Volume 200 - Issue 2
A pilot study of an influenza vaccination or mask mandate in an Australian tertiary health service
Authors: Rhonda L Stuart, Elizabeth E Gillespie and Peter G Kerr
Med J Aust 2014; 200 (2): 83-84. || doi: 10.5694/mja13.10947
Published online: 3 February 2014
Published online: 3 February 2014
Enforcing vaccination or mask-wearing leads to increased vaccination rates among heath care workers
To the Editor: Health care workers (HCWs) play an important role in influenza prevention. They are at risk of exposure and subsequent illness which can lead to transmission to close contacts and patients.1 Conversely, high HCW influenza vaccination rates can reduce nosocomial influenza, decrease sickness absenteeism and are cost-effective.2,3 Despite this and the increasingly visible voluntary vaccination programs, the rates of influenza vaccination among HCWs in Australia vary between 16.3% and 58.7%.4 The Victorian Department of Health has recently stated that HCW vaccination must be > 75% in 2014.
Monash Health is a tertiary referral service in Melbourne, Australia, with 2200 beds and 13 389 HCWs. The service provides for 1.3 million residents. The Department of Nephrology (DN) provides dialysis and transplant services and employs 208 HCWs. Annual HCW influenza vaccination is undertaken through the Infection Control and Epidemiology Unit, with vaccinations recorded in a secure database. The program is free and incorporates mobile rounds, extended hours and promotion via newsletters and announcements.
To increase influenza vaccination rates in the DN, we undertook a pilot study to understand the feasibility and acceptance of a program requiring HCWs to receive vaccination or wear a mask during influenza season. The study was approved by the Monash Health Ethics Committee as a quality study.
In December 2012, the DN was informed that to increase influenza vaccination rates, unvaccinated HCWs would be asked to wear a surgical mask during patient care throughout the influenza season. Staff were given the opportunity to ask questions about the program and raise any concerns. In February 2013, a follow-up letter confirmed that the program would be enforced, and vaccination commenced in April 2013 (when the vaccine became available).
Overall, 193/208 HCWs (92.8%) in the DN received the vaccine in 2013. This compared with 6873/13 181 (52.1%) for the remainder of Monash Health in 2013 (P < 0.001) and a vaccine uptake of 47% in the DN in 2012 (P < 0.001).
We found that a program that enforced vaccination or the wearing of a mask had a major impact on vaccination rates. This is the first Australian report of such an initiative. The reasoning behind the use of face masks is twofold. First, it is an incentive, since not being vaccinated equates to a few months of mask-wearing. Second, mask-wearing can be seen as a means of decreasing transmission of influenza in the hospital setting.
The right of an individual to choose vaccination is longstanding and one that is used by antivaccine campaigners. Poland argued that mandated HCW influenza vaccination is ethically, morally, legally and financially well founded,5 and many health associations support HCW influenza vaccination mandates in the United States. Of note, HCWs in the DN are mandated to have hepatitis B vaccination to protect themselves and patients, and this is not controversial.
Limitations of our pilot study include the small number of HCWs involved and the fact that unit leadership was strong within the DN, such that our results may not be generalisable. Nevertheless, the program contributed to a vaccination rate far exceeding our expectations. Further studies on the use of influenza vaccination mandates for HCWs in the Australian health care setting are required.
Competing interests
No relevant disclosures.
References
- Salgado CD, Giannetta ET, Hayden FG, Farr BM. Preventing nosocomial influenza by improving the vaccine acceptance rate of clinicians. Infect Control Hosp Epidemiol 2004; 25: 923-928. 0_CHDEJGAI
- Chan SS. Does vaccinating ED health care workers against influenza reduce sickness absenteeism? Am J Emerg Med 2007; 25: 808-811. 0_i1142873
- Burls A, Jordan R, Barton P, et al. Vaccinating healthcare workers against influenza to protect the vulnerable – is it a good use of healthcare resources? A systematic review of the evidence and an economic evaluation. Vaccine 2006; 24: 4212-4221. 0_i1142875
- Seale H, Macintyre CR. Seasonal influenza vaccination in Australian hospital health care workers: a review. Med J Aust 2011; 195: 336-338. 0_i1142877
- Poland GA. Mandating influenza vaccination for health care workers: putting patients and professional ethics over personal preference. Vaccine 2010; 28: 5757-5759. 0_i1142881
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