The Obligation of HCWs to Get Flu Shots

Transcription

1 The Obligation of HCWs to Get Flu Shots The Center for Vaccine Ethics and Policy a program of: The Department of Medical Ethics NYU Langone Medical Ctr, The Wistar Institute and Children s Hospital of Philadelphia

2 Facts are not enough! Vaccine advocates like to blame anti-vaccers but; Anti vaccers know facts and ignore them Plenty of hcws were and remain anti-vax!! Americans believe nutball conspiracy theories that will not yield just to facts such as autism coverup Repeating facts does not respond to moral positions people have for not vaccinating themselves and their children

3 MEASLES

4 Facts are- Necessary Not Sufficient!

5 Facts About Flu Some argue flu vaccine is not that effective Cochrane collaborative, Osterholm et al., challenge effectiveness Some argue not safe Effectiveness is dependent on herd immunity/exposure Effectiveness for vulnerable Effectiveness is not just death but availability to work and symptom control Safety is very very good

6 Facts About Flu Influenza kills 3,000 to 49,000 people in the United States every year. Most of these are small children, the elderly, and people with chronic diseases Causes 200,000 hospitalizations Flu vaccines prevent influenza in 70% of vaccinated healthy adults of working age Vaccine not ideal for elderly people or young children; few well designed studies have been done with existing vaccines to know their true or best possible efficacy we are not likely to understand the best protection that might be achieved from existing influenza vaccines without some semblance of herd immunity protection would probably be better with intradermal vaccines, high-dose vaccines in elderly people, or vaccines with stronger adjuvants than are currently available. To maximize efficacy with existing vaccines, influenza vaccine penetration needs to be maximized.

7 Facts About Flu Influenza kills 3,000 to 49,000 people in the United States every year. Most of these are small children, the elderly, and people with chronic diseases Causes 200,000 hospitalizations Rates of flu in patients fall in direct proportion to vaccination rates of HCWs in institutional settings such as hospitals and nursing homes Studies show few ill effects of vaccines Flu shot helps prevent stillbirths and premature births American Journal of Public Health: June 2012

8 Preventible deaths in kids 105 US kids died of flu; most didn't get vaccine By MIKE STOBBE, AP Medical Writer Friday, March 22, flu season ticle/105-us-kids-died-of-flu-most-didn- t-get-vaccine php#ixzz2OJ2ROP2N

9 Facts About Flu: Incidence rate of influenza in HCWs and healthy, working adults Unvaccinated and vaccinated HCWs were compared to healthy, working adults with the same vaccination status by subgroup meta-analyses for all infections and symptomatic infections, respectively, using serology for influenza diagnosis. incidence rates in HCWs were higher than in working adults. Rates of all infections were found to be lower in vaccinated HCWs than in those who were unvaccinated. Kuster SP, Shah PS, Coleman BL, et al. Incidence of influenza in healthy adults and healthcare workers: a systematic review and meta analysis. PLoS ONE 2011;6:1-9.

10 Facts About Flu So, bottom line, Flu is deadly, especially among the most vulnerable patients. Flu often takes a huge toll in terms of hospitalizations and impact on workforce source: American College of Physicians Vaccine for influenzas are somewhat effective and very very safe Work best with herd immunity to protect vulnerable HCWs more likely to be exposed

11 CDC Recent Recommendation Shortage shaped older recommendation H1N1 changed manufacturing shortage ACIP now recommends universal yearly vaccination for everyone 6 months old

12 Public does not vaccinate General population well under 50% Pregnant women less than 50% Data sources: National Immunization Survey and National Internet Flu Survey, November 2012

13 Pixie Dust

14 Pixie Dust $30 per jar I I became concerned about vaccinating my son and wanted another option to support him during vaccinations. I looked to the research to see if there was something I could do nutritionally to support health during this vulnerable time. So we created VacciShield to fill a gap that we saw in the vaccination process. VacciShield is designed for infants and kids to help support healthy brain, immune, gastrointestinal and detoxification function during vaccination.

15 Magic elixir

16 HCWs Do Not Vaccinate Despite recommendations, national immunization rates among HCWs remain near 60% and have for many years Many voluntary programs Still poor rates (bit better last two years) Rates are poor among HCWs in UK 35% ITALY 20%

17 VOLUNTARY PROGRAMS DO NOT WORK/HAVE NOT WORKED RATES IN Sample PA HOSPITALS percent for Lancaster Regional Medical Center; 50 percent for Heart of Lancaster Regional Medical Center; 56 percent for Brethren Village; 63 percent for Garden Spot Village; 51 percent for Ephrata Community Hospital NURSING HOMES AND HOME CARE???

18 HCWs and Poor Flu shot Rates I know 70% people around me are at risk of getting the flu 60% I am at risk of getting the flu (MMWR aug 19,

19 HCWs and Poor Flu Rates I don t need a shot because-- I stay home I don t have much patient contact I never get the flu I can wear a mask Shots don t work

20 HCWs and Flu Influenza is highly contagious for 24 hours before symptoms begin many people, including unvaccinated healthcare workers are unwitting carriers You can be a carrier and not feel sick

21 HCWs and Flu Health care workers work sick Health care workers do not know when they are infectious Health care workers are expected to show up for work even if they are sick Health care workers often do not get many sick days

22 Case for Mandates

23 HCWs (Docs Nurses) Ethical Duties Protect the vulnerable, weak and defenseless Put patient interests first! Do no harm Be a Role Model not a Hypocrite

24 HCW Duties These duties do not permit of exceptions on religious or philosophical grounds given the potential to do harm to vulnerable and helpless and duty to put patients first Only health grounds allowed for exceptions

25 Duty to Protect Vulnerable Flu preys upon Babies Young children The pregnant The elderly Immune compromised They require protection Protection is herd immunity

26 Patients First Every Code of Ethics AMA, ACP, ANA, SCCM, calls for putting patient interests ahead of professional self interest WMA The medical community has an ethical obligation to act with the safety of patients as its foremost interest.

27 Patients First AMA Code A physician must recognize responsibility to patients first and foremost. To preserve the quality of their performance, physicians have a responsibility to maintain their health and wellness When health or wellness is compromised, so may the safety and effectiveness of the medical care provided.

28 Patients First ANA Code -- The nurse s primary commitment is to the patient, whether an individual, family, group or community. -- The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.

29 Do No Harm Infecting the weak and the vulnerable is to do the worst sort of harm Being unavailable to work in pandemics is to do harm Feeding vaccine fears and anti-vaccine sentiments is to do grave harm Drinking Chinese teas, immune boosting vitamins, bathing with eucalyptus leaves Vaccines are a key weapon in patient safety and cutting hospital based deaths

30 Role Model "Nurses can help improve vaccination rates, study suggests" Reuters (November 23, 2012) - "More elderly and at-risk adults get their flu and pneumonia vaccinations when the shots are coordinated and given by nurses instead of doctors, a new analysis suggests. Researchers linked the changeover to a 44-percent increase in patients' chances of getting a flu shot and a more than doubling of their likelihood of getting vaccinated against pneumonia. Jeffrey Johnson, who worked on the study, said there's been a recent effort to get public health nurses and pharmacists involved in giving vaccines - although policies vary by state in the U.S. He said shifting responsibility to non-doctors might be especially helpful for people with chronic diseases."

31 Many People Face Vaccine Mandates Military Oil workers Astronauts School children Biological and weapons labs Immigrants

32 Duty to be Vaccinated There is a clear obligation/duty to be vaccinated on the part of physicians and other HCWs Leadership of nursing, medicine and pharmacy should be insisting on making flu vaccination a condition of employment for those with clinical duties Health care institutions should be vaccine mandated zones for those who work there and have patient contact Every patient and long-term care resident has a right to request care from vaccinated HCWs for their own safety

33 Duty to be Mandates 2014 Vaccinated Over 400 health systems including CHOP/UPHS, Cincinnati Children's, Abington Hospital, Virginia Mason, Barnes Hospital, Grady Health System, Loyola University Health System, Mission Health, Asheville, UC Davis, UC Irvine, Cook County Health and Hospitals-Chicago, Johns Hopkins, Banner (AZ); Hackettstown, NJ RMC; New York Presbyterian (med exceptions only); NYUMC NY State Mask or Vaccinate Jan, 2014 LA County U.S. DOD civilian healthcare personnel who provide direct patient care in DoD military treatment facilities

34 Du Mandates 2014 Overview Vaccinated exceptions only for medical or proven religious reasons -- exemptees must wear masks some HCP, some HCW, some venders and volunteers some also clerical, dietary, janitorial, and laboratory staff, or may face dismissal Mandatory vaccination endorsed by Infectious Diseases Society of America, American Academy of Pediatrics, Society for Healthcare Epidemiology of America National Patient Safety Foundation American College of Physicians, American Pharmacists Association

35 Mandates About 13% of all HCWs in USA now work at institutions that mandate Among these 98% or better are vaccinated

36 One Institution s mandate experience-- CHOP Went to a mandate in 2009 after failure of serious voluntary efforts started in 2004 Under the mandate, if an employee was not vaccinated and did not have a valid medical or religious exemption, they were placed on unpaid 2 week leave during which time they completed educational activities about vaccination. If the employee was not vaccinated after this 2 week period, their employment was terminated. 7 nurses were fired

37 One Institution-- CHOP A total of 9234 staff were vaccinated 55 medical exemptions were granted by Occupational Health and Human Resources 7 nurses continued to decline vaccination and had their employment terminated 99.3% vaccination rate New employees must be vaccinated

38 Lessons-- CHOP Education and buy-in about mandate was key Talks about facts about vaccines and duties of HCWs were very important Facts alone are not enough to change behavior

39 Future of Mandates Nursing homes, home care? Day care and Pre-K (NYC, CT, RI) What about non-professional hcws? Vendors? Visitors? Teachers, airline personnel?? Other nations? Other vaccines? Setting an example for the public impact??

40 Thank you! The Center for Vaccine Ethics and Policy a program of the Division of Medical Ethics, NYU Langone Medical Center, The Wistar Institute and Children s Hospital of Philadelphia