Hospitals from Boston to Seattle are bribing workers with granola bars, throwing immunization parties, and, in one case, forcing unvaccinated staff members to wear face masks in the hopes of persuading more medical personnel to get an annual flu shot.
Nearly 60 percent of US doctors, nurses, orderlies, and other healthcare workers do not get vaccinated against the flu, putting themselves and their patients at risk, and potentially leaving hospitals and nursing homes shorthanded during the busiest time of the year.
"Every healthcare worker who has direct contact with a patient should take it as part of their professional duty that they accept a flu immunization for the sake of patient safety," said Dr. William Schaffner, chairman of the Department of Preventive Medicine at Vanderbilt University in Nashville.
Disappointed that national vaccination rates in hospitals and nursing homes have risen only slightly, regulators this year are cracking down.
In Massachusetts, the state has ordered nursing homes and other long-term care facilities to offer shots to workers - and to keep a list of everybody who refuses so that if there's a flu outbreak, disease trackers will know who is vaccinated and who is not.
At the same time, a national hospital accrediting agency has told administrators to vaccinate more employees or potentially forfeit the seal of approval that is needed to receive federal funding. Hospitals must track vaccination rates, dissect the reasons behind staffers' refusal to get shots, and then craft a strategy for getting vaccine into the arms of more workers, according to the new rules from the Joint Commission.
"We're putting a special spotlight on influenza because it is such a problem," said Louise Kuhny, an accrediting board official.
Each year, 36,000 people die in the United States from influenza, mainly the elderly. For decades, public health authorities have exhorted people 65 and older to be vaccinated, but two studies in recent weeks arrived at opposite conclusions about the value of flu shots for the elderly. One said the benefits are exaggerated while the other declared that flu vaccinations significantly reduce the incidence of severe pneumonia and even death.
Against that backdrop, campaigns to vaccinate healthcare workers have assumed heightened urgency, especially because researchers believe that younger shot recipients derive stronger protection from the vaccine. A 2004 study found that by increasing the percentage of vaccinated healthcare workers, a Virginia medical center recorded a significant reduction in patients catching the flu while hospitalized. With two-thirds of the staff immunized, not a single hospitalized patient contracted flu during one season.
Other studies have found potential connections between sick staff members and hospital flu outbreaks. In a French hospital the virus swept through an organ transplant unit, and in Canada it led to illness and one death in a neonatal intensive care unit where only 15 percent of the staff was vaccinated.
But some health workers remain reluctant to get vaccinated.
There are doctors and nurses who are afraid of needles. And there are healthcare workers who harbor the same misconceptions about the flu vaccine common among the public.
"I gave a talk at a hospital in Western Massachusetts and somebody on the staff said, 'Every time I get a flu shot, I get sick the next day.' That is an absolute myth," said Dr. Alfred DeMaria, director of communicable disease control for the Massachusetts Department of Public Health. "And that kind of mythology is a major barrier."
Another myth: Workers in hospitals and clinics figure that they encounter so many flu-ridden patients over the course of the winter that they acquire immunity to the germ bit by bit.
"They have this false sense that when it's full blown, their body and their immune system have been exposed to it so many times that they're not going to get it," said Dr. Bruce Auerbach, president-elect of the Massachusetts Medical Society.
A Seattle hospital, Virginia Mason Medical Center, has gone further than anywhere else in its campaign to get workers vaccinated. Starting in 2005, the hospital mandated that staff members receive a shot or wear a mask for the duration of flu season.
Last year, staff vaccination rates soared to 98.5 percent, from 55 percent a few years before.
"Patients expect to be coming into a place that's safe. They don't expect to be getting infected in the place where they come for healthcare," said Dr. Joyce Lammert, chief of medicine at Virginia Mason.
Rather than demand that workers get vaccinated, which they view as too Draconian, most hospitals are appealing to workers' sense of duty, as vaccination drives begin this month.
If staff members will not come to where shots are being dispensed free of charge, then the shots are taken to them. At Beth Israel Deaconess Medical Center, that means nurses will trundle through every in-patient ward and certain outpatient clinics offering immunizations to workers, said Kelly Orlando, director of ambulatory operations at the hospital, where 60 percent of employees were vaccinated last year.
Similar measures will be evident at Brigham and Women's Hospital.
"We try each year to make it as easy as possible for people," said Dr. Robert Goldszer, associate chief medical officer at the Brigham, who conceded that "it's sad but true" that even then some staffers do not get inoculated.
"But I'm sure," he said, "there are people who work for accountants who don't do their taxes on time."
Stephen Smith can be reached at firstname.lastname@example.org.