ESSENTIAL COMPONENTS OF A COMPREHENSIVE INFLUENZA PREVENTION PROGRAM

In response to the 2009 novel H1N1 influenza pandemic, federal agencies—the Centers for Disease Control and Prevention (CDC) and the Occupational Safety and Health Administration (OSHA)—have reviewed the efficacy of their current guidelines to prevent transmission of the virus, and state health departments and healthcare employers (in both the private and public sectors) are developing and implementing new policies. A recent trend in some facilities, healthcare systems and across New York state is to require mandatory seasonal and H1N1 influenza vaccinations for healthcare workers as a condition of employment. Neither the CDC nor the Joint Commission has determined this to be a useful policy—although both support influenza immunization.

The program and policy council of AFT Healthcare opposes mandatory influenza immunization and, instead, encourages its members to become informed about flu vaccinations, their risks and benefits, and to make their own decisions.

Typically, fewer than 40 percent of healthcare workers participate in seasonal flu immunization campaigns—for a variety of reasons that include fear of adverse effects, lack of concrete understanding of the benefits and risks of vaccination, and concerns about its effectiveness. Research shows that when immunization campaigns provide healthcare workers with sufficient information, voluntary participation rates can be as high as 90 percent. We believe a comprehensive employee influenza immunization campaign should include the following components:

• Employee education that includes the risks and benefits of flu vaccinations, as well as efficacy rates of the vaccine;
• Employee education that addresses myths and misunderstandings about flu vaccinations;
• Vaccinations provided during work hours and at the work site;
• Vaccinations provided at no cost to employees; and
• Informed declination for those who opt out of immunization after receiving education as described above.

Immunization alone does not eliminate the risk of exposure and transmission of the flu virus, nor does it eliminate employer responsibility to develop and implement a comprehensive pandemic influenza plan. Immunization may be the most effective tool, but it is one of many that should be used to protect patients and healthcare workers.

As part of this plan, employers also should provide occupational exposure-control strategies, including respiratory isolation rooms (with negative airflow) for those suspected of H1N1 infection, as well as respirator protection for employees. Recent findings from an Institute of Medicine expert panel convened by the CDC and OSHA found that a fit-tested N95 respirator is the minimum protection for all healthcare workers in close contact with patients with suspected or confirmed H1N1 influenza. The recommendation conforms to guidelines issued by the CDC, OSHA and the National Institute for Occupational Safety and Health.

Such a comprehensive approach also includes limiting the transmission of the virus to patients and others, as well as limiting the risk of exposure among healthcare workers. Other characteristics of a comprehensive program should include:

• Exposure assessment throughout a facility, with employee involvement in gauging risks for patients and various types of workers;
• A written exposure-control plan (that includes the elements listed below) for both patients and workers that is available upon request;
• Education and training on measures to limit transmission;
• Sufficient and appropriate protective equipment for all workers in direct contact with those with suspected or confirmed H1N1 influenza;
• Alternate assignments for those with underlying illness that makes them especially at risk for contracting H1N1 and/or developing complications;
• Identification of negative air flow isolation rooms for suspected or confirmed flu patients;
• Flexible and nonpunitive leave policies for infected healthcare workers or workers who need to care for ill family members; and
• Provision of antiviral medications to those employees who have been exposed, without protection, to an infected individual.

A good model for this approach is the OSHA blood-borne pathogen standard, which requires employers to assess potential exposures throughout a facility and then develop a plan to address those exposures. This standard requires annual education and training that addresses exposure-control methods in the facility as well as provides information on the benefits of hepatitis B vaccination.