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Experts call for mandatory signed declaration for all staff refusing influenza vaccination

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Mandatory signed opt-out clauses are critical to increasing influenza vaccination rates among direct care healthcare staff, according to a new paper released by health experts.1

The paper, developed by the Influenza Specialist Group, identifies three critical steps for healthcare facilities to help improve vaccination rates among their direct care staff:1

  • Mandatory signed declaration by all staff who decline to be vaccinated, and stating their reasons;
  • Continued improvements in education about, and access to, vaccination;
  • Mandatory vaccination of all direct care staff within critical high-risk areas.

"Over recent years there’s been significant discussion about the need to improve influenza vaccination rates among direct care staff, but even so vaccination rates remain suboptimal; usually below 50% within Australian healthcare facilities," said Dr Alan Hampson, Influenza Specialist Group Chair and internationally recognised expert on influenza.  "It’s now time to move from debating the issue to implementing some positive action – the ISG believes this can be achieved in three critical steps."

Dr Hampson went on to say that the need for high levels of influenza vaccination among direct care staff – for annual seasonal epidemics as well as any potential pandemic situation – had recently been highlighted by concerns about A/H1N1 ‘swine influenza’. 

"Providing direct care staff with an appropriate vaccine is a critical element of the Australian Health Management Plan for Pandemic Influenza, otherwise known as the AHMPPI," said Dr Hampson. "The AHMPPI recognises the need to maintain essential health services during an influenza pandemic and includes provision of vaccine, once available, in a staged approach to all health care workers. However, the impact of influenza in the health care sector is not restricted to pandemics; it is with us to varying degrees every influenza season."

"We know from experience and clinical evidence that direct care staff have among the lowest vaccination rates in healthcare facilities – with doctors often lowest of all," said Dr John Litt, SA GP and Senior Lecturer at Flinders University. "In addition, many non-clinical staff such as receptionists may not consider themselves personally at-risk. This is not the case, as was demonstrated in 2007 when a SA GP surgery receptionist died from influenza complications."

There are several significant benefits in vaccinating direct care workers against influenza – to themselves, to their patients and to healthcare facilities as a whole. The likelihood of a direct care worker becoming infected with influenza is relatively high, with up to half of all staff being infected during some outbreaks.2,3 In addition, direct care staff vaccination has been associated with a nearly 50 percent mortality reduction in long-term care (from 22.4% to 13.6%).4


Dr Hampson said that improving direct care staff vaccination rates had become a key focus for a number of state and territory governments – often with impressive results. As much of this work currently focuses on government-funded public hospitals, it is important that other healthcare facilities aren’t left behind – particularly in private/aged-care facilities and in primary care, where vaccination is often much more difficult to access and not actively promoted.

Even when healthcare facilities make influenza vaccination free and readily available, many staff remain unvaccinated – often because of a perceived lack of need for vaccination, as well as concerns about adverse reactions and vaccine efficacy.5-9

"Thus the benefit of something like a mandatory signed declaration by all staff who decline vaccination provides the opportunity to educate staff about the relative benefits and risks of influenza vaccination, including duty of care," said Dr Hampson. "It also requires direct care staff to make an active choice about vaccination, and enables effective record keeping of staff vaccination."

Dr Hampson went on to say that the Influenza Specialist Group acknowledged the significant workload of staff at healthcare facilities and how easy it was for influenza vaccination of direct care staff to fall to the bottom of the list.  However, he pointed to a 2005 WA cost-benefit analysis, which found an estimated $65 cost saving per person vaccinated10 as helping to illustrate that the work was worth the investment – both from a financial perspective and as a duty of care towards staff and patients.

"In medical school we are taught primum non nocere – first do no harm," added Professor Robert Booy, Professor of Paediatrics, University of Sydney. "Healthcare professionals and their employers thus need to ensure infections such as influenza aren’t brought into the hospital or clinic; and vaccination is such an easy first step towards this."


References:

  1. Influenza Specialist Group. Influenza Vaccination Among Healthcare Workers (Discussion Paper). May 2009. Available at: http://www.influenzaspecialistgroup.org.au/
  2. Ruel N, Odelin MF, Jolly J et al. Outbreaks due to respiratory syncytial virus and influenza virus A/H3N in institutionalized aged. Role of immunological status to influenza vaccine and possible implication of caregivers in the transmission. Presse Med. 2002 Mar 2;31(8):349-55
  3. Salgado CD, Farr BM, Hall KK, Hayden FG. Influenza in the acute hospital setting. Lancet Infect Dis 2002 March;2:145-55
  4. Carman WF, Elder AG, Wallace LA et al. Effects of influenza vaccinatinon of health-care workers on mortality of elderly people in long-term care: a randomized controlled trial. Lancet 2000; 355(9198): 93-97
  5. McLennan S, Gillett G, Celi LA. Healer, heal thyself: health care workers and the influenza vaccination. Am J Infect Control. 2008 Feb;36(1):1-4
  6. Thomas RE, Jefferson T, Demicheli V, Rivetti D. Influenza vaccination for healthcare workers who work with the elderly. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD005187. DOI: 10.1002/14651858.CD005187.pub2
  7. Mehta M, Pastor CA, Shah B. Achieving optimal influenza vaccination rates: a survey-based study of healthcare workers in an urban hospital. J of Hosp Infect. 2008 Sept 70(1):76-9
  8. Anikeeva O, Braunack-Mayer A, Rogers W. Requiring influenza vaccination for health care workers. Am J Public Health 2009 Jan;99(1):24-99
  9. Kaufman J, Davis J, Krause V. Influenza immunisation of doctors at an Australian tertiary hospital: immunisation rate and factors contributing to uptake. Com Dis Intell. 2008
  10. National Institute of Clinical Studies. Flu Facts: Health Professionals (factsheet). Last updated 8 December 2008. Accessed at: www.fightflu.gov.au/ professionals
  11. National Health and Medical Research Council, The Australian Immunisation Handbook 9th Edition 2008, Available at: http://immunise.health.gov.au/ internet/ immunise/ publishing.nsf/ Content/ Handbook-home
  12. Cruickshank M, Ferguson J, editors. Reducing Harm to Patients from Health Care Associated Infection: The Role of Surveillance: Australian Commission on Safety and Quality in Health Care, 2008

(Source: Influenza Specialist Group: May 2009)



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Dates

Posted On: 12 May, 2009
Modified On: 19 March, 2014

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