On October 24, 2012, we posted about Government’s new influenza protection policy for health workers. The discussion has been ongoing ever since, and several nurses have submitted comments or emailed us with questions about how the new policy will impact them. Not wanting to leave our readers hanging, we asked the Ministry to provide answers to some of the key questions nurses have raised.
1. Could the Association work with government to develop some sort of bibliography that has all the most recent evidence and articles about this important topic?
Yes we can and will. As we work to pull together a more comprehensive list, the Ministry has pointed out that there are some resources currently posted on the Immunize BC website (see http://immunizebc.ca/node/551). ARNBC and the Ministry will continue to work together to develop a list of additional information that supports the discussion. Watch this space for more information.
2. Why did nurses learn about this change in policy through the media? Why wasn’t there a dedicated campaign to inform those who are impacted first?
The Ministry feels it’s unfortunate that some employees learned of this decision through the media, as that was certainly not their intention. Health authorities did communicate to their staff in advance of the public announcement, and health industry unions were sent the policy for review a couple of weeks prior; however, it is likely that some staff were not able to access their employer communication before the media picked up the announcement.
Each health authority is delivering their own comprehensive communications to employees, through things like staff intranets and newsletters, QA sessions with managers or staff, work station screen savers, and the QA documents posted. Every effort is being made to ensure employees have access to the information they need, in a timely way.
3. Does a nurse have to put a mask on when entering the hospital and not take it off until they leave? Are there exceptions? Can a nurse remove their mask in the cafeteria for instance, even though there are patients around? Can a nurse take it off if they are trying to talk to a patient about something personal or emotional? Do nurses have to wear masks if they’re giving a presentation or meeting with their manager?”
Immunize BC has posted information on wearing masks (Influenza Control Policy – wearing masks). The policy speaks to type of mask, where masks are required and when they should be changed. The policy states that: Unvaccinated health care workers are required to wear a mask when in patient care locations. Only areas such as cafeterias and lunch rooms reserved for the consumption of food are exempt. Unvaccinated workers would also not be required to wear a mask in administration-only areas, including a private office, where patients are not present.
4. Was due diligence done to determine why some individuals choose to not have flu shots? Has government exhausted ways to get people to do it voluntarily? Wasn’t a stepped missed – the one where people actually make the effort to not just stick up signs in bathrooms, but to educate, to inform and to provide evidence and education to change that thinking?
Each year, comprehensive education and vaccine encouragement efforts have been made across health authorities, through things like peer immunization champions, contests for staff giveaways (even for things like a vacation getaway and an iPad!) and articles on intranets and in newsletters. Despite every effort having been made to increase voluntary rates, we were still not getting the kind of uptake needed to ensure patients are safe.
5. Does the mask work both ways (i.e., will it prevent an individual from getting sick at the same time it keeps patients from getting sick, or does it just help the patients?)
Yes the masks work both ways. Masks can serve as a method of source control of infected health care workers who may have no or minimal influenza-like illness symptoms. Masks may protect unvaccinated health care workers from as yet unrecognized infected patients, visitors or other health professionals with influenza. However, while mask wearing does likely confer some benefit on the wearer, the primary goal in this policy is to protect patients.
6. How or will this be applied to the dental profession? What about community health nurses or people doing home visits?
The policy applies to all Health Authority employees (unionized and excluded), other credentialed professionals, residents, volunteers, students, contractors, and vendors (collectively, these individuals are referred to as “Covered Individuals”) who attend a patient care area. Any dental professionals covered in the aforementioned group will be expected to adhere to the policy.
A Patient Care Location includes: any building, property, or site owned, leased, rented or operated by a Health Authority where there are patients, residents or clients who are receiving care; and any patient/client/resident home or other location where Covered Individuals interact with the patient/client/resident in the course of his/her work for the Health Authority.
7. If it’s just a hospital policy, isn’t that kind of like brushing only one tooth?
The policy applies to any building, property, or site owned, leased, rented or operated by a Health Authority where there are patients, residents or clients who are receiving care; and any patient/client/resident home or other location where Covered Individuals interact with the patient/client/resident in the course of his/her work for the Health Authority.
8. As a culture we’re too heavily focused on immunizations. Normal, healthy adults should be able to either fight the flu off and if unable to do so will not suffer long term serious consequences as a result of having the flu. Is it really necessary to suggest we’re being remiss if we don’t get a flu shot? Is this really a matter of public health? What about our personal choices, not only nurses but as individuals?
Nearly every professional code of ethics in the health care field – from medicine, to nursing, to pharmacists – outlines that the interests of the patient must come first, and that healthcare workers have a duty to act in the best interests of their patients, and not put them at undue risk of harm. The flu can cause serious illness in those most at risk – including seniors, people with compromised immune systems, respiratory illnesses or a variety of other underlying causes. In other words: many of our patients and long-term care residents.
According to the Public Health Agency of Canada, nationally there are between 2,000 and 8,000 deaths per year from influenza and its complications. Hospitalized patients are frequently more vulnerable to influenza than members of the general population and healthcare workers have been implicated as the source of influenza in healthcare settings (infected individuals are highly contagious and can transmit influenza for 24 hours before they are symptomatic). Vaccination of healthcare workers will reduce their risk of getting influenza and spreading it to patients. The flu vaccine is safe and effective and, when used in conjunction with other infection control practices such as hand washing and remaining home when sick, it is extremely effective at preventing illness.
The policy allows for personal choice - workers have the option to wear a mask if they are unable to be vaccinated, or choose not to.
Government also reminds us that while normal, healthy adults are likely able to fight off infection far better, the point of this policy is to protect patients – people who by definition are NOT healthy. These are the very people who are at risk of serious complications. By protecting yourself from getting sick with as many tools at your disposal as possible – including flu shots – you are protecting your patients who do not have those options available to them.
The provincial news release and backgrounder can be found on the Ministry of Health website (Click to View)
ARNBC's news release on the flu shot issue can be found on our site under News (Click to View)