News & Events

MNA/NNU Position Statement Opposing Mandatory Masking of Health Care Workers as Flu Prevention Strategy

12.20.2012

 

Introduction
The Massachusetts Nurses Association strongly opposes a new policy being implemented by a number of hospital and health care employers calling for mandatory masking of health care workers as a component of a flu prevention program. 
Rather than focus on systems and policies that actually prevent flu transmission, many institutions are now focused on setting a misguided and ineffective policy which mandates that healthy health care workers wear a mask for eight to twelve hours while on duty if unvaccinated. We encourage nurses to become educated on the risks and benefits of the influenza vaccine and decide whether to vaccinate, but we are against mandated vaccination and mandated masking.
The defining issue is there is no medical evidence that the masking of unvaccinated, healthy nurses prevents the transmission of influenza. The medical evidence shows that surgical masks are designed to prevent dispersion and are not designed to prevent inhalation of airborne particles containing virus, therefore masks would be more effective if placed on people who are coughing or sneezing, whether patients or workers. Masking an asymptomatic  nurse is neither preventive in the spread of infection nor appropriate.
Under hospital masking policies patients, visitors and vendors, who may not follow the other acceptable prevention measures noted below, are more likely to be vectors of illnesses and are free to walk around facilities unmasked while nurses and others are forced to wear masks, with no benefit to the patient population. 
What is Behind the Masking Policy?
Healthcare facilities throughout the country are required to meet a 90 percent influenza vaccine rate among employees or risk losing a portion of Medicare reimbursement. The Massachusetts Nurses Association believes that the practice of mandating a mask is a punitive, coercive way of bullying workers into vaccination to avoid being penalized for failure to reach the required vaccination threshold.

The Massachusetts Nurses Association recommends that all health care workers become educated about the benefits and risks of the influenza vaccine and consider immunization unless contraindicated for health or personal reasons.

The MNA supports the current voluntary influenza immunization program as directed by the Massachusetts Department of Public Health, which has proven to be highly successful, increasing rates of flu vaccination in health care facilities. Please review the Influenza Position Statement on the MNA’s web site under Health and Safety at www.massnurses.org
Controlling the Spread of Flu needs a multipronged approach to Infection Prevention!

Influenza is a community-acquired disease, not a hospital- acquired disease and transmission can be prevented within a facility if the hospital has good infection control processes. Those processes should include:
·         Educate all staff about appropriate infection prevention practices.
·         Practice good hand hygiene.
·         Educate all patients, employees, vendors and visitors about the flu vaccine (VIS).
·         Voluntary Flu Vaccination -- The influenza (flu), vaccine is partially protective against three viruses. The published effectiveness rate of this vaccine gives individuals approximately a 50% chance of contracting the flu, but there are other influenza like illnesses (ILI), for which there are no vaccines. This does not mean you should not receive the influenza, vaccine; on the contrary, the current flu vaccine protects against the three viruses that are highly virulent. The vaccine helps protect high risk patients, health care workers and the community.
 
·         Establish and enforce guidelines by Environmental Services (housekeeping and food service staff), to include cleaning surfaces and disinfecting patient rooms. The staff need education on when, where and how to clean to prevent the transmission of influenza.
·         Screen patients in the Emergency Department and mask patients who are positive for influenza. After appropriate treatment, they may be well enough to be sent home to recover. If patients require admission, they need an isolation room with appropriate precautions.
 
·         Isolate infected patients in private rooms, with air filters to prevent the spread of infection.
 
·         Restrict visitors and vendors from close patient contact, or have them wear personal protective equipment when visiting a patient.
·         Ensure Safe and appropriate RN and support staff levels that allow for proper care of patients and infection control procedures. In fact, inadequate staffing is a major cause of all types of hospital acquired infections. Understaffing of RNs and other staff makes it more difficult to maintain appropriate hand washing and infection control procedures. Cuts in housekeeping staff make it more difficult to maintain sanitary conditions that will prevent the spread of infection in hospitals.
 
·         Create better illness prevention policies! Nurses and health care workers need to be allowed to utilize sick time and stay home if they are ill, as recommended by the Center for Disease Control and Prevention (CDC). Nurses should not be disciplined for taking the time necessary to recover.
 
·         Work with your infection prevention specialist within your facility.
 
Bibliography:
http://www.reuters.com/article/2012/12/12/idUS153651+12-Dec-2012+PRN20121212
William G. Buchta, MD, MS, MPH, is the medical director for occupational health services in the division of preventive, occupational and aerospace medicine at the Mayo Clinic in Rochester, Minn. Accessed 9/30/11. He spoke at the NECOEM conference in Boston November 28, 2012.
www.acoem.org
ACOEM Responds to HHS Flu Action Plan October 11, 2010: Seasonal Influenza Prevention in Healthcare Workers, November 17, 2008.
http://hicprevent.blogs.ahcmedia.com./2012/01/24/flu-mask-policies-patient-safety-or-punitive. Hospital Infection Control, Jan. 24, 2012, Gary Evans.
http://www.haponline.org/downloads/HAP_DOH_Influenza_Vaccination_of_Health_Care_Personnel_Letter_May2012.pdf