Academic journal article Online Journal of Issues in Nursing

Influenza Vaccination in Healthcare Workers: Should It Be Mandatory?

Academic journal article Online Journal of Issues in Nursing

Influenza Vaccination in Healthcare Workers: Should It Be Mandatory?

Article excerpt

Abstract

Since 1981 the Centers for Disease Control and Prevention has recommended that healthcare workers receive vaccination against influenza in an effort to reduce transmission of the virus to their colleagues and to the vulnerable people in their care. To date inadequate progress has been made in terms of increasing yearly healthcare worker influenza vaccination rates. In this article the author reviews influenza epidemiology, prevention, vaccination, and evidence related to vaccination benefits; and discusses the elimination of barriers to vaccination. Voluntary interventions to increase vaccination rates are described. The benefits and challenges of mandatory vaccination, including both mandating of individual vaccination and institutional vaccination programs are reviewed. In the conclusion, the author advocates for rejecting mandatory individual vaccination and supporting institutional mandates that protect the right of the individual to decline vaccination for religious, medical, or philosophical reasons.

Citation: Sullivan, P., (Nov. 2, 2009) "Influenza Vaccination in Healthcare Workers: Should it be Mandatory?" OJIN: The Online Journal of Issues in Nursing Vol. 15 No. 1. Available: www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol152010/No 1Jan2010/Articles-Previous-Topic/Mandatory-Influenza-Vaccination-in-Healthcare-Workers.aspx

Keywords: barriers to vaccination, communicable disease, influenza, influenza vaccine, influenza transmission by healthcare personnel, institutional vaccination programs, patient safety, mandatory vaccination, voluntary vaccination

Influenza, an infectious disease that occurs annually in temperate regions around the world, affects an estimated 5 -15% of the world's population and results in 500,000 deaths annually ÍWorld Health Organization, [WHO], 2009b"). In the United States (US), between 1979 and 2001, an average of 226,000 persons were hospitalized and 36,000 died each year as a result of complications from influenza ("Centers for Disease Control and Prevention rCDCI, 2007). Cross-transmission of influenza infection from healthcare workers (HCW) to patients has been described in various clinical settings, including long-term-care facilities (LTCF), oncology units, solid transplant units, neonatal intensive care units (NICU), and pediatric units ÍMalavaud et al., 2001: Muñoz et al., 1999: Slinger & Dennis, 2002; Weinstock et al., 2000).

Since 1981, the CDC (2006) has recommended that HCWs receive vaccination against influenza in an effort to reduce transmission of the virus to their colleagues and to the vulnerable people in their care. To date, inadequate progress has been made in terms of increasing HCW influenza vaccination rates among HCWs which remain less than 50% (CDC, 2008). Healthcare workers have identified a number of barriers to vaccination. Although multifaceted programs that eliminate these barriers and support voluntary vaccination have been effective in increasing vaccination rates, these programs are a recent phenomenon, and have not been widespread. Healthcare agencies are now considering mandatory influenza vaccination for their healthcare providers.

Given the seriousness of the disease, its potential for cross-transmission, and the lack of HCW voluntary compliance with vaccination, Poland, Tosh, and Jacobson (2005) have argued that mandatory vaccination is ethically warranted. Backer (2006) and also Poland and Jacobson (2007) have supported mandatory influenza vaccination, likening mandatory influenza vaccination to laws mandating Hepatitis B programs. It is important to note, however, that Hepatitis B vaccination is not mandated for individual HCWs, but rather institutions are mandated to offer the vaccine to all persons with the potential for blood exposures (Occupational Health and Safety Administration [OSHA], 1991). Currently HCWs maintain the right to decline Hepatitis B vaccination (OSHA, 2009V Others oppose mandating individual vaccination of HCW's, describing it as punitive. …

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