The limited vaccine supply

The photo is from the flu vaccine clinics at Community General Hospital.

To date, some 85% of Community’s employees have been vaccinated against seasonal flu. That’s a significant number, but we have not yet reached 100%, as required by the New York State Commissioner of Health.

Yesterday a State Supreme Court judge issued a temporary restraining order that bars the State Commissioner from mandating flu shots for hospital personnel. Stay tuned.

Although we received all the seasonal flu vaccine we ordered, our order was placed long before the Commissioner mandated 100% vaccinations. Because of the mandate, the vaccine use rate is greater than expected, and this has reduced the amount of vaccine we have available for the general community.

Each year Community General provides flu vaccinations for workers at dozens of local companies. Because of the higher vaccine rate this season, we will be far short of the supply needed for these companies.

In addition, other hospitals reportedly do not have enough vaccine even for their own staffs to meet the 100% directive.

Because the supplies of seasonal flu vaccine are limited, we notified the Onondaga County Health Commissioner that, after we comply with our flu plan and the state mandate, we will transfer the limited amount remaining to the County for its redistribution based on priority community needs.

We have also informed area companies about the vaccine supply problem. They are not happy, understandably so. The companies have a heightened awareness of influenza risk this year, and their employees have been counting on Community’s annual flu shots. I am sorry we will not have the vaccine for our company flu clinics, as planned.

With respect to H1N1 (“swine flu”), Community received a supply of the vaccine last week, and vaccinations for medical staff, employees, and volunteers begin October 22.

Flu vaccines for health care workers are a patient safety issue. By protecting ourselves, we confer a measure of protection on the vulnerable patients in our care.

Civil liberties v. mandatory flu shots

"I just don't like to have somebody tell me what to put in my body. . . .My biggest concern is my civil liberties."

That, according to The Post-Standard, is the opinion of a registered nurse who works at another Syracuse hospital. The nurse is referring to a new state policy requiring all hospital staff to have the flu vaccine. [1]

The mandate becomes effective November 30, when flu vaccinations are required for anyone working in a hospital ("paid or unpaid") with direct patient care responsibilities. The mandate also includes hospital personnel “whose activities are such that they pose a risk of transmission of influenza to patients or to those who provide direct care to patients.”

In an open letter to health care workers last month, Dr. Richard Daines, New York's health commissioner, said:

[T]he facts are very clear: the welfare of patients is, without any doubt, best served by the very high rates of staff immunity that can only be achieved with mandatory influenza vaccination – not the 40-50% rates of staff immunization historically achieved with even the most vigorous of voluntary programs.

Dr. Daines is referring to the phenomenon of herd immunity, about which I wrote last year. The "herd effect" is typically achieved at high levels of immunity, say, 80% or more. A source of justifiable pride: last year Community's employees achieved an 85% flu vaccination rate on a voluntary basis, possibly the highest number in the state.

What is the responsibility of a hospital employee to take all reasonable precautions to prevent the spread of infection among patients? Are a citizen's individual rights subordinate to the individual's responsibility, when working in a hospital, to minimize health risks for patients?

In the case of the influenza, Dr. Daines is squarely on the side caregiver responsibility: “We as health care workers need to put patients’ interests ahead of our own preferences,” he said, according to The Post-Standard.

A similar thought was expressed last month by a physician at Community's medical executive committee. Following a brief discussion about the state's vaccination requirement, the doctor observed: “The regulation…represents a game change," he said, "in which there is no right for a caregiver to expose a patient to additional risk.”

Flu shots are not the first such mandate for hospital staffs. New York has long required hospital workers to be immunized against measles and rubella as a condition of employment. The state also requires each of us in a hospital to have an annual tuberculosis test.

I am happy to report that, as of last week, 1,092 of Community's employees, physicians and volunteers have been vaccinated against the seasonal flu. More flu clinics for hospital staff are scheduled, as we willingly comply with the state's patient safety requirement.

My thanks, especially, to hospital volunteers, who are covered by the regulation, as they roll up their sleeves for the good of patients.

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[1] In a letter dated August 26, 2009, the State Department of Health cited an “emergency regulation” of August 13, requiring vaccinations of all hospital personnel. The regulation applies to both seasonal flu and the H1N1 (swine) flu vaccines.

Swine flu?

The Centers for Disease Control and Prevention (CDC) has updated its instructions for the public, for health professionals, and for laboratories regarding the swine influenza A virus (H1N1) that has been identified in Mexico and in parts of Texas and California.

There is a story in today's New York Times about the possible swine flu infection of students at a school in Queens, NY. Some students were reportedly in Mexico recently.

Now is the time to remind ourselves about lessons learned from the SARS outbreak in 2003 -- just in case the N1H1 virus turns out to be highly contagious and an international threat.

On March 7, 2003, different SARS patients reported within hours of one another to different hospitals in Vancouver and Toronto, Canada. According to the subsequent report by a Canadian Commission, the health care personnel responded differently in each city. As I have written before:

Because the Vancouver hospital followed strict precautions, there was no SARS epidemic in British Columbia. In Toronto precautions were inconsistently used. As a result, 44 people died in Ontario and 375 became sick with SARS. 'Of the…people who contracted SARS in Ontario,' says the [Commission's] report, '72 percent were infected in a health care setting….[and] 45 percent were health care workers.' In Vancouver only one health care worker contracted SARS.

If standard precautions are not used consistently by health care workers, we put ourselves at risk. Worse, we become part of the chain of infection for others.

With a new strain of swine flu in the news, it seems a good time for all of us in health care to remind ourselves about the importance of following standard precautions 100% of the time.

85% of employees were vaccinated

State Health Commissioner Richard Daines was in Syracuse last week to meet with hospital CEOs and their staffs about community health issues. One of Dr. Daines' questions: what percentage of hospital employees received the flu vaccination?

At Community General, 85% of our active employees were vaccinated this season, and that's up from our 73% vaccination rate last year. In addition, Community immunized over 400 members of employee families and the medical staff.

I've written before about the importance of the herd effect in preventing influenza among hospital patients and staff.

Congratulations to the staffs of Community's Infection Control and Employee Health Offices, as well as to the nursing leaders who assisted in achieving the 85%. And thanks, especially, to employees who recognize their responsibility to patients and staff in helping prevent the spread of influenza.

Nationally the average flu vaccination rate for hospital employees was 44% during the 2007-2008 flu season.