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New York requires healthcare workers who refuse vaccination to wear masks

Monday September 30, 2013
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Citing unacceptably low influenza vaccination rates among healthcare and residential agency personnel in New York, the state Department of Health plans to require all unvaccinated personnel in these organizations to wear surgical or procedure masks during times when the state health commissioner determines influenza is prevalent, to decrease the risk of transmission to patients and residents.

"As healthcare workers, we have to be concerned about the health and welfare of our patients and the health and welfare of ourselves, so I think itís a good rule," said Maureen T. White, RN, MBA, NEA-BC, FAAN, senior vice president and CNE at North Shore-LIJ Health System in Great Neck, N.Y. "There are many ways people can get influenza, but it shouldnít be from a caregiver."

Jeffrey Hammond, spokesman for the stateís Department of Health, confirmed the mask policy was adopted in April and will go into effect this year. The policy also will affect home health workers.

Jill Goldstein, RN, MA, MS, vice president of congregate care at Visiting Nurse Service of New York, said, "VNSNY has fully supported 'roll up or mask upí since it was proposed. We believe that it is an efficient and effective way to help reduce the risk of the influenza virus for members of the healthcare team, their families, and the patients and communities they serve. At VNSNY, we will adopt this practice without hesitation; it is the right thing to do."

Catherine Gallogly-Simon, RN, MS, NEA-BC, CCRN, vice president of nursing at Downstate Long Island College Hospital in Brooklyn, said she thought the policy would benefit patients and encourage hospitals to make a concerted vaccination effort.

"We do it routinely for our patients, but many nurses refuse the vaccine," Gallogly-Simon said. "The evidence shows getting vaccinated for the flu reduces significantly your risk of dying from influenza."

Downstate provides free on-site vaccinations and holds ice cream socials for those who receive one. Still, some nurses refuse, primarily because they are fearful they will get the flu from the vaccine, which is not possible with the killed virus used in currently available injectable vaccines, Gallogly-Simon said.

"There are still a lot of myths," said White, of North Shore-LIJ, which offers free on-unit vaccinations that 68% of healthcare workers received there this year. "We try to make sure we provide them with enough of the right information to make the right decision."

AnnMarie Vigorito, RN, BSN, CIC, director of infection prevention and control at Blythedale Childrenís Hospital in Valhalla, N.Y. — which achieved a 79% vaccination rate last year because of a concentrated vaccination effort — explained that what people perceive as becoming sick is an immune reaction as the body builds antibodies.

Both Blythedale and North Shoreís rates are much better than the state average. During the 2011-2012 flu season, New York State hospitals reported healthcare worker vaccination rates ranging from 11.1% to 97.8%, with an average of 48.4%. This contrasts with a 66.9% hospital worker vaccination rate nationwide for that season, according to the U.S. Centers for Disease Control and Prevention. New York nursing homes reported an average personnel vaccination rate of 45%, according to state records.

"When you have an unvaccinated population in a hospital, that can be a dangerous thing," Vigorito said. "You can be asymptomatic for influenza and still transmit the virus."

Goldstein said healthcare workers are at increased risk of acquiring influenza and acknowledges many will not accept the vaccine.

"If a significant portion of this workforce goes unvaccinated, it is imperative that we utilize other methods to protect both them and the many lives they touch," Goldstein said.

Susan Engel, RN, BSN, infection prevention program manager at BAYADA Home Health Care in Mount Laurel, N.J., agreed that a mask will provide some protection if the person is incubating the virus, but she thinks wearing one will frighten patients, particularly children and people with dementia.

The regulation acknowledges that masks are not as effective as vaccination, but it said evidence indicates wearing a surgical or procedure mask will lessen transmission by containing respiratory secretions and limiting exposure to others. The regulation states that "the Infectious Disease Society of America recommends that healthcare personnel who are not vaccinated for influenza wear masks."

Healthcare organizations also will be required to document the influenza vaccination status of their employees and provide the masks to those not vaccinated. The state health department estimates the cost to be 10 cents to 25 cents per mask, depending on quantity ordered. It called the cost a "modest investment" to protect the health and safety of patients, residents and personnel.

Cost is a concern, with reimbursement sometimes being low. However, cost should never be a factor in safety, Engel said.

Employees will have to keep changing masks for them to remain effective barriers, Vigorito said, who added that masks would have to be changed between every patient and every 20 minutes to prevent moisture from building up and organisms from coming through the mask.

"Itís going to be burdensome, but I understand the rationale," Vigorito said. "Itís going to be difficult to monitor the compliance."

Gallogly-Simon expressed concern that nurses may not comply because it is difficult to wear a mask all day. She said she expects ID badges to be modified to easily identify who has received the vaccine.

North Shore-LIJ implemented a mask policy this year in its pediatric, maternity and labor and delivery units. A small population of caregivers did not get vaccinated but complied with the mask policy.

"It absolutely can work," White said. "It comes down to having a strong sense of conviction that it is the right thing to do. As caregivers and patient advocates, we owe it to the public to do everything we can to make sure they are safe within our environment."

Debra Anscombe Wood, RN, is a freelance writer.

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