Health workers have been blamed for putting vulnerable patients at risk and
worsening the winter’s flu outbreak by refusing to have flu jabs.
Fewer than one in seven frontline NHS staff had a flu jab last year, The
Times has learnt, despite a recommendation that they do so. The Royal
College of General Practitioners called last night for hospital doctors,
GPs, nurses, carers and other staff to have compulsory jabs or be banned
from contact with patients other than in exceptional circumstances.
Figures to be published next week by the Department of Health will show that
the vast majority of health professionals ignored government advice that
everyone in direct contact with patients be immunised.
Of the hundreds of patients seriously affected by staff transmission of flu,
some were infected while being treated in high-dependency wards.
The health department figures show that only 14 per cent of frontline workers
had a flu jab before the 2008-09 season, despite warnings from Sir Liam
Donaldson, the Chief Medical Officer for England, that immunisation rates
had to improve.
The flu outbreak over Christmas and the new year was the worst for eight
years, with more than 60 cases per 100,000 head of population. About 2,000
deaths are attributed to flu annually – although the number can rise to more
than 10,000 in bad years. The number for this winter has not yet been
released.
Some hospitals suffered serious flu outbreaks exacerbated by staff
transmission of the highly contagious virus, while shortages of workers put
pressure on accident and emergency departments. Anecdotal reports suggest
that on occasion patients brought to hospital by ambulance had to wait for
up to five hours because staff were so overstretched by absenteeism and
higher admission rates caused by flu.
At Royal Liverpool University Hospital, nearly 100 patients caught flu,
including on high-dependency wards treating blood diseases and kidney
problems.
Low levels of vaccination among staff were identified by the Health Protection
Agency as a significant factor in the outbreak. When health chiefs in
Liverpool asked any unvaccinated staff to get a jab to help to control the
outbreak, almost 1,300 came forward.
All frontline workers should be offered jabs through programmes run by health
trusts from early October, at the start of the annual vaccination campaign.
Uptake rates, which have been low historically, rose to close to 20 per cent
of NHS frontline workers in 2005 but have fallen away since.
Dr George Kassianos, the immunisation spokesman for the Royal College, said it
was incumbent on ministers and health leaders to make sure that patients
were not put at greater risk from contact with the NHS. Dr Kassianos said
that a form of compulsory vaccination – where anyone not wishing to have a
flu jab should not be put in frontline roles unless under exceptional
circumstances – should be considered.
“The only way to boost the effectiveness of the flu vaccine is to immunise the
people who are delivering the care – in hospitals, nursing homes,
residential homes and GPs’ surgeries,” he said. “We are now so hot on
infections such as MRSA, so why are we not on influenza? You are placing
patients’ lives at risk if you give them the flu.
“It may make sense to say that if staff want to work in contact with patients,
then they need to be immunised. We have to think of the patient on the
hospital bed. They have a right not to contract flu from a carer.” Under the
code of practice for health-care-acquired infections issued by the NHS, and
monitored by the Healthcare Commission, trusts are required to “ensure, so
far as is reasonably practicable, that healthcare workers are free of, and
protected from, exposure to communicable infections”.
However, a study of NHS attitudes conducted by the Government last year found
that most staff did not view flu as a serious illness and thought the
vaccine unnecessary because they were not at risk.
Trusts reported staff vaccine compliance as a “key problem area”.A conference
was even held by the Department of Health last June for flu vaccine campaign
organisers to improve NHS workers’ uptake.
Michael Summers, the vice-chairman of the Patients’ Association, said that the
latest figures seen by The Times were “very concerning”.
“NHS staff must lead by example. They know that patients are vulnerable to flu
if they themselves are infected but also if they fall sick and have to stay
at home, which will also affect patient care. They know the risks this is
posing to patients.”
A health department spokesman said that the Government accepted that
improvement was required, but mandatory vaccination was not being considered.
“We want to see flu immunisation rates in healthcare workers increase because
it will benefit both patients and staff. The recently published code of
practice emphasises the need for NHS organisations to have an immunisation
policy in place and to ensure staff’s immunisation status is reviewed and
updated,” he said.
Infection spreads like wildfire
Case study: Royal Liverpool University Hospital
The risks of having a workforce with poor levels of flu immunisation were
highlighted by the speed of the outbreak at Royal Liverpool University
Hospital over Christmas.
Data released by the Health Protection Agency (HPA) shows that a patient in a
haematology ward was found to be suffering from a flu infection at the end
of November. Within ten days, 11 cases were identified in haematology, the
renal ward, accident and emergency and outpatients — while five members of
staff were also affected. The strain was found to be resistant to a common
antiviral treatment, oseltamivir, and a second drug had to be used. The
virus was passed around the hospital, mainly by health workers. In total 115
cases of influenza A were confirmed.
As well as giving antivirals as a preventive measure on high-risk wards and
advising jabs for relatives and other visitors, the hospital took staff with
flu symptoms off duty. Vaccinations were later offered to all NHS workers,
and 1,299 staff had the jab in the first two weeks of December. All should
have been offered vaccinations at the start of the flu campaign two months
earlier.
The reaction to the outbreak, which had ended by January 6, was commended by
the HPA for averting more serious risks to vulnerable patients, but the
agency noted that it was a timely warning of “how easily influenza can
spread in a healthcare setting when the virus is circulating in the
community and staff vaccination levels are low”.
Virus kills between 2,000 and 10,000 Britons every year
— Flu, or influenza, is a disease of the lungs and upper airways caused
by infection with a flu virus
— The virus is usually spread in the small droplets of saliva that are
coughed or sneezed into the atmosphere by an infected person. Direct contact
with hands that are contaminated with the virus can spread infection
— The main symptoms are a high temperature, aches and pains, loss of
appetite, nausea and a harsh, dry cough. The worst of the symptoms last for
two or three days but the tiredness that comes with flu can last as long as
three weeks
— It takes between one and four days to go from being infected to having
the full symptoms. People are infectious from the day before symptoms start
— Health and care workers are entitled to a free vaccination
— Colds and flu affect 15 million people each year in Britain
— About 2,000 Britons die from flu every year. The figure can rise to
10,000 in a bad year
— The 1918 “Spanish flu” pandemic is estimated to have infected up to a
billion people, half of the world’s population at the time. The figure
surpasses the total for any other single outbreak of disease, including the
Black Death
