Clarification: I'm in favor of mandating influenza vaccination of healthcare workers (for now)
There's been some misunderstanding of the motivation behind my recent posts offering suggestions for improving the implementation of compulsory influenza vaccination policies and acknowledging the limitations of the existing data supporting vaccine mandates. Most of the snark was on twitter where folks challenged my commitment to infection prevention and my interpretation of the data. If I can dish it, I better be able to take it. With that being said, however, I still feel a need to clarify my support for mandatory influenza vaccination policies in both acute care and long-term care settings. But...
1) I will only support such policies for 4-5 years. If those that push these policies can't come up with better clinical trial data during that time, I'm going to call BS. There is simply no excuse for stretching the existing data to drive change now and not validating your claims. Recommend the mandate, but then do the proper studies.
2) CDC and others must fund studies evaluating the benefits of mandatory vaccine policies in acute care settings. There is never going to be a better time than now, when hospitals are implementing mandatory vaccination programs, to fund the necessary cluster-randomized and quasi-experimental studies. Wouldn't it be great if we could find 50 or more hospitals planning to implement an influenza vaccine mandate and then fund a mixed-methods, stepped-wedge cluster randomized trial as those hospitals implemented the policy over the next 3-4 years? I think it can happen and SHEA, IDSA, PIDS and APIC need to demand such a study.
3) As Sara Cosgrove and I wrote in the 2007 SHEA Business-Case Guideline: "Most hospital epidemiologists or infection control specialists want to increase the resources available for infection control activities, but it is important to avoid overestimating benefits or underestimating staff and time costs. Overestimation in an initial analysis may improve the situation in the short term, but it will hinder efforts and necessary trust in the long term after actual resource audits are performed." There's simply no excuse for hand waiving and over promising the benefits of healthcare worker influenza vaccination. It erodes trust and prevents the necessary validation studies from being funded. Please take the long view and don't be afraid to challenge dogma.
Happy holidays!
1) I will only support such policies for 4-5 years. If those that push these policies can't come up with better clinical trial data during that time, I'm going to call BS. There is simply no excuse for stretching the existing data to drive change now and not validating your claims. Recommend the mandate, but then do the proper studies.
2) CDC and others must fund studies evaluating the benefits of mandatory vaccine policies in acute care settings. There is never going to be a better time than now, when hospitals are implementing mandatory vaccination programs, to fund the necessary cluster-randomized and quasi-experimental studies. Wouldn't it be great if we could find 50 or more hospitals planning to implement an influenza vaccine mandate and then fund a mixed-methods, stepped-wedge cluster randomized trial as those hospitals implemented the policy over the next 3-4 years? I think it can happen and SHEA, IDSA, PIDS and APIC need to demand such a study.
3) As Sara Cosgrove and I wrote in the 2007 SHEA Business-Case Guideline: "Most hospital epidemiologists or infection control specialists want to increase the resources available for infection control activities, but it is important to avoid overestimating benefits or underestimating staff and time costs. Overestimation in an initial analysis may improve the situation in the short term, but it will hinder efforts and necessary trust in the long term after actual resource audits are performed." There's simply no excuse for hand waiving and over promising the benefits of healthcare worker influenza vaccination. It erodes trust and prevents the necessary validation studies from being funded. Please take the long view and don't be afraid to challenge dogma.
Happy holidays!
Eli: Why would SHEA demand a study of HCW influenza vaccination? They concluded 5 years ago based on minimal data that healthcare workers should be fired if they refuse to be vaccinated. Hardly anyone objected. And the rest is history. We did this to ourselves.
ReplyDeleteI agree SHEA getting involved is unlikely. But there are others that just might. The other thing is that SHEA leadership changes over time. My hope is that different folks will see things differently. With that said, if we don't study it now, we will never be able to study it.
DeleteDoing a better job of enforcing hand washing and cleaning appropriately would save a lot more lives and prevent a lot more flu transmission then a shot that by all accounts including the CDC is a "shot in the dark". Once a hospital can manage to get their Drs. and staff to wash their hands and stop the transmission of hospital based infections , but forcing staff to get a shot that has a rocky success rate at best just takes the focus off what is really killing patients.
ReplyDeleteThanks for your comment Diane. I agree that hand hygiene is critical, although a far more complicated issue. We have hospitals designed to restrict hand hygiene compliance (e.g. no alcohol dispensers in rooms because of fire codes) and other barriers. With that said, any influenza prevention bundle must start and end with hand hygiene compliance.
DeleteWe presented at ID Week that we saw NO impact on healthcare worker absenteeism with increasing vaccination rates from ~25% to ~75% over 3 years with a mask-or-shot mandate policy. Absenteeism showed no statistical change. If mandatory vaccination has an impact, it likely isn't on employee absenteeism. It's the right thing to do, but arguments about other impacts aren't based on much.
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