Maryland hospitals have become more aggressive in recent years about vaccinating workers for the flu, but public health officials are pushing for even stricter programs to halt the spread of a virus that kills thousands each year.
As manufacturers have begun shipping vaccine for the 2011-2012 flu season and vaccination programs are being planned, some officials are pushing hospitals to make vaccinations mandatory for employees. They say the vaccine is the most effective means of protecting workers and adds a crucial layer of safety for highly vulnerable patients such as newborns, the elderly and those with compromised immune systems.
"It's really a safety issue. It warrants a stronger stance because volunteer programs haven't worked," said Dr. Thomas R. Talbot, an epidemiologist at the Vanderbilt University School of Medicine who studies vaccination rates.
Just over 80 percent of Maryland hospital workers got the flu vaccine last season, in many cases because their employers required it, according to the most recent data from the state. The national average was about 60 percent, according to federal data.
Yet of 46 hospitals surveyed in Maryland, just 19 vaccinated at least 90 percent of their workers — and 13 of those had mandatory policies.
"Hospitals that stepped up and impressed on staff how critical it is for patient safety that workers be vaccinated clearly were the hospitals that were successful," said Frances B. Phillips, a deputy secretary of the Maryland Department of Health and Mental Hygiene. "Those that had mandatory policies were clustered at the top. We'll see what other hospitals do in response to the data."
At MedStar Health, which has a mandatory policy, chief medical officer Dr. William L. Thomas contends that more hospitals should start such initiatives. He's been advocating a policy of mandatory vaccination at hospitals across the nation and explaining the logistics of documenting the vaccinations of so many people — 26,000 in MedStar's case.
"If you look at data on how many people die in this country from influenza, it overwhelms all other hospital-acquired infections in numbers, and you couple that with the voluntary vaccination programs that weren't successful in getting 98 to 100 percent of employees, and this becomes an argument for a mandatory policy," he said. "[MedStar] should have adopted a policy 10 years ago. Everyone should collectively take their courage pills and do this."
Thomas said only a few people have quit rather than get a flu vaccination. The policy affects all staff, volunteers and even vendors, but he said the idea came from doctors, nurses and other clinical staff, and they were successful in conveying the importance to patient safety.
The flu season generally runs from October to May in the United States, and everyone older than 6 months should be vaccinated — including all health care workers, according to the federal Centers for Disease Control and Prevention. Between 5 percent and 20 percent of the U.S. population gets the flu every year, the CDC says. More than 200,000 people are typically hospitalized, and deaths can run as high as 49,000.
This is the second season the Maryland Health Care Commission has collected information from hospitals around the state. The numbers include full- and part-time workers who got a flu shot or mist between September 2010 and mid-April 2011. It's part of a larger effort by the commission to document hospital-acquired infections.
The survey shows that 13 hospitals fell below the 70 percent mark and six vaccinated significantly fewer workers than the season before. Overall, 81 percent of workers were vaccinated, up from 78 percent the season before. About 15 percent declined for approved religious or medical reasons.
Hospitals in the Baltimore area with some of the highest rates include MedStar facilities such as Union Memorial, and the Greater Baltimore Medical Center and Harford Memorial Hospital. Among those with the lowest rates are St. Agnes, Mercy Medical Center and Sinai. Officials at several hospitals said they are working to increase the number vaccinated.
Phillips said the state is also working with nursing homes to ensure that their workers are being vaccinated.
All Maryland hospitals provide workers free, on-site vaccinations. Eighteen of the hospitals reported mandatory employee vaccination policies, but the state discounted a few of them because they did not appear to include serious consequences such as suspension or termination if the policies were not followed.
Many professional societies support mandatory flu vaccinations for health care workers, though no federal agency now requires them. Neither does the Joint Commission, which accredits American hospitals. The Center for Medicare and Medicaid Services, which oversees the public health care programs, is considering a mandate.
Some hospitals across the country have said that such a policy would be an unfunded mandate and heavy-handed. But many hospitals have been turning to mandates on their own in the past five years, Talbot said.
The Vanderbilt epidemiologist said Virginia Mason Medical Center in Seattle was probably the first to mandate vaccinations in 2005, followed by St. Louis-based BJC HealthCare, which operates 13 hospitals. In 2009 MedStar, which has nine hospitals in the Baltimore-Washington region, adopted a mandatory policy and has since achieved vaccination rates near 100 percent.
Talbot said public health officials have been recommending the vaccinations for health care workers for more than two decades, but voluntary campaigns have often achieved no better than 40 percent to 60 percent compliance.
He said the reasons workers give for skipping vaccination are the same the public gives: They have no time, don't like needles, don't believe it's effective, fear getting flu from the vaccine, and don't often get sick. They also say that if they become ill, they will stay home or wear a mask at work.
But Thomas said workers can easily pass the virus to patients before showing symptoms themselves. He said the vaccine is fairly effective and does not cause the flu.
States in general have not pushed mandatory polices. Maryland is one of just four states that collect vaccination rates as a quality measurement, Talbot said. The others are California, Ohio and Iowa.
West Virginia considered a mandatory policy but didn't pursue it, Talbot said. New York passed a policy only to suspend it during the 2009 vaccine shortage.
Some workers' groups, including National Nurses' United, which has 170,000 members nationwide, encourage members to get vaccinated but do not support mandatory policies. DeAnn McEwen, vice president of the nurses' union and an intensive-care nurse in California, believes most nurses get vaccinated voluntarily to protect themselves and their patients.
"We really believe education is key," she said. "There are still myths out there. Workers should be presented with the actual risks and benefits, and once they understand the vaccine has been proven to be safe and effective, they may be more willing to take it."
Mary Smith, an intensive-care nurse who lives in Waldorf, said mandatory policies infringe on an individual's right to decline medical treatment. She worries that she might have an adverse reaction from the vaccine and prefers to be given information each year so she can evaluate the risks and benefits.
She noted that there are year-round means of protecting workers and patients from viruses, such as hand-washing, covering coughs and sending sick workers home.
"I think mandatory policies are unfair," she said. "They're asking you to inject something into your body. Why not provide education and let me decide?"
But Talbot said patient safety is too important and that he expects the use of mandatory policies to grow despite opposition. In Maryland, the state's association of hospitals is studying the issue. Johns Hopkins, meanwhile, plans to make vaccination mandatory in all of the system hospitals and affiliates by December 2012.
Percentage of hospital workers vaccinated:
James Lawrence Kernan 99.8 (mandatory policy)
Union Memorial 99.2 (mandatory)
Harbor 98.8 (mandatory)
Franklin Square 98.4 (mandatory)
Good Samaritan 98.1 (mandatory)
Greater Baltimore Medical Center 97.9 (mandatory)
Harford Memorial 95.4 (mandatory)
Johns Hopkins Bayview 88.1
Johns Hopkins 86.7
Baltimore Washington Medical Center 84.8 (mandatory)
University of Maryland Medical Center 83.9 (mandatory)
Howard County General 83.6
Maryland General 78.8
Anne Arundel Medical Center 66.6
Bon Secours 66.0
Mercy Medical Center 56.3
St. Agnes 53.8
To see the report, go to the Maryland Health Care Commission website, mhcc.maryland.gov.