The push for mandatory seasonal flu vaccination in the nation’s hospitals continues, increasing patient safety but leading to job loss for healthcare workers who refuse to comply.
The most recent example in this ongoing saga comes from Essentia Health in Duluth, MN, where some 50 healthcare workers recently were fired for refusing flu shots.
The hospital confirmed that approximately 50 healthcare workers were terminated, but did not provide more specifics on the individual firings.
In the aftermath, some 99.5% of Essentia Health’s 13,900 employees had been immunized, approved for an exemption, or were in the exemption process, says Rajesh Prabhu, MD, an infectious disease physician and chief patient quality and safety officer.
Religious and medical exemptions are allowed within the flu immunization policy based on written documentation, he says. The Minnesota Nurses Association (MNA), which represents some 2,000 nurses at Essentia, filed a grievance and vowed to fight the firings and restore the workers’ jobs.
The MNA favors allowing worker choice, but is not against flu vaccination per se. “We maintain that voluntary, incentivized flu shot programs work much better than mandated policies,” says Rick Fuentes, MA, an MNA spokesman in St. Paul.
“Employees with medical or religious objections to the flu shot, including allergic reactions, however mild, should be exempted,” he adds.
Under a 2016 EEOC ruling, Saint Vincent Hospital in Erie, PA, had to provide back pay and offers of reinstatement to six individuals who had been fired for refusing flu shots. The EEOC alleged “discrimination because of religion by failing to accommodate their sincerely held religious beliefs and practices that prevented them from receiving the influenza vaccine.”1
When prior voluntary policies at Essentia failed to lift the immunization rate above the 80% range, the decision was made to go to a mandate, Prabhu says.
“The CDC and state public health departments have continued to urge all healthcare personnel to get immunized against influenza,” he says. “Many healthcare organizations, just like our own, have been unable to achieve high levels of immunization without a required influenza immunization program.”
Based on analysis performed prior to implementing the mandate, Prabhu and colleagues found that some 600 healthcare organizations nationally that require influenza immunization were achieving much higher vaccination rates.
“We knew that we could and should do better for our patients,” he says. “The CDC reported that Minnesota ranks 44th in the nation when it comes to healthcare personnel flu vaccination.”
Indeed, data collected by the CDC’s National Healthcare Safety Network show that 81.4% of healthcare workers in Minnesota were immunized for flu in the 2016-2017 season. Percentages ranged from Alaska’s low of 75.2% to a high of 97.1% in Colorado.2
Critics of such policies have questioned how a vaccine that has a typical seasonal efficacy of no more than 60% can be mandated. The counterargument is that any degree of protection gained will protect patients and keep healthcare workers out of sick bay. One study found that inpatients exposed to at least one contagious healthcare worker were five times more likely to develop hospital-acquired influenza-like illness than those with no similar exposure.3
An ancillary concern is that some healthcare workers with flu still will report for duty, exposing patients and coworkers to the virus. A recently published study4 found that 41.4% of 1,914 healthcare workers with influenza-like illness (ILI) still showed up for work for a median of three days, reports lead author Sophia Chiu, MD, MPH, of the National Institute for Occupational Safety and Health.
“We reported 44.6% working with ILI being vaccinated during the season,” she says. “There were 29.2% working with ILI who reported they had not been vaccinated. However, we did not ask them specifically about when they were vaccinated relative to their episode of illness.”
- U.S. Equal Employment Opportunity Commission v. Saint Vincent Health Center. Civil action No.16-224 Erie. U.S. District Court for the Western District of Pennsylvania, Sept. 22, 2016. Available at: http://bit.ly/2hjr7WR. Accessed Dec. 5, 2017.
- CDC. 2013-14 through 2016-17 Influenza Seasons Health Care Personnel Vaccination Trend Report. Sept. 28, 2017. Available at: http://bit.ly/2AInVPr. Accessed Dec. 5, 2017.
- Vanhems P, Voirin N, Roche S, et al. Risk of influenza-like illness in an acute health care setting during community influenza epidemics in 2004-2005, 2005-2006, and 2006-2007: a prospective study. Arch Intern Med 2011;171:151–157.
- Chiu S, Black CL, Greby SM, et al. Working with influenza-like illness: Presenteeism among US health care personnel during the 2014-2015 influenza season. Am J Infect Control 2017;45(11):1254-1258.
