Post Punk Kitchen Forum

Do your health beliefs and values include infecting your patients with diseases that could potentially kill them? If that's how you feel, then the hospital has an obligation to not let you near patients who could have weak immune systems.

Once you become a health care professional, your own personal beliefs are trumped by your obligation to the patients you care for. I would be incredibly angry to find that a health care professional I was working with (or had taken my children to) had infected me or them with the flu or some other disease because they refused to be immunized.

So, no, your decisions do not deserve the same autonomy granted to your patients. That was a decision you should have realized you were making when you became a health care professional.

2 health beliefs I have: 1) meticulous hand hygiene prevents the spread of infection (this is supported by evidence as the most effective infection-control measure); 2) I stay home when I'm sick.

Neither of those are "beliefs" but rather methods supported by scientific theory and evidence. Neither precludes you from transmitting influenza, as you can be contagious before you develop symptoms. Hand washing doesn't completely eliminate microbes on your hands, and it doesn't address respiratory droplets. Masks can reduce the risk in that regard, but again don't eliminate it.

And let me tell you, I respect the hell out of health care workers-- it is (stupidly at this point) a largely thankless job. (People besides big-name surgeons and stuff should be highly respected, but so should teachers, if you see what I mean.)

Yeah, although the pharmacist is also an employee, and is protected by law to refuse to fulfill prescriptions.

I cannot believe this is actually the law. It just seems so absurd to me. When I go to the pharmacy, they are required by law to order any medication my doctor has prescribed to me, even if they have another brand or I could walk 20 mins to another pharmacy.. Because it's medicine, and it's important. I cannot believe that someone working in a pharmacy can say "nah, it's against my beliefs". My mind is officially blown.

But it doesn't make sense when it comes to the flu shot. And vaccines for other diseases don't all have the same chemicals as in the flu shot.

The flu shot is only 60% effective and only inoculates you against a select few of the hundreds of strains of flu floating around out there. So I really don't see the point of injecting myself with a bunch of mercury for something that probably isn't going to do anything anyway,

I guess we don't hear about it but every flu season, 10s of thousands of people die from the flu in the US, mostly elderly and some young. We tend to hear about the young people. Yes, it inoculates only a few strains of flu, the ones deemed most critical. yes it isn't as effective since it is the killed virus so that you can't actually get the virus from the flu but even if it is only 60% effective that might make the difference between someone getting the flu and dying or not getting the flu.

Actually, at 60% effectiveness, it probably IS going to do something.

Most years around 3,000 people, not tens. Every now and then for whatever reason it hits the 5 digits. The elderly are at higher risk then the young. It makes sense for people in the high risk category to get it. I'm not high risk, so it doesn't make sense for me.


Funny, I wouldn't take a birth control pill that was 60% effective. Birth control is 99.% effective. Want to have this conversation again when the flu shot is 99% effective?

So, you are comparing IUD and implants to flu shots? Birth Control Pills require that you take the pill at the same time each day and not forget. In real life they are less effective than either the IUD or the implant.

I just wanted to clear one thing up, as I've seen it a couple of times here. The flu shot is a killed virus, so you can't get influenza from it. That it is killed, however, does not make it less effective than a live virus vaccine. The nasal spray flu vaccine is actually a live attenuated virus, and from what I have read so far it is slightly less effective than the shot. Healthy people won't get influenza from the nasal spray vaccine either because it is a weakened virus, but it could theoretically cause an infection in certain groups of people so it isn't recommended for everyone.

I was comparing the effectiveness. A lot of things we take are much more then 60% effective. That's the point. 60% effectiveness is not convincing for me. Most of our vaccines, medications, medical procedures have much higher rates of effectiveness when used properly when compared to the flu shot. it doesn't matter which one you want to single out.
IUD' and implants scare me. I don't like the idea of objects hanging out in my body.
I also don't see how having to use something properly is some sort of argument against it. That's just an argument to follow instructions and use things the way they were intended.

When you are working with people with compromised immune systems, a 60% effectiveness is still better than 0% effectiveness. Most often normal healthy people don't get the flu shot for themselves, they get it to try to prevent spreading the flu to others.

I apologize for misinformation then, I thought I had read that the live attenuated virus was more effective but I could've misread.

I was comparing the effectiveness. A lot of things we take are much more then 60% effective. That's the point. 60% effectiveness is not convincing for me. Most of our vaccines, medications, medical procedures have much higher rates of effectiveness when used properly when compared to the flu shot. it doesn't matter which one you want to single out.
IUD' and implants scare me. I don't like the idea of objects hanging out in my body.
I also don't see how having to use something properly is some sort of argument against it. That's just an argument to follow instructions and use things the way they were intended.

ACP Policy on Influenza Vaccination of Health Care Workers
BACKGROUND
The discussion over vaccination of health care workers (HCWs) for influenza must begin
with an undisputed set of facts: 1) Influenza vaccines are safe and effective, 2)
Unvaccinated HCWs spread influenza to their patients, 3) Hospitalized and other
vulnerable patients can have prolonged hospitalizations, severe illnesses, and can die as a
result of influenza transmission from HCWs.
Transmission of influenza from HCWs to patients has been documented in nearly every
health care setting.
1
Multiple studies show that 70 percent or more of HCWs continue to
work despite being ill with influenza, increasing exposure of patients and co-workers.
Serologic studies suggest that up to 25% of HCWs have evidence of influenza infection
each season.
2,3
Influenza can be transmitted while asymptomatic – allowing HCWs to
spread the infection to patients and other staff before they know they are ill.
4
Fifty
percent of HCWs who have influenza infections are asymptomatic or have only minor
symptoms.
5
A review of nosocomial influenza outbreaks in the hospital setting compared attack rates
of patients with those of HCWs, and found that HCW attack rates mirrored, and even
surpassed, patient attack rates in epidemic areas of the hospital.
6
In addition, the study
reported median excess patient mortality rates of 16 percent, with rates in excess of 33 to
60 percent for ICU and transplant units.
LEADERS ON THIS ISSUE
The Centers for Disease Control and Prevention has recommended influenza vaccination
for all health care workers since 1981. The major professional societies have all endorsed
and published recommendations requiring HCWs with direct patient care to be
immunized. In addition, the Joint Commission standard (effective January 2007) requires
organizations to establish an annual influenza vaccination program, educate staff and
physicians about flu vaccination, evaluate vaccination rates and reasons for
nonparticipation in the immunization program at the unit level, and implement
enhancements to the program to increase participation.
The recommendation of the Adult Immunization Advisory Board is that a series of
educational activities be centered on this message:
An annual influenza vaccine should be required for every health care worker with
direct patient care activities, unless a medical contraindication to influenza
immunization exists or a religious objection to immunization exists. If, however,
health care workers invoke those exceptions, they must still fulfill their ethical
obligations to patients and colleagues by not engaging in direct patient care
activities if flu-like symptoms are present. In addition, those health care workers
who cannot receive flu vaccines due to medical or religious contraindications should either be re-assigned to non-patient care areas during influenza season or wear a
mask at all times during influenza season in the context of patient care.
In so doing, we are proposing only to do for influenza vaccination of HCW that which we
already require for HCWs for hepatitis B, measles, mumps, varicella, and annual TB
screening. HCW immunization rates now exceed 96% - 99% after mandatory
requirements for rubella, measles, mumps, hepatitis B, and varicella vaccinations. Once
OSHA mandated Hepatitis B immunization for HCWs – OR – informed declination,
immunization rates skyrocketed and now exceed 99%.
THE EVIDENCE
Immunizing health care workers safely and effectively prevents a significant number of
influenza infections, hospitalizations, and deaths among the patients they care for, as well
as preventing workplace disruption and medical errors by workers absent from work due
to illness, or present at work but ill.
7,8,9
Influenza vaccination of HCWs lowers mortality among patients. A study of 20 hospitals
found an overall 51% staff vaccination rate in hospitals where vaccine was offered vs.
5% staff vaccination rate in hospitals where influenza vaccine was not offered. Mortality
among patients was 13.6% (102/749) in the hospitals providing HCW vaccination vs.
22.4% (154/688) (P = 0.01) in hospitals that did not.
10
In another study of 12 hospitals,
HCWs and patients were randomized to receive influenza vaccine. There was no
difference in patient mortality between hospitals with patients who received vaccine and
patients who did not. However, the mortality rate among patients in hospitals where
HCWs got vaccine was 10%, compared with 17% among hospitals that did not immunize
HCWs.
11
Influenza vaccination of health care workers results in improved patient safety, improved
employee safety, and decreased health care expenditures.
12,13
In a 2003 study of
University of Ontario house staff, house staff reported working during most days they
were ill and infectious. Vaccination was associated with a 30% decrease in ILI (p=0.05),
a 43% decrease in fever and cough (p=0.03), and a 63% reduction in absenteeism. Thirty
percent of unvaccinated but 60% of vaccinated residents believed flu vaccination should
be mandatory, but depended upon the system to make sure they received it.
14
AN ETHICAL OBLIGATION
Vaccinating HCWs against influenza represents a duty of care, and a standard of quality
care,
15,16,17
so it should be reasonable that this duty should supersede HCW personal
preference. Internists care for the patients most at risk of influenza-related morbidity and
mortality. As Rea and Upshur state ―Physicians have an obligation to their patients to
take all reasonable actions to prevent transmission in the context of patient care.‖
18
The
needs of the patients we as internists are privileged to care for must come before HCW
preference – and as the professional society representing internists, ACP endorses taking
such a leadership position. REFERENCES
1
The Society for Healthcare Epidemiology of America. SHEA Position Paper: Influenza
vaccination of healthcare workers and vaccine allocation for healthcare workers during
vaccine shortages, 2005. Available at http://www.sheaonline.org/Assets/files/ ... L_9-28.pdf. Accessed 05/07/07.
2
Carman WF, Elder AG, Wallace LA, et al. Effects of influenza vaccination of healthcare workers on mortality of elderly people in long-term care: a randomised controlled
trial. Lancet. 2000 Jan 8;355(9198):93-7.
3
Potter J, Stott DJ, Roberts MA, et al. Influenza vaccination of health care workers in
long-term-care hospitals reduces the mortality of elderly patients. J Infect Dis. 1997
Jan;175(1):1-6.
4
Ludwig-Beymer P, Gerc SC. An influenza prevention campaign: the employee
perspective. J Nurs Care Qual. 2002 Apr;16(3):1-12.
5
Stott DJ, Kerr G, Carman WF. Nosocomial transmission of influenza. Occup Med
(Lond). 2002 Aug;52(5):249-53.
6
Salgado CD, Farr BM, Hall KK, Hayden FG. Influenza in the acute hospital setting.
Lancet Infect Dis. 2002 Mar;2(3):145-55. Review. Erratum in: Lancet Infect Dis 2002
Jun;2(6):383.
7Wilde JA, McMillan JA, Serwint J, Butta J, O’Riordan MA, Steinhoff MC.
Effectiveness of influenza vaccine in health care professionals. A randomized trial. JAMA
1999;281:908–13.
8
Bridges CB, Thompson WW, Meltzer MI, Reeve GR, Talamonti WJ, Cox NJ, et al.
Effectiveness and cost-benefit of influenza vaccination of healthy working adults: A
randomized controlled trial. JAMA 2000;284:1655–63.
9
Demicheli V, Jefferson T, Rivetti D, Deeks J. Prevention and early treatment of
influenza in healthy adults. Vaccine 2000;18:957–1030.
10
Carman WF, Elder AG, Wallace LA, et al. Effects of influenza vaccination of healthcare workers on mortality of elderly people in long-term care: a randomised controlled
trial. Lancet. 2000 Jan 8;355(9198):93-7.
11
Potter J, Stott DJ, Roberts MA, et al. Influenza vaccination of health care workers in
long-term-care hospitals reduces the mortality of elderly patients. J Infect Dis. 1997
Jan;175(1):1-6.
12
Nichol KL, Lind A, Margolis KL, Murdoch M, McFadden R, Hauge M, et al. The
effectiveness of vaccination against influenza in healthy, working adults. N Engl J Med
1995;333:889–93.
13
Carman WF, Elder AG, Wallace LA, McAulay K, Walker A, Murray GD, et al. Effects
of influenza vaccination of health-care workers on mortality of elderly people in longterm care: a randomised controlled trial. Lancet 2000;355:93–7.
14
Lester RT, McGeer A, Tomlinson G, Detsky AS. Infect Control Hosp Epidemiol. 2003
Nov;24(11):839-44.
15
Partnership for Prevention. Strengthening adult immunization: a call to action.
Available at http://prevent.org/images/stories/Files ... Action.pdf. Accessed
05/07/07.
16
National Quality Forum. Safe practices for better healthcare: 2006 Update—a
consensus report. Washington DC, 2006.

My immune system isn't compromised. Washing my hands is more effective then getting a shot. besides I don't get the flu. Can't spread something I don't have.

My immune system isn't compromised. Washing my hands is more effective then getting a shot. besides I don't get the flu. Can't spread something I don't have.