Flu triggers ‘vaccinate or mask’ rules at hospitals
​​Marcela Delatone, an environmental services worker at Palomar Health, ​​​​​​gets the influenza vaccination at Palomar Health, Sept. 21, 2015. Megan Wood, inewsource

Flu triggers ‘vaccinate or mask’ rules at hospitals

To protect patients, more than 100,000 health care workers in hospitals, nursing homes, clinics and ambulances are required to be vaccinated against the flu or wear a surgical mask. But in hospital settings alone, roughly 9 percent declined the vaccine during the flu season that ended March 31, according to an inewsource survey.

To minimize the possibility of a patient acquiring the flu from a health care worker, San Diego County now mandates that providers get immunized or wear a mask on the job. The issue is so important Medicare publicly reports immunization rates for each hospital.

San Diego County health officials issued that order last November as some local hospitals were reporting as many as 33 percent of workers declined to get vaccinated during the 2013-2014 season.

Workers, including physicians, who receive flu shots or nasal mist are identified with a nonremovable sticker on their badges. Workers without a sticker are supposed to be masked when in patient care areas.

Enforcement policies vary among hospitals, from requiring counseling for those who refuse vaccinations to suspension or termination, depending on the workplace setting and exposure to vulnerable patients. One hospital even ties bonuses to a quality measurement system that includes vaccination rates in various units.

Health officials believe the evidence is clear that influenza-infected health care workers — whether they are symptomatic or not — can transmit the virus.

“Patients in our health care facilities are especially vulnerable to influenza,” Dr. Wilma J. Wooten, San Diego County health officer and director, wrote in her Nov. 4 order. Likewise, vaccination reduces health care workers’ absenteeism, perhaps at times when nurses and doctors are needed most.  Similar orders were issued by dozens of other county public health jurisdictions in the state.

The 2014-2015 vaccination rate of 9 percent among 70,000 eligible hospital staff was an improvement over the year before when the rate was about 17 percent. Also during the last flu season, the effectiveness of the vaccination was a low 23 percent, which meant many people who received the vaccine got sick anyway, eroding confidence in the vaccine.

Asked to comment on last year’s improvement in the vaccination rate, Wooten said in an email that while her order was “welcomed and encouraged … We’ll need several years to determine the success of the order.”

She said for the flu season starting on Oct. 1, the county again will emphasize the importance of vaccination.

“As you know,” she wrote, “there are myths about flu vaccine that are persistent, and we will continue to educate the public and providers about the safety and effectiveness of the vaccine.”

Although health care workers in a variety of settings are required to get immunized or wear a mask,  immunization rates are only available for acute care hospital workers. inewsource analyzed the most current data, which is not yet available on a public website, from 16 hospitals in the county by asking what they reported to the National Healthcare Safety Network, a nationally comparable database operated by the Centers for Disease Control and Prevention (CDC).

Marcela Delatone and her colleague sign consent forms to receive the influenza vaccination at Palomar Health, Sept. 21, 2015. Megan Wood, inewsource

Marcela Delatone and her colleague sign consent forms to receive the influenza vaccination at Palomar Health, Sept. 21, 2015. Megan Wood, inewsource

Paradise Valley Hospital in National City reported for 2014-2015 the highest rate of refusal among acute care staff members, which include physicians, volunteers and students, with 23 percent declining the vaccine. At UCSD Medical Center and at Alvarado Hospital, 13 percent said no to the vaccine.

In contrast, Sharp Chula Vista reported 4 percent of its health care workers declined.

Some hospitals dramatically improved their vaccination rates from the 2013-2014 flu season year, such as Palomar Medical Center in Escondido and Pomerado Hospital in Poway, which went from 73 percent and 74 percent, respectively, to 90.7 percent and 93.5 percent. Scripps Mercy Hospital, which reports to federal officials a combined percentage for its Chula Vista and Hillcrest facilities, jumped from a combined 76 percent in 2013-2014 to 88.9 percent and 92.4 percent respectively last year, Scripps hospital officials said.

Vaccination rate for eligible health care workers
Medical Center 2013-14 2014-15
Fallbrook Hospital District 67% Closed Nov. 2014
Alvarado Hospital Medical Center 67% 87%
Paradise Valley Hospital 70% 77%
Palomar Health Downtown Campus 73% 91%
Pomerado Hospital 74% 94%
Scripps Mercy hospitals 76% 92%
Scripps Memorial Hospital – Encinitas 81% 93%
Scripps Memorial Hospital – La Jolla 82% 94%
Tri-City Medical Center 85% 91%
Kaiser Foundation Hospital – San Diego 85% 92%
University of California San Diego Medical Center 88% 87%
Sharp Grossmont Hospital 89% 93%
Sharp Chula Vista Medical Center 91% 96%
Sharp Coronado Hospital and Healthcare Center 91% 88%
Scripps Green Hospital 91% 92%
Sharp Memorial Hospital 92% 94%

Source: 2013-14 data from CMS Hospital Compare; 2014-15 data from inewsource survey of individual hospitals

Asked why Paradise Valley’s immunization rate was low, spokeswoman Laura Gilbert replied in an email that education campaigns have been expanded “to be more informative of the rationale behind getting the flu vaccine, which is to protect both our patients and staff.”

So-called myth-buster posters are placed around the hospital to “counter any vaccine myths, such as that the vaccine causes flu or is not effective,” Gilbert said.

In response to Alvarado’s immunization efforts, she said, the hospital  vaccinated 20 percent more health care workers over the previous year, and has added locations and times when the flu immunizations are available to staff.

The push is on, starting this week, across the country to get health care workers immunized, in part as an example for the general public.

You can check vaccination rates for health care workers at your hospital.

Last December, the Medicare website, Hospital Compare, began publicly reporting percentages of vaccinated staff and physicians. You can find the information under the “timely and effective care” and “preventive care” tabs, and compare reports for each of more than 3,600 hospitals.

As defined by the National Quality Forum, which endorses measures used for assessing health care quality, the percentages for each hospital include all healthcare workers who spend “at least one working day” between Oct. 1, and March 31 in the health care facility regardless of clinical responsibility or patient contact.

The percentages for 2014-2015 in our story were reported by the hospitals to inewsource. The official numbers are expected on Hospital Compare next month.

All San Diego County hospitals, like most across the country, offer applicable workers immunization through shots or nasal mist at no cost through employee clinics, roving carts or with stations strategically situated near entrances.

To give hospitals time to implement outreach programs, hospital officials say they will require unvaccinated workers to wear masks starting Nov. 1.

A week ago, Palomar Medical Center launched its  employee immunization program at no cost.

Deborah Miller, clinical lab scientist, said she was getting immunized “because I’d much rather have the shot than get sick. I can’t afford to take the time off from work. And I don’t want to expose the rest of my family.”

Besides, she said, wearing a mask would be “annoying.”

Lead staff chaplain John Van Cleef said he worried about how patients would see him if he were wearing a mask.

“I don’t want to be visiting them with a mask over my face when I’m trying to talk with them,” he said.

At Kaiser Permanente San Diego, physician and employee immunization is so important that vaccination thresholds per hospital unit are factored into the algorithm for annual bonuses, as high as $1,300 per employee last year, for 9,000 eligible physicians, employees, volunteers and paid staff, said Daniel Spain, administrator for Kaiser Permanente San Diego’s Employee Health Services.

That helped bump Kaiser’s immunization rates from 85 percent in the 2013-2014 season to 92 percent for 2014-2015.

“And for those (unvaccinated) employees who persist in not wearing the surgical mask, maybe because it’s uncomfortable or they’re alleging other reasons, corrective action would be implemented,” Spain said.

Ultimately, he said, that could mean suspension without pay until they “come into compliance or they’re terminated.”  In a prior year, Spain said, nine unvaccinated employees “elected to leave” rather than wear a mask.

Ironically, the busiest parts of a hospital, such as the emergency room, are often the toughest to penetrate, Spain said.

Also, he noted, “there is certainly a segment of our workforce that has resisted this and considered it an infringement upon their personal liberties. “It’s a small but vocal percentage.”

Many health care workers opposed to getting vaccinated ask why immunization requirements should be imposed only on them. During flu season, they argue, an infected visitor or family member, or another patient may just as easily transmit the virus to a patient, suggesting that perhaps patients and visitors show proof of vaccination before entering the hospital

Part of the problem in convincing health care workers of the need to get immunized is that in some years, like last year, the viruses used to make the vaccines have been a poor match to that season’s circulating viruses.

Because of production schedule requirements, it takes months to develop a vaccine, so it’s virtually impossible for manufacturers to switch gears in the middle of a flu season and have a better matched vaccine to distribute before the season is over.

Wooten said 70 people died of influenza locally last year, and nationally, the death toll annually can be as high as 49,000, with 200,000 hospitalizations.

How effective this year’s vaccine will be is unknown.

In a news conference Sept. 17, CDC director Dr. Thomas Frieden said that officials believe this year’s vaccine will be a much better match than last year’s  because sampled viruses have been “closely related” to the vaccine.

The average San Diego County hospital worker immunization rate last year appears on track with that of the national hospital worker immunization rate of 90.4 percent, which was reported by the CDC in a Sept. 18 CDC report.

The report noted that vaccination “was highest among health care providers who were required by their employer to be vaccinated (96.0 percent).”

In some hospitals, the mandate for unimmunized health care workers to wear a mask pushes them to get immunized because masks are uncomfortable.

“Most (workers who resist vaccination) will wear them for a couple  of weeks,” said nurse Valerie Martinez, director of quality, patient safety and infection control for Palomar Health. Then, “they’ll usually say, ‘Oh, you know, I’m going to get the vaccine. There really is no reason why I shouldn’t.’”

On TV…

Here is some additional coverage by Clark on this topic:

Jan. 14, 2015 • Flu Vaccination Pressure Ratchets Up at Hospitals

Aug. 13, 2015 • Push to Vaccinate Healthworkers is On

Aug. 19, 2011 • Healthcare Workers Still Skeptical about Flu Vaccinations

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About Cheryl Clark:

Cheryl Clark
Cheryl Clark is a senior healthcare reporter at inewsource. To contact her with questions, tips or corrections, email cherylclark@inewsource.org.