Friday, December 3, 2010

Take me home, country roads, to the place….

…where hospitals can decide for themselves how to vaccinate their workers against the flu. Sorry, those lyrics don’t really work. Still, West Virginia has decided against a statewide mandate for healthcare worker influenza vaccination.

I’m not sure this is big news, as I am not aware of how many states have decided to step into this issue—I had assumed that most would leave it up to each hospital. Maybe someone can enlighten.

I am blogging about this for two reasons. First, and most importantly, because West Virginia is Mike Edmond’s home state (or at least he went to college and med school in West Virginia). Here is a photo of Mike as a child, before he decided to pursue a career in medicine and was more interested in the banjo. Second, I wanted to report that our hospital is now at a 93% influenza vaccination rate without a mandate. If you recall, last year our shiny new mandate went down in flames after SEIU filed an injunction. So I’m especially proud of the fact that our healthcare workers are stepping up to be vaccinated without being forced to do so by threat of termination.

4 comments:

  1. 93% is excellent, but I still wouldn't want one of the other 7% coughing on my premature baby.

    I really wonder what other kinds of attitudes one would find in these HCW. If they think they know better than the ACIP about influenza vaccine, why would we expect they would defer to other infection control policies they don't happen to agree with, or even to physicians' orders in general?

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  2. I think this is a good point. One thing we often see when we measure compliance in ICUs is that HCWs that are compliant with contact precautions are also more compliant with hand hygiene. We are never sure if we have just identified a "compliant" individual or that the act of putting on gowns/gloves reminds HCWs to clean their hands.

    This also points out one flaw (the other is sub-clinical infection or transmissible infection prior to symptom development) with Mike's push for reducing presenteeism in influenza. I suspect that the worst offenders in presenteeism are also the ones not getting their flu vaccine, so the math and patient benefits don't add up.

    This doesn't mean we have to mandate vaccine, but I don't think we can hide behind preventing presenteeism as a solution.

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  3. Agree that it's possible that those noncompliant with vaccine may be more likely to be present when sick, though not aware of any data regarding that, and it may be more related to hospital sick leave policies.

    Regarding asymptomatic and presymptomatic transmission of influenza, Leonard Mermel's systematic review of the issue concluded that 'there is scant, if any evidence that asymptomatic or presymptomatic individuals play an important role in influenza transmission." [Public Health Reports 2009;124:193-196.]

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  4. When I read Mermel's letter in PHR I focused on his concluding sentence: "More definitive transmission studies are sorely needed." Thus, definitive studies have not been completed. In a hospital, how would you study it? Daily detection for virus and daily symptom profile for an entire season? That would be an expensive and likely not even definitive study.

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