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March 21, 2011

Pa. health systems may require influenza shots for employees

By Liz Zemba
Tribune-Review

ALLEGHENY, Pa. — Registered nurse Sherri Adobato is accustomed to administering flu vaccine.

When it came to her own health, she usually skipped the shot — until a co-worker, David P. Sechrist, fell victim to a deadly bout with the H1N1 virus.

"I'm a nurse, and I never get the flu shot, even though I give them, because I believe that's everybody's choice," said Adobato, the employee health nurse for Fayette EMS.

Two health systems — Excela Health in Westmoreland County and UPMC in Allegheny — are debating whether public health interests might outweigh the personal choice of health care workers. Two health systems in Philadelphia have made influenza vaccinations mandatory for their employees.

The benefits to patients are clear if health care workers get flu shots, maintains Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania.

"If you can get close to 100 percent vaccination rates, you can cut patient death rates from flu by 40 percent," Caplan said.

He and other experts called for mandatory flu shots for health care workers in a position paper issued in August by The Society for Healthcare Epidemiology of America.

"When David got sick and was diagnosed, I felt, I'm getting the flu shot," Adobato said. "It's unreal to me that someone would die from the flu in this day and age, with vaccines available and the treatments we have. This is an eye-opener."

Sechrist, a 30-year-old paramedic and dispatcher, died last month. He was not vaccinated for the flu, even though a free shot was available from his employer.

Thirty-five of his co-workers opted to get shots after Sechrist became ill. Only 35 of the ambulance company's 200 employees were vaccinated before his death, Adobato said.

Reluctance abounds
The national average for influenza-vaccinated health care workers is 52.7 percent, up 7.1 percent over the previous year, reports the Centers for Disease Control and Prevention. It recommends they be vaccinated to protect themselves and to guard against becoming carriers of viruses.

Nationally, about 33.4 percent of adults ages 19-49 get the shot.

Between 40 percent and 50 percent of Excela Health's 5,000 employees, volunteers and physicians received this year's vaccine, said spokeswoman Robin Jennings. Two of the largest health care providers in Allegheny, West Penn Allegheny and UPMC, also offer free shots to their employees.

Dr. Anita Srikameswaran, a UPMC spokeswoman, said two-thirds of the system's 50,000 employees received the vaccination. West Penn Allegheny did not provide figures.

"The reluctance of health care workers to be vaccinated is the same as for nonhealth care workers," said CDC spokesman Jeff Dimond.

"Some don't think they will get sick. Some just never get around to it. Some don't want to be vaccinated for any reason."

While the CDC recommends flu shots for everyone 6 months and older, the government cannot mandate them for health care workers, Dimond said.

That has left the decision to make the vaccinations mandatory up to individual employers. Excela Health is considering the idea, according to Jennings.

"We continue to evaluate our program and the possibility of making the flu vaccine mandatory," Srikameswaran said.

Spokesman Dan Laurent said West Penn Allegheny has no plans to mandate the vaccinations, choosing instead to educate workers on the risk of transmission and the vaccine's role in prevention.

"We respect the right of employees to make their own individual health care decisions," Laurent said. "It's a delicate balance, between that and public safety, and our approach has been to aggressively push for shots."

The University of Pennsylvania Health System and The Children's Hospital of Philadelphia have made influenza vaccinations mandatory for their employees. Dr. Neil Fishman, director of health care epidemiology, infection prevention and control for the health system, said vaccinations became mandatory when voluntary participation fell short.

"We tried a lot of different interventions to improve vaccination rates, ranging from a mandatory declination policy, meaning people had to actively decline, and we produced a music video that you can still see on YouTube," said Fishman, past president of The Society for Healthcare Epidemiology of America.

"We had 24/7 influenza vaccine available, for free, but through all our interventions, we got our rate up to a little over 50 percent, and we decided that just wasn't acceptable," he said.

Flu shots became mandatory in 2009 for 23,000 employees at three hospitals and clinical locations. Employees without a medical or religious reason to decline are suspended without pay for the entire flu season, Fishman said.

Four employees chose suspension, Fishman said. The Children's Hospital of Philadelphia terminates employees who refuse the shots, he said.

Children's said that nine employees who refused shots in 2009 are no longer employed there. The hospital's 9,400 workers must be vaccinated to protect pediatric patients who are at greater risk of flu complications, it said in a prepared statement.

Drop in death rate cited
For more than a decade, Dr. Gregory Poland, director of the Mayo Clinic Vaccine Research Group, has advocated mandatory influenza vaccinations for health care workers. Noting that an estimated 36,000 Americans die annually of flu complications, he said health workers have a "professional and even legal duty" to get the shots.

"We have six decades of safety and efficacy data about this vaccine, so we know it works and would protect patients if health care workers got it," Poland said. "Four studies show that when they get it, the death rate of patients they care for drops dramatically."

Studies involved 44 facilities in the United States and 40 facilities in France.

Poland said organizations have been slow to mandate flu vaccinations for fear employees will balk.

"Isn't that shocking, a hospital not taking a patient safety maneuver because of fears of employee push-back?" Poland said.

To allay employee fears when it implemented its policy, University of Pennsylvania officials met with workers to explain the reasons behind it. They hosted town meetings, spoke with individual departments, handed out educational materials and enlisted the help of hospital chaplains and community religious leaders to address concerns.

"We were very proactive in making certain that everyone understood why we had decided to pursue this policy, and took pains to make certain this just wasn't another burden being thrust upon them," Fishman said.

Poland said nurses have been the most vocal opponents.

Katie Brewer, a registered nurse and senior policy analyst for the Maryland-based American Nurses Association, said it "believes nurses have a professional obligation" to be vaccinated against the flu and other illnesses. The shots should be voluntary, she said.

"Mandatory policies should come from a higher level of authority, such as a state government," Brewer said. "That ensures fairness and consistency throughout the entire area, that there's a standard policy and ample opportunity for all stakeholders to have feedback and have their voices heard in those deliberations."

Although flu season is nearing an end, the CDC still recommends the shots because cases have been reported as late as May. This year's vaccine protects against three strains of flu virus, including H1N1.

Copyright 2011 Tribune Review Publishing Company

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