Beginning in 2007, TJC provided a strong incentive to institutions by stipulating that influenza vaccination programs were a criterion for maintaining accreditation (TJC, 2006). They require that institutions implement a program that provides on site influenza vaccination, that they provide education to staff about the disease and vaccine, and that they document reasons why people refuse it. Healthcare institutions that implemented aggressive, multi-faceted programs targeting barriers to vaccination prior to the TJC mandate, have been successful in increasing and sustaining acceptable vaccination rates. With the new TJC mandate, it is reasonable to expect that immunization rates will continue to improve. Additionally, efforts to improve immunization rates in the general population through the Healthy People 2010 campaign are ongoing. As these rates improve to targeted goals, it is expected that the level of influenza disease in the community will also decrease, as will the opportunity for cross-transmission of the disease.
...the majority of the experts respect the right of the individual to decline vaccination for religious, medical, or philosophical reasons. HCWs support this approach, because it preserves their freedom, their right to refuse vaccination for a valid reason. In summary there is strong agreement among the experts studying the control of influenza outbreaks that influenza vaccination is an effective measure to decrease the spread of the disease. It is a measure with very few serious side effects. The experts also recognize that institutional vaccination programs can be effective in increasing vaccination rates when barriers to vaccination are identified and addressed. Ongoing research is continuing to strengthen these institutional programs. Most importantly, the majority of the experts respect the right of the individual to decline vaccination for religious, medical, or philosophical reasons. HCWs support this approach, because it preserves their freedom, their right to refuse vaccination for a valid reason. Additionally institutional, as opposed to individual vaccination mandates, may avert legal disputes between employers and employees. Based upon these findings, I advocate for rejecting the mandating of individual HCW vaccination. Instead, I support mandating that institutions offer comprehensive programs that eliminate barriers to voluntary immunization, while respecting the right of the individual to decline vaccination for religious, medical, or philosophical reasons. Obtaining a signed declination detailing reasons for refusing vaccine may lead to program enhancements that will aid in achieving and sustaining high rates of voluntary HCW vaccination.
Author
Paula L. Sullivan, DHSc, MSN, APRN
E-mail: psullivan6@rr.ec.com
Paula Sullivan began her career in nursing as a diploma graduate, later completing her BSN at Worcester State College in Worcester, MA, and her MSN in Ambulatory/Community Health at the University of Massachusetts at Worcester. She completed her doctoral studies at Nova Southeastern University in Florida in 2008. In addition to working as a nurse practitioner in community and occupational health settings, she has taught nursing at the associate, baccalaureate, and graduate degree levels. Prior to moving to North Carolina in 2008, Dr. Sullivan spent 14 years in hospital employee health settings, the last six as Director of Employee Health & Infection Control at Georgetown University Hospital in Washinton, DC. She is currently the co-investigator in a study to determine critical care nurse readiness to respond to an act of bioterrorism; this study is due for completion in the winter of 2009. Dr. Sullivan is on the faculty at Brunswick Community College in Bolivia, NC.
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© 2009 OJIN: The Online Journal of Issues in Nursing
Article published November 2, 2009