AMA asked to encourage health worker flu shots

With an eye toward the upcoming flu season, the California Medical Assn. is urging the American Medical Association to strengthen its stand on flu shots for health care workers.

Current AMA policy calls for hospital medical staffs to delineate under what circumstances immunizations should be administered. The CMA proposal, which is set to be presented and debated during the AMA House of Delegates meeting that begins June 18, asks the AMA to work to ensure that hospitals possess a system for measuring or maximizing the number of health care workers receiving the vaccine.

Ronald Bangasser, MD, past president of the California Medical Assn. and a member of the joint AMA and Centers for Disease Control and Prevention National Influenza Vaccine Summit, said proponents of increasing or mandating flu vaccinations for health care workers considered pursuing state or federal legislation, but opted to approach the AMA and the Joint Commission on Accreditation of Healthcare Organizations.

"We thought it would be easier and quicker to put an accreditation standard that hospitals have to have a program to encourage and increase the number of health care worker vaccinations," he said. "We could get it done faster by getting it on the hospital radar screens."

By receiving flu vaccines, workers would reduce the flu's transmission to patients, reduce transmission among staff and therefore reduce the number of staff sick days, which also can adversely affect patient care and death rates.

"No one wants to transmit the disease," Bangasser said. "Most people think [getting the flu vaccine] is a good idea. It's not hard to convince people. It just needs to be higher on the agenda."

According to the CDC, about 36% of health care professionals receive immunizations against the flu virus.

A call for mandating

Gregory Poland, MD, director of the Mayo Clinic's vaccine research group, believes that education and encouragement go only so far. He supports mandating the flu vaccine along the lines of immunizations for hepatitis B or rubella, he said.

"Here we recommend it for patients, but we don't take it. Patient safety suffers," he said, noting that some 36,000 influenza-related deaths occur each year. "There are workers who pass it on to people who die. We have a problem with intermittent staff shortages [from workers who have the flu], and we know the effect of absences on the quality of care. Then there's presenteeism, when people come to work ill. That's a problem, too.

"There is a medical justification, an economic justification and an ethical justification and perhaps a legal justification regarding patient safety and quality of care," he added.

The Virginia Mason Medical Center in Seattle attempted to mandate flu vaccines for all of its health care workers last year, but the program never got off the ground because of the vaccine shortage and because its nurses union threatened a lawsuit, said Kim Davis, VMMC communications manager. Internal teams are in the process of devising a plan for this flu season, she said.

While the American Nurses Assn. encourages the immunization of all health care workers, "we do not support forced immunization," said Carol Cooke, ANA spokeswoman. "We think it should be a nurse's personal decision."

JCAHO, meanwhile, is waiting to act on an opinion from the CDC's advisory committee on immunization practices.

"We do expect to bring this issue forward," said Robert Wise, MD, vice president of the division of standards for the joint commission. "Depending upon the opinion is whether there would be some sort of requirement.

"We know that it's a controversial issue," Wise said, "so we're waiting for a scientific report prior to making a final decision."