Mandating influenza vaccination of health care workers: A patient safety, quality of care, and public trust issue

Influenza causes yearly epidemic disease and occasional pandemics. Because of this, health care workers (HCWs) are routinely exposed to influenza in the course of their patient care duties. As a result, transmission from HCW to HCW, and HCW to patients occurs, leading to evidence for increased morbidity and mortality among the patients cared for by unimmunized HCWs. Despite the existence of safe and effective influenza vaccines, the majority of HCWs still fail to receive seasonal influenza vaccines. Thus, influenza immunization of HCWs must be seen as a patient safety and quality of care issue. The failure to be immunized, we believe, represents a failure of ethical medical and nursing practice, a failure of leadership among hospitals and health care institutions, and a breach of the public trust accorded to the healing professions. Herein we discuss the rationale and evidence for requiring influenza immunization of HCWs; describe the current state of such programs in the United States and Europe; discuss the implementation of mandatory programs and their results at the practice, institutional, legislative, and professional society levels; and conclude with a call for mandating influenza immunization of all HCWs.