After cajoling employees to get a flu shot for years - with festive kick-off campaigns and convenient "flu carts" -- hospitals statewide are getting tough on employees this year, with controversial policies that require some workers to mask their face for months if they skip a flu shot.
The polices are an effort to combat the chronically low flu-shot rate of health-care workers. Nationally, only about 40 percent of workers get vaccinated for seasonal influenza, according to the Centers for Disease Control and Prevention. That's slightly higher than the general public's rate of 35 percent last year.
"The CDC has said every year that health-care workers should be vaccinated for influenza, as far back as the early '80s," said Joyce Lammert, chief of medicine at Virginia Mason Hospital and Medical Center.
But despite the recommendations -- and the nudging efforts of hospitals - the vaccination rate has remained low.
"It's been clear that voluntary methods have not been very effective," Lammert said. "And when you consider the 60 percent who are not being vaccinated, to me, it's kind of frightening."
Last week, the Washington State Hospital Association announced that 94 of the state's 98 hospitals had adopted a policy requiring health-care workers to get a flu shot or nasal mist, or take another "patient protective action."
It's up to hospitals to decide what that protective action should be.
Get a flu shot or cover your face - for months
Harborview Medical Center, which had a vaccination rate of 73 percent last year, now requires workers who skip a flu shot to watch an educational video and sign an opt-out form.
Swedish Medical Center, where only 60 percent of workers got a flu shot last year, goes a step further. It requires health-care employees who decline vaccination to wear a mask when flu cases are active in the community, generally from November to April.
But Virginia Mason has by far the toughest policy. For five years, the hospital has required most employees to get vaccinated unless they qualify for a religious or medical exemption. Otherwise, they're fired.
Nearly 99 percent of Virginia Mason's 5,000 employees were vaccinated last year. Non-vaccinated workers must wear masks.
"(Health care workers) don't get a flu shot for the same reasons people in the public don't get a flu shot. They think, 'I don't get sick. It's going to make my arm hurt for a day,' " said Cassie Sauer, vice-president of public affairs for the Washington State Hospital Association. The group was behind the big push for new policies this year.
"But there is a code of ethics that requires health-care workers to put the interests of patients above their own interests," Sauer said. "They care for people who are vulnerable and weak. It's a duty to not expose people, to not make them sicker."
Nurses' union balks
Mandatory flu shots and the use of masks have been a contentious issue in health care for years, with lawsuits, conflicting science and general resistance. Last year, the New York State Health Department adopted a stringent rule requiring all workers with direct patient contact to get vaccinated. The measure was soon rescinded.
In Washington, SEIU Healthcare 1199 Northwest, which represents local nurses, opposes mandatory policies, because they give people "a false sense of security," said Chris Barton, the local's secretary and treasurer.
"It really isn't what it looks like, in terms of people feeling safe going into hospitals," said Barton, a registered nurse. She said required shots may prompt workers to think they no longer have to follow standard hygiene practices, such as hand-washing. Plus, the CDC doesn't recommend mandatory policies, she said.
The union also views face-masking as a punitive practice unsupported by research.
"It's uncomfortable," Barton said. "It's supposed to be a mark on you, that you're an irresponsible, uncooperative health-care worker." The union is working with Swedish to relax its face-mask policy if the vaccination rate reaches a certain percent.
Timothy Dellit, the medical director for infection control at Harborview, agreed with Barton's views. He said no evidence supports that masks prevent in-hospital flu transmissions, but said they may encourage people to get a shot.
"It's like a scarlet letter," he said. He said he prefers encouragement and education - like debunking the myth that 'the flu shot makes you sick' - before resorting to orders.
At Virginia Mason, the first hospital in the country to adopt a mandatory flu-shot policy, the vaccination rate of employees surged from 30 percent in 2004 to nearly 99 percent last year. A total of nine people have quit or were fired due to refusal to be vaccinated.
"When you think about it, it really is all about the safety of our patients," said Lammert, the hospital's chief of medicine. She said masks are routinely used to prevent disease transmission.
But the effort has come with some cost. About 600 unionized nurses are exempt from mandated shots, after the hospital lost a fight with the Washington State Nurses Association over collective bargaining. But the Virginia Mason nurses has a high vaccination rate -- 96 percent last year.
Still, a grievance over the wearing of masks has lasted five years and is now pending with the National Labor Relations Board.
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