Walking the Talk on Patient Safety – North Bay Regional Health Centre’s Immunization Policy

Mandatory immunization of Health Care Workers (HCWs) is a hot topic right now given that the BC government decided against implementing a regulation that would require mandatory influenza immunization. Their decision to delay was influenced by pressure from BC’s health care unions, who believe that to enforce mandatory immunization on HCWs to be punitive, maintaining that immunization should remain a personal, voluntary choice. 

This view is in contrast to the position taken by the Public Health Ontario, which maintains that the flu shot to be mandatory for all health-care workers in the province. The Provincial Infectious Diseases Advisory Committee on Infection Prevention and Control, in its updated Best Practices for Infection Prevention and Control Programs in Ontario, recommends that annual influenza vaccination should be a condition of continued employment in, or appointment to, health care organizations. 

Likewise, the Canadian Nursing Association (CNA) has taken the position that, “policies that place immunization as a condition of service should be introduced if health-care worker influenza immunization coverage levels are not protective of patients, and reasonable efforts have been undertaken with education and enhancing accessibility to immunization.”  

Over the past five years, the median influenza immunization rate for Health Care Workers (HCWs) in Ontario hospitals has ranged from approximately 40-60 per centdespite Hospital influenza education and awareness campaigns.  Historically, North Bay Regional Health Centre (NBRHC) has reported rates within this range, with an additional challenge that many employees do not receive the influenza vaccine until after influenza activity has peaked in the community and patients and employees are at greatest risk of contracting and transmitting influenza. 

The North Bay Regional Health Centre sought to prevent patient exposure during periods of increased community influenza activity by ensuring that all employees are vaccinated or taking antiviral medication. Historically, the NBRHC’s influenza policy focused only on situations where there was an outbreak of nosocomially acquired influenza within the hospital itself. 

The revised NBRHC policy states that when there is influenza activity in the district, a risk assessment will be undertaken in consultation with the Medical Officer of Health. If it is determined that patients or staff at NBRHC are at risk of suffering the consequences of acquiring influenza, including morbidity and mortality, then all staff at designated NBRHC facilities will be required to be vaccinated to attend at work.

The use of antiviral medications in such a situation is outlined in another section of the policy.  This shifts the immunization requirement from internal outbreak to a more proactive approach, using localized influenza activity in the community and a recommendation from the district Medical Officer of Health. The Infection Prevention and Control Department monitors influenza activity in the community and has ongoing discussions with front-line managers, senior team, and Public Health to assess at what point the NBRHC should implement staffing restrictions. 

It is important to note that, while many people refer to our policy as “mandatory”, influenza immunization in not a condition of employment for NBRHC staff.  Staff will not be disciplined for refusing the flu shot.  Rather, staff members have the choice to be vaccinated or to be on an administrative leave in the case of significant influenza activity in the community.  Those on leave have the option of using vacation credits to maintain some or all of their pay.

This season NBRHC reached a 90 per cent staff immunization rate.  We believe this high immunization rate, in conjunction with vigilant staff adherence to infection control practices, including hand washing compliance, use of PPE, staying home when symptomatic, and cleaning practices by our environmental services team, has been instrumental to NBRHC’s avoidance of any internal influenza outbreaks this season, despite significant activity in the community.    We are very proud of all of our staff for the efforts made to ensure the ongoing safety of our patients.

Reaching a 90 per cent staff immunization rate has not been without challenges.   Pressure has been placed on the NBRHC by Unions and staff to amend our policy. A  significant portion of staff have reported that the requirement to be immunized amounts to “bullying” and “coercion”, expressing that the “choice” to be on unpaid administrative leave is not really free choice, as it directly impacts their livelihood.  In addition, this revised policy has had a significant impact on labour relations, as we have received grievances from each of our Unions (OPSEU, CUPE, and ONA) regarding the implementation of the Influenza Protocol this year.

While the organization believes in the strong position that it has taken to safeguard our patients during influenza season, we are very concerned with the impact this has had on staff engagement and on our relationship with employees and unions.  This month we will be undertaking a review of our influenza policy and processes, engaging front-line staff, managers, physicians, and union leadership to hear and respond to concerns.  We believe that, through this dialogue, we will create a revised policy that meets the needs of all stakeholders, including our patients, for whom we are committed to providing the highest level of patient safety attainable.

Although by no means an exhaustive list, I’d like to specifically mention Danielle Baker, our Director of Risk Management, Patti Byers (preceded by Kim Carter) our Coordinator Infection Prevention & Control,and Janet McLean, our Coordinator of Occupational Health Services for their leadership in effectively managing the significant challenges arising from the implementation of the influenza protocol this influenza season and the work already underway to improve the policy for next season

Also critical to our success was the untiring support from Dr. James Chirco, our Medical Officer of Health. His support has assisted us in developing and implementing an Influenza Protocol that enables us to be a leader in this area of patient safety. In addition, our Board of Directors, informed by our ethics committee, has stood firmly behind the management team in endorsing this course of action. 

While we recognize there is room for improvement of our existing practices, we strongly believe we are on the right course and are “walking the talk” on patient safety.