Flu shot fight

Vicki Dinning pushed her mobile flu cart down the halls of Holy Family Hospital in Spokane, searching for her next volunteer – or victim, as the case may be.

Staffers in the path of the woman known as “the Shot Lady” knew it was no use to flee. Instead, they either swore they’d already received this year’s vaccination against influenza, or they sighed and rolled up a sleeve.

“If you don’t come see her, she comes to get you,” said Cindy Simcox, a 51-year-old food service worker.

Dinning’s efforts haven’t gone unrewarded. In a nation where less than 40 percent of health care workers get flu shots, and a region where rates dip as low as 25 percent, the employee health nurse gets nearly 60 percent of Holy Family’s staffers to submit to her needle.

“I’m hoping to boost my percentages this year,” said Dinning.

Soon, however, Dinning and other employee health coordinators might have to do more than hope for more immunizations.

Under a plan about to be considered by the state Board of Health, Washington health workers could face mandatory flu shots.

In January, the board is expected to start discussing the possibility that all health workers with direct patient care responsibilities be required to get flu shots, or to document medical, religious or other reasons for declining, said Craig McLaughlin, the group’s executive director.

The agency is moving gingerly into the issue that pits worker rights against a health precaution that could save tens of thousands of lives each year.

“If you want to control the spread of disease, you want to look at work sites, including hospitals and care centers,” McLaughlin said.

However, some employees unions and many health care workers say that while they support immunization, forced vaccination is not the answer.

“We don’t believe a mandate is the best method for compliance,” said Anne Tan Piazza, spokeswoman for the Washington State Nurses Association. “We think you get the best results through education.”

After schoolchildren, health care workers are considered the biggest spreaders of communicable disease, including influenza, which causes an estimated 200,000 hospitalizations and 36,000 deaths a year nationwide, according to the federal Centers for Disease Control and Prevention.

Unvaccinated workers in hospitals, nursing homes and other care centers can spread the flu to vulnerable patients, even before they become ill themselves, experts say. About half of people with influenza have no symptoms but remain contagious.

Repeated studies have shown that vaccinating health care workers not only decreases flu among patients, but also cuts down on staff absenteeism and medical visits, according to the CDC. The group has urged annual immunization for health workers since 1984.

“This is a patient safety issue,” said Dr. W. Hugh Maloney, president of the Washington State Medical Association, whose delegates recently agreed to support a health board mandate. “Everybody should be encouraged to do it or say why they won’t.”

Still, vaccination rates for health care workers are surprisingly modest – about 36 percent nationwide, according to the CDC. In the Inland Northwest, rates ranged last year from a low of about 25 percent at Kootenai Medical Center in Coeur d’Alene to a high of more than 80 percent at the Veterans Affairs Medical Center in Spokane, hospital officials said.

Staff members at the Coeur d’Alene hospital are working hard to increase those rates, said Lisa Johnson, a KMC spokeswoman. Idaho state health officials have no plans to make immunization mandatory, but local hospitals are hoping voluntary efforts will work.

Part of the reason for the low levels of immunization last year was concern over shortages of vaccine, Johnson said. This year, the supply is plentiful.

“We’re already way over that,” she said. “On Tuesday, we were at 48 percent.”

At Sacred Heart Medical Center, about 40 percent of more than 4,300 employees received flu shots during last year’s season, said Roy Almeida, senior epidemiologist for infectious diseases. Two weeks ago, this year’s percentage already was at 44 percent.

“Ideally, I’d like to see it 80 percent or 90 percent,” Almeida said.

Starting next year, hospitals and care centers will be required to offer influenza immunization and information to employees, volunteers and contractors before they can be approved by the Joint Commission on Accreditation of Healthcare Organizations.

Immunization is not mandatory under the new JCAHO standards, however.

“It’s actually a pretty controversial thing,” said Almeida.

In fact, the nurses association has spent more than two years locked in a bitter court battle with Seattle’s Virginia Mason Medical Center, which became the first hospital in the nation to require that nurses be immunized or face termination.

Piazza, the group’s spokeswoman, said the association supports immunization, but not a mandatory requirement.

Several union workers were fired for refusing to be immunized and a few dozen were excused for medical or religious reasons. Meanwhile, Virginia Mason posted an immunization rate of 96 percent among its 5,000 employees last spring, hospital officials said.

“Our goal is to keep patients safe,” Gary S. Kaplan, the hospital’s chairman and chief executive, said in a statement. “… When faced with an opportunity to prevent an avoidable death, the path becomes clear.”

Implementing a similar mandate statewide would be tough, even health board officials agreed. The board doesn’t have specific authority to impose such a rule, and it’s not clear how far its general powers extend, McLaughlin said.

“We have to decide whether the board of health should do it on its own, or whether it should be addressed through legislation,” he added.

At least seven states have legislation requiring health workers to receive annual flu vaccines or sign documents declining them. At least 15 states have regulations covering vaccination of health care workers in long-term care centers.

Strong opposition is likely in Washington, however. Some health workers believe they’re healthy and that they don’t need the shots. Others falsely worry that getting a flu shot will make them sick. Still others simply don’t want to be forced to comply.

“I’m not for mandatory,” said Mary Mueller, 55, an emergency room charge nurse at Holy Family Hospital. “I think they’re intelligent people and they can make their own decisions.”

Hospital administrators agree.

“I’m sure if it were mandatory, we’d have more objections,” said Jane Schilke, associate director of the VA Medical Center, where an aggressive education effort ensures that more than 80 percent of staff members get shots. “It goes against the independent spirit of people in this part of the country.”

It’s better to boost the rate of immunizations through information and accessibility, said Almeida, the epidemiologist at Sacred Heart.

“I just don’t know in terms of morale and employee satisfaction. I don’t know that it’s the best thing to do,” he said of making the shots mandatory.

The secret is to make immunization easy and fun, said Dinning, who organizes early morning and late-night flu clinics, in addition to the mobile cart.

“The biggest thing is education,” she said. “And usually I bring candy.”