AHA adds its voice to call for mandatory flu shots

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AHA adds its voice to call for mandatory flu shots

How to sell mandatory flu shots to hospital staff

After reading this article, you will be able to:

  • Discuss why more hospitals need to adopt ­mandatory influenza immunization policies
  • Identify the process for educating staff on the importance of accepting seasonal influenza immunization
  • Describe the elements of a typical policy including choice to use flu mask as alternative to immunization

Add another voice to the call for mandatory influenza vaccinations for healthcare workers.

This time the voice isn't coming from the bleachers, but rather from the box seats, as the endorsement is from the American Hospital Association (AHA), a group made up of hospital and healthcare executives.

In April, the AHA's board of trustees approved a new policy urging its members to institute a ­mandatory flu shot policy for healthcare workers. To protect the lives and welfare of patients and employees, the AHA said it "supports mandatory patient safety policies that require either influenza vaccination or wearing a mask in the presence of patients across healthcare settings during flu season."

That's welcome news to infection preventionists, who have been battling to get healthcare workers vaccinated against influenza each season. "I can say it in one word: Hallelujah!" says Peggy Prinz Luebbert, MS, MS(ASCP), CIC, CHSP, a consultant and owner of Healthcare Interventions in Omaha, NE, who works with healthcare organizations across the country.

"It sets a standard for the nation of what ­hospitals should be doing," says Deborah L. Wexler, MD, ­exec­utive director of the Immunization Action Coalition in Saint Paul, MN. "The AHA is another major organization that is being added to the ranks of those doing the right thing for patient safety."


In the past, the AHA had a policy encouraging flu vaccination for healthcare workers, but had not gone as far as making it mandatory, says Nancy Foster, AHA's vice president of quality and patient safety.

The organization kept an eye on the clinical evidence and decided earlier this year that it was clear the call for mandatory vaccination was a step it needed to take to protect patients, she says.

The evidence is very strong that high levels of ­vaccination result in reduced transmission of flu from workers to patients and also among healthcare workers, Foster says. The evidence also shows that in healthcare organizations with high rates of vaccinations, there is a decrease in the number of patient deaths from influenza, she adds.

"This really is about patient safety," Foster says.

Hospitals that want to adopt a mandatory policy don't have to reinvent the wheel since numerous facilities have already made flu shots mandatory for healthcare workers.

To share the experiences of hospitals that have already implemented mandatory policies, the AHA has hosted three conference calls for its members from July through September. Foster says 350-500 hospitals have participated in each of those calls.

The AHA also provides resources and tools to assist hospitals in establishing policies and creating ­campaigns to educate workers on the Hospitals in Pursuit of ­Excellence website at

Foster says hospitals that have adopted a successful mandatory vaccination program have told her support from leadership is necessary. "It was absolutely essential they had the support of leadership, including and especially the CEO, the [chief operating officer], and the board [of trustees]," she says.

It's important that those individuals stand in line and receive their flu shot, as well as talk about the reasons for the mandatory policy, she says.


Mandatory flu shot policies are legal, Foster says.

All of the hospitals with a mandatory policy have included alternatives for healthcare workers who have medical contraindications or legitimate reasons not to receive a vaccination, she says.

One alternative, which the AHA policy endorses, is to require healthcare workers who don't receive a flu shot to wear a mask when in contact with patients to prevent flu transmission, Foster says. Some hospitals help workers find jobs in their organizations where they are not in contact with patients, she adds.


The more organizations, especially ones such as the AHA, that endorse mandatory vaccinations, the more compliance the healthcare industry will see, says Wexler.

More and more hospitals are mandating influenza vaccination, she says. "I think this is the snowball that is going to keep rolling down the hill."

Some hospitals mandate flu vaccination unless workers have a medical contraindication, she says. Some also allow workers to decline because of religious reasons.

Workers need to know why hospitals are requiring mandatory vaccination, Wexler says, so they don't feel this is something foisted upon them for no good reason. "Education is a key component of this," she says.

Adopting a mandatory influenza vaccine policy requires some intense work, she says. "This is a major undertaking in any hospital."

The good news is once it is in place, it becomes easy in future years to have a successful vaccination program with an extremely high vaccination rate, says Wexler.

Libby Chinnes, RN, BSN, CIC, an independent infection control consultant with IC Solutions, LLC, based in Mt. Pleasant, SC, who assists healthcare facilities nationwide, says she has spent 30 years trying to convince healthcare workers that flu vaccination protects patients.

"It's such an easy no-brainer thing. It's hard for me to understand we are still fighting this battle 30 years later," she says.

Chinnes applauds the AHA's stand but says individual hospitals will have to decide whether to make flu ­vaccinations mandatory. Some healthcare workers may never be convinced they should get a flu shot.

"I think it's going to take a true major [flu] outbreak in our country for some healthcare workers to heed the warning. They don't perceive themselves at risk. They don't see it as a patient safety issue," she says.

One way for hospitals to get healthcare workers to acknowledge the risks to patients is to have them sign a declination form, says Chinnes. The form requires healthcare workers to confirm in writing that they understand by not getting a flu shot they may be placing patients under their care at risk of contracting influenza, she says.

For a sample form, go to the OSHA Healthcare ­Advisor Tools page at

Cutbacks could mean fewer patients protected by flu vaccinations

There's one more reason why it's important for healthcare workers to receive an influenza vaccination this year.

Due to cutbacks in free flu shots, some hospitals may find that fewer of their patients are protected from influenza by an annual vaccination.

In many communities, federal and state budget cuts have halved the number of free vaccine doses available this flu season, meaning many cities and towns have had to cut back sharply on the number of people who get free flu shots at community-run clinics.

While the free clinics remain, in Massachusetts, for instance, the state has told local health departments to limit them to uninsured people and those whose health insurance does not cover the vaccine. In the past, many communities offered free shots to anyone who wanted one.

With the cuts, many people, including Medicare and Medicaid recipients, will have to get a flu shot by making an appointment with their physician or going to a pharmacy with a walk-in clinic that offers the vaccination.

That has some health officials worried about a reduction in the number of people, including seniors, who receive a flu vaccination. "I suspect strongly that people will not get vaccinated in the numbers that we have had in the past. That does not bode well for the health of the community," Larry Ramdin, health agent in Salem, MA, told The Salem News.

"Unfortunately, it's a sign of the economic times," Ramdin said.

With fewer people immunized, the influenza virus has more opportunity to spread.

While the amount of free vaccine may be limited in some communities, the vaccine itself is expected to be plentiful this year.

Requiring masks for healthcare workers

Healthcare workers either need to get an influenza vac­cination or wear a mask when working with patients during flu season, according to a new American Hospital Association (AHA) policy.

That's a necessary step to protect the safety of patients, says Nancy Foster, AHA's vice president of quality and ­patient safety.

While a flu shot is preferable, wearing a mask is a way to minimize the transmission of droplets that can cause ­influenza, she says.


But is mask-wearing practical?

"I won't say it's the most comfortable option. But the risk to patients is too great [not to require it]," Foster says.

Hospitals often start vaccinating workers with flu vaccine in September, and flu season can run as late as through April.

"You're looking at months of wearing a mask," says Libby Chinnes, RN, BSN, CIC, an independent infection control consultant with IC Solutions, LLC, based in Mt. Pleasant, SC.

The requirement to wear a mask may be an incentive for some healthcare workers to get a flu vaccination, Chinnes says. "If you wear a mask for very long, it gets hot and uncomfortable," she says.


If hospitals are going to require masks for healthcare workers who decline the flu vaccine, they need to make that part of their policy, Chinnes says.

The hard part will be enforcement, she says, since workers may need to wear a mask for five or six months.

"Masking is a hassle for employees and can be problematic for hospitals to enforce," says Deborah L. Wexler, MD, executive director of the ­Immunization Action Coalition in Saint Paul, MN.

Monitoring healthcare workers who must wear a mask because they haven't had a flu shot is a challenge, agrees Peggy Prinz Luebbert, MS, MS(ASCP), CIC, CHSP, a consultant and owner of ­Healthcare ­Interventions in ­Omaha, NE, who works with healthcare ­organizations across the country.

Luebbert has worked with a couple of hospitals that have required masks and it does provide some motivation for workers to get a flu shot.

Healthcare workers are required to wear a mask as soon as they enter the facility, from October 1 to March 1, she says.

The healthcare workers are required to indicate on their identification badge whether they have had a flu vaccination or must wear a mask, she says. For instance, a blue dot indicates the worker has had a flu shot, while a red dot indicates they have not had it.

Luebbert admits it is like wearing a scarlet letter for those who don't get a flu shot.

The masks themselves are "awful," she says. "The employees hate it. It's uncomfortable and the patients can't see your face. And the patients hate it because they can't see the worker's expression."

It must be the responsibility of the employee's manager to monitor workers to ensure they are wearing their mask, Luebbert says. Infection preventionists cannot be everywhere in a hospital to monitor all workers.


Hospitals should be prepared for questions from patients and family members who may wonder why a worker is wearing a mask when providing care, says Chinnes.

"I think hospitals should come up with some kind of script so a healthcare worker can say, ‘This is why I'm wearing a mask,' " she says. Hospitals don't want patients to think they are allowing a worker who is sick to take care of them.

Luebbert agrees that hospitals need to communicate to patients and family members why workers are wearing a mask. One hospital put up a poster in its lobby advising people that both visitors and employees who had not been vaccinated against the flu must wear a mask during flu season, she says.