses?

Should hospitals require flu vaccines for nurses?

Vaccines are a controversial topic with passionate people on both sides of the debate, especially when we talk about mandatory vaccinations. In these situations, I think that it's important to look at the data and stay as objective as possible. 

The Clip: On Mandatory Flu Vaccines for Healthcare Providers


Why do hospitals care so much about flu vaccines? 

Flu vaccines have existed since the 1930s, but only recently have we been feeling extreme pressure inside healthcare facilities for required vaccines as healthcare providers.  Sadly, as is the case with most things, the change in behavior can be traced to money.

Starting in 2014, healthcare facilities were required to report the vaccination rates of the staff [1]. Some feel that the percentage of staff that are vaccinated may effect medicare reimbursements in the future. 

Of note: I found this quote "According to the American Hospital Association, a 100 bed hospital that failed to comply could be expected to lose about $320,000 in payments" in several blog posts (ex1)(ex2) but I can't actually find the source of this claim or how the AHA got this number.  I also can't find anything from CMS that specifically says hospital reimbursement will be tied to vaccine rates.  So if anyone has seen a source from CMS, email it to me and i'll be eternally grateful. 

The only thing I know for sure is that the percentage of vaccinated providers is reported to CMS, which is then listed on the Hospital Compare Website - under Timely and Effective Care.

And that's it...

So is the push for mandatory vaccines because potential customers can see and compare vaccination rates? Or is it because of a general fear that this metric will be tied to reimbursement in the future?  

Mandatory Flu Vaccines: What about the patients?

But wait, isn't all this flu vaccine stuff because the vaccine is good for patients? Here's where things get dicey. You can find research papers that back up both claims.

  • Here is the National Quality Forum (NQF) report that started us on the mandatory vaccine train ride.  Within the report, they source 9 papers. Here are two that jumped at me. 
    • This JAMA article is an example of a randomized, double-blind, control study, where they tested the blood of the subjects for influenza.  Testing the blood was not part of many of the studies cited in the NQF report.
      • Conclusions: "Influenza vaccine is effective in preventing infection by influenza A and B in health care professionals and may reduce reported days of work absence and febrile respiratory illness. These data support a policy of annual influenza vaccination of health care professionals."
    • This AGS article studied the mortality rate of patients in nursing homes where the majority of staff were vaccinated, and places where the majority of staff weren't vaccinated.  
      • Conclusions: "Primary unadjusted analysis did not show significantly lower mortality in residents in the vaccination arm (odds ratio=0.86, P=.08), although multivariate-adjusted analysis showed 20% lower mortality (P=.02), and a strong correlation was observed between staff vaccination coverage and all-cause mortality in residents (correlation coefficient=−0.42, P=.007)"
  • So it seems like there is some evidence that healthcare workers that got vaccinated had a lower rate of infection, and that less elderly patients died in facilities where there were more vaccinated healthcare workers. 
  • It's important to note that very few of the studies actually confirmed influenza with a blood test on patients, so it may be a stretch to say that the reason they died was because of the flu. 
  • Also it's important to note that many of the studies were not done over multiple flu seasons, so it's possible that the specific season had unusually positive, or unusually negative results.

Why nurses should not be required to get the vaccine? 

I read a pretty good article written by REALfarmacy that goes way deep into the reasons why healthcare workers shouldn't be forced to get a vaccine.  There are a lot of anecdotal stories which i'm not a huge fan of, but the arguments they make are worth repeating for your consideration. The main sticking points that I got from the blog post were: 

  • "Studies over 64 years fail to show that staff vaccinations reduce flu infections and deaths in patients–but good luck figuring that out from the gobbledygook they published"
  • "The first question, “Is it safe?” is controversial. How safe? If measured by payouts by the federal vaccine injury compensation program, it’s clear that flu vaccines are not safe for everyone. In fact, injuries caused by the flu vaccine have resulted in the most awards granted by the Vaccine Court in recent years, and these are increasingly going to adults. In years past, the vast majority of compensated cases involved children injured by childhood vaccines."

  • "Does it protect staff? Not if one were to read the true placebo flu vaccine efficacy study recently published in Clinical Infectious Diseases. Those who were vaccinated for the flu had 5.5 times more respiratory illness than those who were not vaccinated. Other studies show that repeated annual flu vaccines decrease their effectiveness."

  • "Does it protect patients? This is what the CDC considers the “quality” measure for a hospital, however, there is no statistically significant evidence that HCW flu vaccinations protect patients, according to meta-analyses by CochraneWHO and the CDC itself. And they really looked hard for it! So, it can safely be assumed that a flu shot does not help patients, despite many studies paid for by organizations that very much wanted to find such evidence"

Conclusions on mandatory flu vaccines for nurses?

Personally, I think that the fact that there isn't any long-term, multi-year data that shows the effectiveness of the flu vaccine, and that there are very real ethical and religious consequences to forcing workers to get vaccinated...

We should probably just present the data, and let the healthcare providers decide for themselves. 

What do you think?

Share your thoughts in the comments below.  Should we require flu vaccines for healthcare workers or not? 

Resources Mentioned in Article

[1]: Measuring and Reporting Influenza Vaccination Coverage among Health Care Personnel in Your Long-Term Care Facility | https://www.cdc.gov/flu/toolkit/long-term-care/reporting.htm

A victory for patient advocacy!

A victory for patient advocacy!

Flo's Cookie Jar: Helping RN Students Through Tough Times

Flo's Cookie Jar: Helping RN Students Through Tough Times