According to the CDC, in the US, deaths from influenza (flu) can hit up to 49,000 annually. As nurses, we all work really hard at preventing transmission of infections within the hospitals through diligence with hand washing, aseptic technique with IV access, and contact precautions for patients with C. Diff, MRSA, and VRE because we care about our patients and we are also helping them heal from their current illnesses. Why does it feel different to protect our patients by getting a vaccine that is required by the hospital as opposed to following all of the other policies and protocols that are imposed upon us? Yes, we are taking a medication, an injection, created to prevent an illness that is easily spread and can have devastating effects to our patients...either through infecting them or infecting other staff members and leaving us without adequate staffing to take care of said patients.
It does seem to take away our ability to make an informed decision: How do you know what YOU think is best when the information from the CDC recommends that basically, everyone should get the flu vaccine, of which there are a few different kinds of vaccinations that you can get, and then there are always hospital policies about flu vaccinations that can also have an impact on when and what type of flu vaccine you obtain?
How the Vaccinations Work
This year all of the vaccinations are either trivalent or quadrivalent to protect against the two strains of influenza A and either 1 or 2 strains of Influenza B that research indicates will be most virulent this season. You can be vaccinated two different ways, either by nasal spray or through an actual injection; two weeks after vaccination, your body starts to create antibodies against the flu that will help prevent you from getting infected, and if you do, it will be a very mild form, like a cold, but you will not have the true flu.
The injection is an inactivated form of the virus, and, being injected with the inactivated strains of the flu, means that you aren't actually infected with the live virus so you won't get the flu from the vaccine. After the injection, there may be some redness at the site, soreness, and low fever that can last 1-2 days.
The nasal-spray vaccine is made with living, but weakened, flu virus that does cause an immune response, but you don't get as sick as you would with the actual flu after use. It is not suggested for pregnant women or asthmatics (there can be an acute respiratory reaction from the live virus directly reacting with the lungs.) After the nasal-spray vaccine, the side effects are a little more than the injection: runny nose, headache, sore throat, and cough that last just a few days. This gives your immune system a real challenge because you are actually getting the virus, so you do feel unwell for a few days.
What are the Types of Vaccines?
Trivalent:
Standard- dose injection: can be given to anyone 6 months old to 64 years of age.
Intradermal injection: a dose given with a smaller needle into the skin instead of intramuscularly and can be given to patients aged 18 years to 64 years.
High dose injection: is recommended for adults over the age of 65 years because of a diminished immune system, the injection has more antigens prevalent to help prevent the flu.
Recombinant egg-free injection: for those with an egg allergy and it is approved for adults over 18 years.
Quadrivalent:
Standard-dose injection: can be given to anyone 6 months to 64 years of age.
Nasal Spray: can be given to anyone 2 years through 64 years, however, it is emphasized for children 2 years to 8 years that have no other medical conditions that could be complicated by the flu.
Who should get vaccinated?
According to the CDC, basically everyone 6 months and older should get vaccinated (which I tend to agree with!)
The "high risk" list for definite vaccination:
- Pregnant women (injection only)
- Children younger than 5 years old (especially those in pre-school activities, daycare, etc.)
- Anyone > 50-years-old
- Anyone with chronic medical conditions
- People who live in nursing homes or long-term care facilities
- People who live with or care for those at high risk (healthcare workers, family members of those at high risk, and family and caregivers for those less than 6 months old.)
Who might need to discuss their risk further with their healthcare provider?
- Anyone with an allergy to chicken eggs (if the non-egg injection is not available)
- Anyone who has had a severe reaction in the past (i.e. anaphylactic reaction)
- Anyone who has had Guillain-Barre syndrome within 6 weeks of a flu vaccine
- Children under 6 months of age (their immune systems are too immature to respond appropriately)
- Anyone who actively has a fever or is unwell.
How does hospital policy work?
Patients: Where I work, and in most of the surrounding hospitals (I don't want to say all because there are a lot of hospitals and I haven't discussed with each one), every patient is screened within 24 hours of admission and offered the flu shot. Every single one. And this screening allows everyone on the healthcare team to be a part of the conversation (whether patients rule in or out) and we educate and discuss with patients their own risks.
Staff: When it comes to the staff, our policy is that all staff that work in direct patient care, are required to have a flu vaccine (which is offered free of charge to all staff), and it needs to be documented by mid-November each year, as a contingency of employment. If you are medically unable to have a flu shot, it needs to be documented annually. It is part of a safety initiative to prevent the spread of disease and protect patients. If you get the vaccine from the hospital, you get the injection that is offered.
I appreciate that they offer kiosks to get my flu shot, and they collect the paperwork to file away for me; it couldn't be easier. But once I started doing some research for my family members who had questions about which vaccines they should get, I realized that I put zero thought into receiving a vaccine. I would never take a medication without knowing the side effects, dose, type, etc. but because it is policy, and easy, without a medical consult, I got the injection. I honestly didn't even know all of the options that I had for flu vaccines! I would have gotten it anyway, I am a believer in the flu vaccine, and I always have been, but I am not sure how I feel that I let hospital policy blind me from going to my own healthcare practitioner and making a truly informed decision that might be best for me.
What do others think about getting the flu vaccine mandated at work? Does it make you feel like you made a medical decision with little to no actual thought about it?
I know the flu shot is best practice to protect our patients and ourselves...I just wish there was a way to make me feel like I was making an informed medical decision about getting a vaccine, as we encourage all of our patients to do, even though it is mandated.
banterings
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holisticallyminded, GREAT POST!!!
You are so correct in your assertion that our bodies are designed to defend themselves. I remember a simple idea that was thought groundbreaking:
Keep your nose moist. As uncomfortable as it may be, a runny nose is actually a good defense against colds and the flu. Sounds gross, but mucus traps viruses and clears them from the body.
Another issue that was reported in BJM (I believe) is that we as a society are too clean. This attributed to higher rates of asthma in western countries. I point out the river me and my brother played in growing up, and tell people that is why I don't get sick.
Finally is the plastic food industry. Between the artificial food and all the antibiotics and hormones pumped in to the food that we eat, it is no wonder that our immune systems are screwed up. Remember the debate over "Cereal boxes more nNutritious than cereal?"