Flu Shot or Mask?

[Nurse Beth]

Recently at the nurse's station at work, I was talking with Lisa. Lisa was wearing a surgical mask. To keep her job, she has to wear a mask until flu season is over because she declined to get a flu vaccination this year.

I asked how it felt to wear a mask for 12 hours. She said, "Well...it's kinda claustrophobic, but I'm getting used to it. What's really weird is people keep asking me to repeat myself.. It's like they can't hear me if they can't see my lips moving. And when I smile at patients, I have to try really hard to smile with my eyes."

Position Statements

The American Nurses Association (ANA), the Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP), a CDC panel of medical and public health experts that advises on vaccine use, all align in recommending flu vaccines for healthcare workers with allowable exceptions for religious and/or medical reasons.

National Nurses United (NNU) opposes mandatory flu shots as fostering an atmosphere of distrust. Likewise, they oppose masking on the basis of stigmatizing the individual.

Masking: the Science

The influenza virus is transmitted by direct contact, large droplet spray (like a sneeze or cough, distance of about 3 feet), and by aerosolization (smaller particle aerosols).

The rationale for masking is that unvaccinated asymptomatic persons can shed the influenza virus for 24 hours before symptoms appear and up to 5 days after the onset of illness. However, minimal data regarding aerosol shedding and infectiousness of aerosol particulates exist.

The effectiveness of N95 respirator masks in preventing transmission of airborne viruses has been shown but the results of studies on the efficacy of surgical masks are mixed.

Many surgical masks are not certified as protective against respiratory infections and are loose fitting. There are no clear guidelines on how frequently surgical masks should be changed.

According to the CDC, there are no definitive studies to show that surgical masks worn by health-care workers reduce influenza transmission.

Legislation

State law, state Departments of Health, and county health officers have the authority to mandate flu shots and/or masks. For example, California state law (Health & Safety Code §1288.7 / Cal OSHA §5199) requires either flu vaccination or the signing of a declination statement for all acute care hospital workers and most health-care personnel, including clinic and office-based staff.

Additionally, many county health officers in California mandate that health care workers either receive an annual flu vaccine or wear a mask during the flu season.

Employee Rights

Many acute care facilities have adopted coercive "flu shot or mask" policies. In some cases, healthcare workers have been fired for refusing to be vaccinated.

Legally, most employers can require flu shots as a condition of employment as most employees work under an "at-will" work agreement.

However, the research used by employers to justify mandating flu vaccines for healthcare workers may be flawed and insufficient. Four such studies cited by employers were conducted in long-term care facilities and have not been proven to be generalizable to acute care settings.

Ethics

The ANA maintains vaccination is a public health concern and nurses should role model illness prevention through immunization. Nurses have a responsibility to not place their patients at risk.

Vaccination is for the greater good, but individual rights must also be considered. Sometimes the ethical principle of preventing harm is in direct conflict with the ethical principle of autonomy.

Protective or Punitive?

When I see a co-worker wearing a surgical mask I cringe a little. My core values of justice and fairness are triggered. Is this really about protecting patients based on robust evidence or is this about shaming the nurse?

I believe in doing what is best for the greatest good but I also believe in autonomy. It comes down to personal rights versus social responsibility. I am pro-vaccination but stop short of supporting "flu shot or mask" policies.

For me, it would take irrefutable evidence of patient benefit to justify overriding personal rights and I don't believe we have that.

The rush to disregard individual freedom over scanty evidence concerns me more than the thought of Lisa not wearing a surgical mask.

Do you believe nurses should be required to get mandatory flu shots or mask? Why or why not? I'd love to hear your view.

More thought-provoking articles by Nurse Beth:

Ageism in Nursing is Real

Why Do Nurses Quit?

References

Booth, C. M., Clayton, M., Crook, B., & Gawn, J. M. (2013). Effectiveness of surgical masks against influenza bioaerosols. Journal of Hospital Infection, 84(1), 22-26.

CDC. Interim Guidance for the Use of Masks to Control Influenza Transmission.2009. Accessed January 2017 Interim Guidance for the Use of Masks to Control Influenza Transmission

| Health Professionals | Seasonal Influenza (Flu)

Serres, G., Skowronski, D., Gardam, M., Lemieux, C., Yassi, A., Patrick, D., Krajden, M., Loeb, M., Colignon, P., Carrat, F. 2017. Influenza Vaccination of Healthcare Workers: Critical Analysis of the Evidence for Patient Benefit Underpinning Policies of Enforcement. PLOS.org. accessed January 2017 Influenza Vaccination of Healthcare Workers: Critical Analysis of the Evidence for Patient Benefit Underpinning Policies of Enforcement

[tnbutterfly - Mary, BSN]

When your comment refers to another post/member, please use the QUOTE button located at the bottom of the post so others know what post you are referring to.

[mrl3fnp]

A 2008 study published in the International Journal of Infectious Diseases concluded that when used correctly, masks are highly effective in preventing the spread of viral infections. Family members of children with flu-like illnesses who used the masks properly were 80 percent less likely to be diagnosed with the illness. Surprisingly, the difference between types of masks used was insignificant. Another study published in the Annals of Internal Medicine reported similar results. Researchers looked at 400 people who had the flu. They found that family members reduced their risk of getting the flu by 70 percent when they washed their hands often and wore surgical masks. Other studies found promising results outside of the household. For example, one such study was conducted by a team of researchers from the University of Michigan on more than 1,000 students living in residence halls. They assigned the student to groups: those who wore masks, those who wore masks and practiced hand hygiene, and those who did neither. The results showed that those who wore masks in residence halls and practiced good handwashing reduced their risk of flu-like illness by an astonishing 75 percent (Story & Cherney, 2015).

I have yet to see an influenza vaccination study showing the effectiveness at reducing the risk of spreading influenza comparable to that of wearing a mask. If health care facilities were really concerned about patient health and reducing the spread of hospital-acquired influenza why do they not implement a mandatory mask wearing policy for everyone? Especially when the flu vaccination is so controversial and so many health care workers have legitimate objections.

Story, C. & Cherney, K. (2015). Healthline: Does Wearing a Mask Prevent the Flu. Retrieved from Does Wearing a Mask Prevent the Flu?.

[Wuzzie]

I don't wear a mask. I was trying to keep it simple for the sheep.:)

This was unnecessary, inflammatory and rude. We have a right to make decisions for ourselves and not be ridiculed for them.

[GM2RN]

Actually no. It's REQUIRED by an employer and you do not follow these regulations they just as easily have the right to terminate you for not abiding.

Actually, some courts disagree. There are nurses who have fought this and won.

[BSN16]

Actually, some courts disagree. There are nurses who have fought this and won.

Yes you don't have to get a shot, but you do have to wear a mask.

[mrl3fnp]

When my employer mandates a policy, especially one that mandates I inject potentially harmful substances, I want it to be supported by evidence-based practice...........No, I demand that it is supported by evidence-based practice. I think most of us can agree that mandating flu shots doesn't feel right inside......There is a reason for that feeling.......Because there is no evidence that flu shots work. In contrast, there is evidence that masks work. Follow the money if you want to explain why there are flu shot mandates because the efficacy of mask wearing is undeniable.

[37changes, ASN, RN]

Have you seen 20-40 million of them? That's how many died in the flu pandemic of 1918-1919. You might want to reconsider your thoughts on this. We're not necessarily talking about a cold with muscle aches; we're talking about a disease capable of killing otherwise strong and healthy children, young adults as well as the stereotypical old folks.

I understand that Wikipedia is not always the most reliable source of information, but it is a good place to go if you want an overview of the subject. I just got done reading about the "1918 flu pandemic" ~ and it was very interesting. Lots to think about there. Many unanswered questions. Thanks for mentioning it.

I have never had a flu shot, I have never gotten one for any of my children, and no one here has ever been diagnosed with influenza. If we've had it, we've been able to deal with it at home, apparently.

There is a list of vaccines that will be "required" if I make it into the fall nursing program, and an annual flu shot is one of them. This thread has given me a lot to think about. Thanks to all who have contributed. It's always interesting to hear the different research and points of view.

[NurseDiane]

I would probably be more inclined to be vaccinated when I hear that the efficacy rate was over 50%. As it is right now, it doesn't even get close to 50%. So, even if a nurse has been vaccinated, there is a VERY HIGH possibility that the vaccine is not effective & they can pass on the virus to their patients even if vaccinated. So, based on scientific research, even vaccinated nurses should wear masks, right? Until the vaccine shows that it is 100% effective, based on numbers alone, only a small number of people are even protected if they are exposed to the specific strain(s) in that year's vaccine. I compare the flu vaccine to buying a toaster: If you bought a toaster, brought it home, stuck 2 pieces of bread in it & pressed the button, and the bread did not toast, you would unplug the toaster, take the bread out, put it back int he box & return it because it did not work. Why should the flu vaccines be any different? Charging patient's insurance companies for something that DOES NOT WORK is FRAUD, plain & simple. If something that is sold doesn't work, whoever paid for it should get their money back. Why is this not happening with flu vaccines? Every person that received a flu vaccine that got the flu should file a claim & get their money back. The flu vaccine is the biggest money grab from drug companies that I have ever seen. 3 years ago my mother got her flu shot from her primary, and on Christmas got so sick with the flu----I don't think I have ever seen her so sick in my life. She was sick for 2.5 weeks, and it took her another 2.5 weeks to recover from it because she was so exhausted, dehydrated & fatigued. Medicare should have gotten their money back for that one, for sure. And everybody wonders why healthcare costs are so high----insurance companies paying out for ineffective vaccines is one reason.

What I find ridiculous is that the mandated mask wearing is based on limited research regarding the flu, flu vaccine & masks----why wear a surgical mask if it doesn't block droplets? And , since research has shown that one has to be within 3 feet of the droplet spray, you have to wonder who is coughing or sneezing 3 feet away from somebody's face? Especially a nurse? 3 feet is pretty darn close. The whole thing just doesn't make any sense, and is not based on any substantial research.

I got a flu shot back in the 90's, when they just came out. I got so sick, and all my doctors kept saying "You can't get sick from the flu shot". Well, I ended up in the hospital, and none of the doctors could figure out why I was so sick. Didn't find out until man years later that the vaccine contains thimerosal as a preservative, and I am allergic to it!! I haven't gotten a flu shot since, and guess what? I haven't had the flu since then either!

What I would like to know is how many of the people that died from getting the flu so far actually got a flu shot---for some funny reason, I never seem to hear those numbers...........

[mrl3fnp]

Although I abhor masks, there is a lot of evidence that mask-wearing dramatically lowers the risk of the transmission of viruses.

[mrl3fnp]

As a nurse, it is MY job to ensure my patient's safety to the best of my ability. That includes doing things like making sure I am completely vaccinated by getting the flu vaccine each year (even in years where it is a poor match). So I wholeheartedly stand behind the mandatory flu vax or mask if you are working in any setting where you can have patient contact. Hospitals, clinics, LTC, etc., but if you're working as a telephonic nurse and never visited patients then it's not as crucial (although if you've ever had the REAL flu you I can guess you would know enough to never want to get it again). If you're not willing to stay UTD on vaccines (those who don't believe vaccines work or are anti-vaxxers, not those with legit allergies) then maybe you should find another line of work, because medicine/nursing does not go hand in hand with pseudoscience.

I would love also to see further studies done to determine what best use of mask would be as discussed in the article.

Nice talking points......But can we talk now about evidence-based practice? There is no evidence that the flu shots work. In contrast, there is a lot of evidence that mask-wearing dramatically lowers the risk of the transmission of viruses. If you really want to protect your patients you need to commit yourself to mask-wearing. Arguing that those who do not wish to inject themselves with potentially harmful substances are somehow not your moral equivalent has to value because it is not supported by evidence.

[RN/WI, ADN, BSN, MSN, RN, APRN]

This was unnecessary, inflammatory and rude. We have a right to make decisions for ourselves and not be ridiculed for them.

. I find in rude that others don't respect everyone's right to not be vaccinated against the flu as well! Imho

[blue_bug]

I think it's bullying. I'd like to see any data where it shows that there's been any measurable difference since instituting these kinds of policies. It's a horribly ineffective vaccine!!!