So there has been a big push to get/force immunizations for healthcare workers, this has mainly been in the hospital or institutional setting. My family has felt this push since my wife is a RN who works in the OR at Delnor. On it’s face this policy sounds like it should reduce the chance of influenza infection of patients seen in the hospital but does it really. It is my estimation, based on what I’ve read, that there are many practices and procedures that are done in healthcare that are either unsupported or lack sufficient support in the literature. Some of these practices and procedures are continued because of either politics or money. A recent paper published September 2015 reveals some great information on what kind of results immunizations have on hospital acquired influenza infection rates.
I don’t want to get into a whole thing about childhood immunizations and risk vs. reward, I’ll save that for another time. Today I want to discuss the policy of forced immunizations on healthcare workers and what this recent evidence has to say about it. The main idea here is that by getting 100% of healthcare workers immunized there should be a decreased risk for patients to contract the flu after hospital stay/admission or encounter. That is also the main idea behind a national strategy of immunization, as we get near 100% immunization rates there should be a decrease in the instance of said infection. If these ideas are true then we should be able to see rates of influenza decrease but according to a recent study this notion might not ring true.
In this study the authors observed immunization rates of employees over five years, 2010-2015. In the first year of the study immunization rate was 49.7%, just under 50%, and rates of hospital acquired influenza was 9.0%. In the next year immunization rate was 56.5% and influenza rate was 4.9%, the next year the rates were 64.9% and 4.3%, the next year they were 91.7% and 5.2% and the last year immunization rate was 89.9% and influenza rate was 4.8%. What the authors concluded, and what you might have as well, is that after reaching a 50% immunization rate there was no meaningful decrease in hospital acquired influenza. One of the investigators was quoted as saying “At a certain point, you don’t have a real return on vaccination for reducing nosocomial flu, and we should look to things like hand-washing, better screening of patients, and better isolation precautions.” Getting near that 100% of employees immunized against influenza does not equate to a 100% decrease in hospital acquired influenza. If you look at the data even at 49.7% there was only a 9.0% infection rate, which is a very small number to begin with and might mean that your risk for developing the flu due to a hospital stay is very low anyway.
As I read the data from this study I cannot help but determine that the forced immunization of healthcare workers is not supported in the literature. If, as a patient, your risk for getting the flu due to a hospital stay is low and forcing healthcare workers to get immunized doesn’t change that rate by a large amount, then this policy of forced immunizations for healthcare workers lacks significant support in the literature. If this policy in unsupported in the literature then it is a policy we can discard since our society is all about moving towards evidenced based practices. If history is a guide, though, I don’t expect a study like this to change this policy because it is one deeply rooted in healthcare politics. Once again evidence based practices will be shoved aside for either politics or money.