6th Edition In-Depth: Staff Health and Safety Immunizations

Standard SQE.8.2.1The hospital identifies staff who are at risk for exposure to and possible transmission of vaccine-preventable diseases and implements a staff vaccination and immunization program.

More than 3 million people worldwide die each year from vaccine preventable diseases. Children’s Hospital of Philadelphia used multiple data sources to identify the world-wide incidence of a variety of vaccine preventable diseases, many of which are prevalent in health care organizations. The number of world-wide cases and the number of deaths for some of the more common contagious diseases found in hospitals is as follows1:

Disease Number of Cases Number of Deaths
Hepatitis A 1.4 million Unavailable
Hepatitis B 2 billion 1 million
Haemophilus influenza type b (Hib) 7-8 million 199,000
Influenza 3-5 million (severe cases) 290,000 – 365,000
Measles 132,000 90,000
Pertussis 24 million 160,700
Pneumonia 14.5 million 826,0000

Many health care workers are at increased risk for exposure to and possible transmission of vaccine-preventable diseases. Infections from individuals who are asymptomatic are very common, particularly in the health care field as studies show health care practitioners often report to work even when they are not feeling well.  

Certain populations are considered to be more vulnerable including older adults, pregnant women, and very young children. People with chronic illnesses, such as asthma and chronic obstructive pulmonary disease (COPD), diabetes, heart disease, and neurologic conditions as well as people with long term illnesses, such as cancer or HIV, are also considered to be at higher risk for contracting an infectious disease; and when hospitalized, they may be at an even greater risk. Significant out breaks and even deaths from a variety of vaccine-preventable diseases — including influenza, hepatitis A, hepatitis B, measles, mumps, rubella, varicella, pertussis and meningitis — have been reported due to transmission of communicable diseases from infectious health care practitioners working in various types of health care facilities.

Health care practitioners have a responsibility to do no harm and health care institutions have an obligation to protect public health. Health care practitioners have a “…professional duty to provide care to all patients without the threat of undue harm caused by nosocomial influenza transmission… The public has a right to expect that health care workers and the institutions in which they work will take all necessary and reasonable precautions to keep them safe and minimize harm.”2 

Standard SQE.8.2.1 does not require hospitals to mandate vaccinations for staff, however, hospitals have an obligation to promote vaccination to staff.  This can be accomplished, in part, by educating all staff about the benefits of being vaccinated, challenging the myths associated with vaccination, and if possible, providing easier access to vaccinations. In addition, the standards also require hospitals to take steps toward reducing the risks associated with the transmission of infectious diseases by unvaccinated health care practitioners. Some suggestions for staff who do not wish to get vaccinated include:

  • Modifying the employee’s work duties, 
  • Having the employee wear a surgical mask, and/or
  • Transferring the employee to a position that does not require patient contact. 

Health care practitioners have an ethical and professional obligation to protect themselves, their coworkers, and patients and families. 


  1. Vaccine Education Center; Children’s Hospital of Philadelphia: Reviewed by Paul A. Offit, MD on March 28, 2018. Global Immunization: Worldwide Disease Incidence. Accessed Jul 31, 2018.  https://www.chop.edu/centers-programs/vaccine-education-center/global-immunization/diseases-and-vaccines-world-view
  2. Ottenber AL, et. al. Vaccinating Health Care Workers Against Influenza: The Ethical and Legal Rationale for a Mandate. Am J Public Health. 2011 February; 101(2): 212–216. Accessed Aug 3, 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3020194/
  3. Influenza Specialist Group. Discussion Paper. Influenza Vaccination Among Healthcare Workers. Accessed Aug 3, 2018. http://www.isg.org.au/assets/assets/influenza-vaccination-among-healthcare-workers-discussion-paper-web.pdf