Vaccinate or mask policies: More punitive than proven?

January 12th, 2015

“Vaccinate or mask” policies have become more prevalent has hospitals try to protect patients and boost seasonal influenza vaccination rates of health care workers. While the approach makes intuitive sense -- protecting patients from workers who may have flu -- some have questioned whether these policies are more punitive than proven, requiring a mask primarily to pressure health care workers to be vaccinated.

As we report in the September 2013 issue of Hospital Employee Health, the Centers for Disease Control and Prevention does not have any recommendations on masking unvaccinated health care workers because there is no data on such programs. “There’s not really an evidence base to review to come up with recommendations. This is simply a matter of expert opinion,” says David Kuhar, MD, medical officer with the CDC's Division of Healthcare Quality Promotion.

While some hospitals have made the issue a moot point by mandating flu vaccination, others are bucking the trend toward vaccine-or-mask policies as they question the infection control rationale.

Hospitals feel pressured to show very high vaccination rates without threatening to fire employees, says Melanie Swift, MD, medical director of the Vanderbilt Occupational Health Clinic. But the policies inadvertently raise other issues if their stated goal is patient protection, she says.

“This kind of policy puts you on a slippery slope,” she says. “You then have no justification not to mask for early epidemics before you’ve got a vaccine, for any novel strain of flu, when vaccine is delayed in a year, or any year that surveillance shows a poor match [between the vaccine and the prevailing strains].

“If you try to follow it as a logical patient safety intervention, it quickly becomes obvious how ridiculous it is,” she says.

Swift also expresses concern about the breach of privacy of the employees’ medical information. Patients, visitors, co-workers and supervisors are all aware of the employees’ vaccination status, and some of those unvaccinated employees have a medical condition that precludes vaccination, she notes.