Now that summer is near, let’s talk about influenza (I’m a little behind on some items). A while ago, I came across this post which demonstrates just how critical influenza vaccination (the ‘flu shot’) is for medical personnel (boldface mine):
As a reminder, we have added patient stories to meetings as a way of “bringing the patient into the room”, clarifying the context for our quality plan, and emphasizing the complexities and the importance of the work we are undertaking.
Today’s story is about a group of patients, a nurse, and influenza. It starts with Patient #1, a 47 year-old woman admitted through the emergency department (ED) in mid-March with fever and shortness of breath. She was transferred to an inpatient unit with a mask on, which triggered the staff on the receiving unit to implement droplet precautions. Initially thought to have pneumonia, testing confirmed her symptoms were the result of influenza type A, H1N1. After four nights in the hospital, she was discharged home after an uneventful hospital stay and a flu shot.
Patient #2, next door to Patient #1, is a 61 year-old man who was admitted in early March for a GI bleed with multiple co-morbidities. His progress was steady until nine days after admission, when he developed a new fever and respiratory symptoms. These symptoms developed on the same day of Patient #1’s admission. Influenza was suspected two days following the development of his fever, and staff implemented droplet precautions. Lab testing confirmed influenza type A. He remained hospitalized for two more days and received a flu shot before being transferred to a skilled nursing facility.
Down the hall, Patient #3, a 71 year-old man, was admitted two days after Patient #1 for acute stroke and urinary tract infection. On day 3 of his hospitalization, he developed a fever and cough. Lab testing confirmed influenza type A. Droplet precautions were ordered with the lab test for influenza. He remained hospitalized an additional four nights and received a flu shot before being discharged.
Patient #4, a 73 year old man, down the hall from the first two patients and around the corner from Patient #3, was admitted on the same day as Patient #1 following a fainting event at home. Due to his long-standing heart issues, he was kept overnight for observation and discharged the following morning. However, he returned to the ED three days later with continued symptoms. He was discharged from the ED only to return the next day with shortness of breath. Six hours after being readmitted, staff suspected influenza and ordered droplet precautions. His lab tests returned positive for influenza type A. After spending three nights in the hospital, he was discharged home after receiving a flu shot. The following day, he was admitted to the intensive care unit and continued receiving treatment as an inpatient for secondary pneumonia, a complication of his influenza type A infection.
The fifth person in our story is a nurse on the unit where these four patients were admitted. She works on a nursing unit whose hand hygiene performance is currently 67%, and where 85% of the unit staff were vaccinated for this year’s seasonal flu. The particular nurse in this case, however, was 1 of only 9 on the unit who chose not to be vaccinated. Her manager stated that the reason the nurse gave for not receiving the vaccine was that she “was not convinced of the evidence that the vaccine protects patients from transmission … she said she would get the vaccine if she truly believed it protected her patients, but that she didn’t.”
This nurse cared for Patient #1 on her first day of admission. She cared for Patient #2 on the eighth and ninth day (when he developed flu symptoms) of his stay. She also cared for Patient #3 on the first two days of his inpatient stay. There does not appear to be any direct contact with this nurse and Patient #4.
The nurse in our story developed symptoms consistent with influenza three days after working with Patient #1 and Patient #2 (which is the usual 1- to 4-day incubation period for influenza). Due to symptoms, she only worked a partial shift that day. Suspecting her symptoms may be influenza, she used a mask until relief staff was available. She returned home and was able to care for herself without medical intervention. She was not tested for influenza and remained off work for one week. She is still undecided about receiving the flu vaccine.
Oregon is one of only two states in the US that prohibits employers from requiring vaccines as a condition of employment. Our organization is actively working with colleagues throughout the state to try to change this.
If I were in a position to do so and were in a high-risk group*, I would refuse any treatment by personnel who haven’t had their flu shot during flu season. Because, you know, germ theory. It is utterly irresponsible to put patients at risk.
Unfortunately, I don’t think this will change until someone brings a lawsuit. And it shouldn’t have to come to that.
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