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Hospitals crack down on workers who refuse flu shots
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zinfamous
No Lifer
ah, the tools that simply don't understand the effectiveness of 60% or more.
please, please--show me your immunology or public health credentials so that I can take your "criticism" with something more than flippant disregard.
It's probably for the better to fire our health care workers that know nothing about health care.
olds
Elite Member
I never took the flu shot while in the Army. When I was around, they medics drank for free.
You are contagious long before you show symptoms. Hospital acquired influenza has a very high mortality rate, around 10 to 20%. Remember around 35,000 people year die from the flu. FYI hand washing would do little to stop the most common hospital infections death as they are caused by airborne bacteria, and not transmitted by hand.
zinfamous
No Lifer
how fucking useless is that number? You're talking about people that contract influenza while in the hospital, and their immunity is already compromised for other reasons.
episodic
Lifer
Wear a mask whenever dealing with patients. You should gown, glove, and mask up anytime you deal with a patient IMHO. If people can say that taking the flu shot is better than nothing, then gown - glove - and mask - should be standard when entering a patients room. Maybe I'm a patient that is immuno compromised, and maybe you are contagious before you show symptoms. Why not gown, mask, and glove before every patient encounter (emergencies aside). If people were serious, the protocol reserved for 'seriously' ill patients would be standard for all.
BTW, the handwashing stats 'would' cause many more 'not' to die, if it approached 100%. Google nonsocomial or hospital acquired infections (HAI's). It is widely quoted and accepted that handwashing is the #1 way to prevent them.
What noone will admit is that if you fire employees for not getting a flu shot, you should fire employees for failing to wash hands between patients - which is arguably much more dangerous.
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BladeVenom
Lifer
Despite massive increase in flu vaccines, there has been no sustained decline in influenza-associated deaths over the past decades. http://www.lung.org/finding-cures/our-research/trend-reports/pi-trend-report.pdf
"Very few deaths are attributed to influenza in the population under age 55"
So it's not a serious problem if you're under 55.
"90% of influenza associated deaths occur among adults 65 years and older."
http://www.cdc.gov/flu/about/disease/us_flu-related_deaths.htm
So the flu is really only a serious danger for the elderly, yet the flu vaccine hasn't actually decreased their death rate from the flu.
"Rates of hospitalization due to influenza increased steadily in the United States from 1979 to 2001; almost two thirds of these hospitalizations were among persons 65 years of age or older. This increase, as well as an increase over time in deaths from any cause attributed to influenza,6 occurred despite the fact that the percentage of persons in this age group who received the influenza vaccine increased from 32% to 67% between 1989 and 1997.9"
http://www.nejm.org/doi/full/10.1056/NEJMcp0807498
So the flu vaccine hasn't decreased deaths, and hospitalization rates have gone up.
Does the Vaccine Matter?
http://www.theatlantic.com/magazine/archive/2009/11/does-the-vaccine-matter/307723/
Reassessing Flu Shots
http://well.blogs.nytimes.com/2012/11/05/reassessing-flu-shots-as-the-season-draws-near/
Side effects for vaccines are common.
www.cdc.gov/vaccines/vac-gen/side-effects.htm
Although they don't give rates for the the flu vaccine, "Still, some researchers aren't comfortable with the safety data. Dr. Tom Jefferson, coordinator of the Vaccines Field for the Cochrane Collaborative, an international group of researchers, reported last year in the British Medical Journal that he had found only six limited studies on safety after reviewing 206 studies on the vaccine. That, he says, is a surprisingly small number considering the widespread use of the vaccine and its mixed bag of ingredients." http://www.cnn.com/2007/HEALTH/10/31/flu.hm.flu.shot/ So little research on the side effects for the flu vaccine.
I see flu rates vary from 5% to 20% every year. Another report said only 13% of people who had flu symptoms actually had the flu, it's usually a cold. So it may be even more rare than people think.
It doesn't make sense to get a flu vaccine if you're under 55. The flu is just an unpleasant inconvenience unless you're elderly. Chances are you won't get the flu in any particular year anyways. The vaccine is at best 62% effective, so even with it you may still get the flu. Worse you need a flu vaccine every year. So that may be 10 to 20 flu shots to actually stop the flu just once. So why go through the discomfort and side effects every year for the small chance that the flu vaccine actually stops the flu that year, when getting the flu isn't even a serious problem if you're under 55. I'd rather take my chances and get the flu than have 20 unnecessary/useless flu shots with their possible side effects. Getting the flu shot doesn't even help soceity at large, since at a pathetic 62% prevention rate, it's not good enough to provide herd immunity even if everyone got a flu shot.
I get all my other vaccines. Other vaccines have over a 99+% effectiveness rate, last a long time, and stop really nasty/deadly disease. The flu vaccine is not very effective, is only good for one year, and the flu is just a minor inconvenience for most of us.
Better solution: WASH YOUR HANDS!
"Very few deaths are attributed to influenza in the population under age 55"
So it's not a serious problem if you're under 55.
"90% of influenza associated deaths occur among adults 65 years and older."
http://www.cdc.gov/flu/about/disease/us_flu-related_deaths.htm
So the flu is really only a serious danger for the elderly, yet the flu vaccine hasn't actually decreased their death rate from the flu.
"Rates of hospitalization due to influenza increased steadily in the United States from 1979 to 2001; almost two thirds of these hospitalizations were among persons 65 years of age or older. This increase, as well as an increase over time in deaths from any cause attributed to influenza,6 occurred despite the fact that the percentage of persons in this age group who received the influenza vaccine increased from 32% to 67% between 1989 and 1997.9"
http://www.nejm.org/doi/full/10.1056/NEJMcp0807498
So the flu vaccine hasn't decreased deaths, and hospitalization rates have gone up.
Does the Vaccine Matter?
http://www.theatlantic.com/magazine/archive/2009/11/does-the-vaccine-matter/307723/
Reassessing Flu Shots
http://well.blogs.nytimes.com/2012/11/05/reassessing-flu-shots-as-the-season-draws-near/
Side effects for vaccines are common.
www.cdc.gov/vaccines/vac-gen/side-effects.htm
Although they don't give rates for the the flu vaccine, "Still, some researchers aren't comfortable with the safety data. Dr. Tom Jefferson, coordinator of the Vaccines Field for the Cochrane Collaborative, an international group of researchers, reported last year in the British Medical Journal that he had found only six limited studies on safety after reviewing 206 studies on the vaccine. That, he says, is a surprisingly small number considering the widespread use of the vaccine and its mixed bag of ingredients." http://www.cnn.com/2007/HEALTH/10/31/flu.hm.flu.shot/ So little research on the side effects for the flu vaccine.
I see flu rates vary from 5% to 20% every year. Another report said only 13% of people who had flu symptoms actually had the flu, it's usually a cold. So it may be even more rare than people think.
It doesn't make sense to get a flu vaccine if you're under 55. The flu is just an unpleasant inconvenience unless you're elderly. Chances are you won't get the flu in any particular year anyways. The vaccine is at best 62% effective, so even with it you may still get the flu. Worse you need a flu vaccine every year. So that may be 10 to 20 flu shots to actually stop the flu just once. So why go through the discomfort and side effects every year for the small chance that the flu vaccine actually stops the flu that year, when getting the flu isn't even a serious problem if you're under 55. I'd rather take my chances and get the flu than have 20 unnecessary/useless flu shots with their possible side effects. Getting the flu shot doesn't even help soceity at large, since at a pathetic 62% prevention rate, it's not good enough to provide herd immunity even if everyone got a flu shot.
I get all my other vaccines. Other vaccines have over a 99+% effectiveness rate, last a long time, and stop really nasty/deadly disease. The flu vaccine is not very effective, is only good for one year, and the flu is just a minor inconvenience for most of us.
Better solution: WASH YOUR HANDS!
Yep. It is mandatory at my hospital and although I never got it before working there, it is best for the patients.
Hand washing would help, but the most common nonsocomial infection death is pneumonia , and study show even with diligent hand washing significant infections and death will still occurs.
Not to contradict my previous post, but we were actually laughing about this at work. I brought up the ~60% effectiveness and how one day a strain of influenza may be supremely deadly and mostly immune to vaccination, possibly plague like.
Could be crazy, but who knows.
episodic
Lifer
It is sad that the most diligent hand washing is not occuring.
So the mask part was ignored, why? Also, alot pneumonia is caught from being intubated and respirators (cleaning issues).
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TraumaRN
Diamond Member
First off, what is your experience within health care besides being a patient?
Second as an ER nurse and as someone who actually sat on committees regarding patient safety, hand washing and infectious diseases, you are quite honestly making foolish suggestions. Every hospital I've worked at, including 2 major/prestigious trauma and research hospitals, are constantly waging a battle to lower health care acquired diseases processes. They are constantly waging a battle to increase hand washing.
Where I work right now has placed alcohol based hand sanitizer on the walls practically every 25 feet because it has been shown to be as effective as hand washing(except against C-diff), and it is quicker and easier for staff to use
But we are all human. Even myself who is well aware of this problem would say that honestly most weeks I'm about 90-95% compliant with hand washing/sanitizing. Working in a busy ER it is easy to forget, especially if a very sick patient appears at the door.
But understand this, what you are proposing would never work. Logistically the amount of stock required to do that would be insane, most hospitals already operate on a razor thin margin and to retrofit every room with gown, glove, mask etc just wouldn't happen. Moreover, let me be very clear, ANY PATIENT THAT REQUIRES EXTRA PPE TO ENTER THE ROOM WE PUT THAT EXTRA PPE ON. We have respiratory, contact, C-diff, etc, precautions. We take reasonable precautions with everyone, but understand in the ER for example, we've been flooded with influenza the last few weeks, it would be pointless for us to try and contain every person. If you are immune compromised, yes of course we do, but considering the open air nature of the ER and how influenza is easily spread through the air, it's basically impossible to contain.
That brings me AGAIN to the point about visitors. Visitors are just as likely to spread infection and even the patients themselves if/when they walk the halls. And many many more visitors/patients DON'T wash their hands either.
And lastly you could never truly prove who gave who an infection in a hospital. Unless of course you want to culture and isolate every person who enters the room, visitors, janitors, doctors, nurses, techs etc etc. Hell even the damn room itself may not be cleaned appropriately, or for a respiratory infection, the hospitals curtains and shared duct work between most rooms do little to stop infection from spreading. And firing anyone for not washing their hands is not an effective way to handle the problem, not to mention everyone would get fired in the facility. Instead, most hospitals choose to educate staff, increase accessibility to hand washing stations, encourage use of alcohol based hand sanitizer as an effective alternative etc etc.
The point of the flu vaccine is to prevent a "typhoid mary" situation from happening within the hospital. The hospitals recognize that we may be healthy or unhealthy carriers of influenza. By vaccinating the entire hospital, you can at least try to limit the spread of influenza. Not to mention keeping your staff healthy in the event of a pandemic, high mortality influenza outbreak, and just keeping your staff healthy in general by not having to use time off and whatnot.
While you may think you have a novel idea in firing people it is just NOT feasible, nor is it an appropriate action when it comes to reducing health care acquired infections. Also keep in mind that hand washing is but one tool in preventing/reducing heath care acquired infections. There are many many others.
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episodic
Lifer
Firing isn't ok for not washing hands - but ok for a vaccine with limited effectiveness? Ok.
Wonder what the actual cost is of a pair of latex gloves, a cheap tissue paper gown, and a mask. 2 or 3 bucks (if that)? So 10$ a day? Hospitals bill many $1000.00's of dollars a day. Again, it is widely quoted, researched, and studied that handwashing compliance is around 50% average. Average means some are better (maybe your hospital) - but some are much worse. My only argument really is that your personal health decisions really shouldn't be dictated by someone else. Heck, and employer should not even be able to ask. You should have the same privacy as every other individual out there. I'd be fine with an option to wear a mask vs. a shot - at least that recognizes a choice.
There exists technology to filter the air for germs/virii - and cleaning should be a priority. All of that would probably save many more lives per year.
Ah, this is what happens when you have underinformed people making opinions on information they don't understand. Influenza by itself doesn't kill. Influenza causes many complications that lead to death, particularly pneumonia. Its quite interesting how you only quote data on deaths from "influenza" but not complications of influenza, as sited in your ALA paper. In fact, the number of deaths from influenza and pneumonia was nearly cut by 25% from 1999 to 2006 with our increased immunization rates. Nice work on selectively omitting that data, and clearly not even reading the paper you posted.
Again, not knowing what you are talking about only makes you look bad. Since 1979, we have a far greater number of older Americans living to older ages, with many more complicating medical histories including congestive heart failure, diabetes, COPD, etc. Those factors play a lot more into the rate of hospitalization for influenza, since the population is much more medically complex than it has been in the past. And despite all of this, death from influenza and pneumonia has been dropping with our increased vaccination rates.
Facepalm. So you quote a bunch of studies, but don't quote the number of studies that examine what is lost to people from influenza infection. I'll start you with this study, Molinari et al, The annual impact of seasonal influenza in the US: measuring disease burden and costs. Vaccine. 2007 Jun 28;25(27):5086-96.
"Based on 2003 US population, we estimated that annual influenza epidemics resulted in an average of 610,660 life-years lost, 3.1 million hospitalized days, and 31.4 million outpatient visits. Direct medical costs averaged $10.4 billion annually. Projected lost earnings due to illness and loss of life amounted to $16.3 billion annually. The total economic burden of annual influenza epidemics using projected statistical life values amounted to $87.1 billion"
We'll start there, since obviously you don't actually read many of the studies about the influenza vaccine.
In addition, you didn't read again one of your above studies. Why? The rate of influenza and pneumonia death rate per 100,000 in children under a year of age has dramatically dropped from 32.3 in 1979 to 6.4 in 2006.
How do we protect children? The vaccine cannot even be given to under age 6 months. We have to vaccine families around children, which means young adults and other children. Somehow your crappy analysis didn't include these key facts...
BladeVenom
Lifer
That's two hospitals, out of how many are there in the country?
Yet tens of thousands are still dying from hospital infections that could have been prevented by following a simple checklist.
TraumaRN
Diamond Member
Firing people for refusing a vaccination that can stop the spread of infectious disease is perfectly acceptable. Lets change it from flu vaccine to polio or pertussis or any other vaccine. To even get hired as a nurse I have to prove all my other vaccinations are up to date, so why not flu.
Firing people for not hand washing is incredibly extreme. You completely ignored what I said about proactive steps most hospitals are taking. I won't repeat them again.
And $10 a day? Are you insane? You clearly have little to no experience inside a hospital. A tissue paper gown is not going to stop anything. The most basic gown we have is designed to be mostly fluid resistant to prevent contact transmission from patient to staff. Gloves are well gloves, and the masks...what kind of mask, do you want N95 masks? Basic respiratory masks? You need both. Moreover, per your suggestion you need it outside every room for every patient for every encounter from every staff member. It would cost way way way more than $10 a day. And it would be burdensome and cumbersome for staff with no guarantee it would decrease infection rates.
To put a little perspective on, my hospital system in an attempt to control costs, worked with our glove supplier and changed the size and shape of the glove dispensing hole in the box in an attempt to reduce waste of gloves. We are a medium sized facility. Amount of waste from gloves. $58,000(!!!) dollars. Hospital supplies, suffice to say are NOT cheap.
Regarding air filters, we have those too. We have a janitor whose only job is to clean the ED. We personally clean/disinfect after every patient is discharged. We do all those things.
And regarding my personal health(and other staff), the hospital in the interest of public health has a duty to ensure that it's workers are as healthy as possible and have no vectors to spread disease. Again I say preventing another Typhoid Mary.
And last, I'm NOT arguing that hand washing isn't effective because it is. But it is NOT the only means of getting an infection in a hospital.
Um, why not do both? Why is there this discussion that we stop performing an effective measures for reducing influenza by stopping vaccination?
Again, unless you work day to day with patients, you don't quite understand the burden that goes into what you are asking for. Nurses have to enter the room several times per day. They cannot reuse previous gowns and gloves, but can masks. The same goes for physicians. Many university based hospitals have several physicians in and out of the room on a daily basis, including interns, residents, and attendings. If a respiratory therapist is needed, there is further burden. Then you have the nursing assistants... etc. Then you add the economic burden of disposing all of the used equipment...
All of which pales in comparison to the cost of a vaccine.
Once again, you dramatically underestimate the burden you are citing. Hepa-filtering is not cheap at all. The cost of extensive cleaning (beyond what a typical hospital does at this point) costs more than just supplies, you have to pay for labor, and the time invested in cleaning a room (a dirty room delays a new patient from entering, which will delay care in the emergency department, which will delay care for those in the waiting room... these things add up in a busy hospital).
So where's this list of hospitals that refuse infection control measures that are almost universally accepted across the country, and refusing JCAHO recommendations?
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TraumaRN
Diamond Member
Yeah 2 hospital systems out of many. And many follow the same guidelines. These are foreign concepts most every hospital in the country and indeed the world is trying to prevent and limit these kinds of infections.
And what is your checklist? Please start telling every hospital your secret to lowering infection rates that doesn't involve massive increases in costs, logistics, staffing, and lost productivity. I'm waiting.
BladeVenom
Lifer
Treatment and detection for pneumonia has improved.
How effective are flu shots in elderly patients? http://www.todayshospitalist.com/index.php?b=articles_read&cnt=740
BladeVenom
Lifer
🙄 Oh yeah? How so? Let me ask you this, how do you diagnose a pneumonia? I know how. Do you?
And what technology suddenly became new in the past 10 years? Not sputum cultures. Not chest x-rays. Not CT scans. We don't have new antibiotics. In fact we are having to treat now MRSA pneumonias, which are horrible to treat.
So what new treatment and detection has been created?
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