California pacific Medical Center	More NurseWeek Features   Smoke-Free Zone   Nurses and patients tackle nicotine addiction   Bloodless Survival     Surgical techniques to use when transfusion drops out of the equation
Barbara DeBaun, RN (center), director of infection control at the California Pacific Medical Center in San Francisco, says that a possible positive point from this year’s flu shortage may be that people will pay more attention to the old ways of flu prevention, such as washing their hands, staying home when they are sick, and using alcohol gel.

As California health care providers scramble to find flu vaccines this year, many nurses are wondering whether they should get a flu shot or skip it this year so more vaccines will be available to their patients. It’s a question without an easy answer, nurse epidemiologists, administrators, and government health officials say.

Some nurses will have no choice, at least until their facilities receive more doses of the vaccine. The Centers for Disease Control and Prevention recommends that all health care workers with “direct patient care” get a flu shot.

But because vaccines are in such short supply, some hospitals and county health departments are prioritizing even among health care workers, recommending that those who do not work with severely at-risk patients put off getting a flu shot until more vaccine becomes available.

Other health facilities — even those with enough vaccines for all qualified workers — report that some nurses were forgoing or postponing the vaccines voluntarily to make sure their elderly or at-risk patients receive the shots.

Whether nurses should get the shot, postpone it, or forgo it altogether is a personal decision and depends on their individual situation, nurses and health officials say.

“It’s noble for nurses to say I would just as soon forfeit my vaccine and give it to a patient,” says Barbara DeBaun, RN, MSN, CIC, director of infection control at the California Pacific Medical Center in San Francisco. But although young, healthy health care workers have a better chance at weathering the flu than sick or elderly people, they also may be more likely to transmit the illness to patients and colleagues.

The state health department recommends that all health care workers involved in direct patient care receive the vaccine so they can stay healthy, says Norma Arceo, spokeswoman for the California Department of Health Services. But some county officials say they have only so much vaccine to go around.

Short supply

After learning that only 58 million of an anticipated 100 million doses of the flu vaccine would be available nationwide this year, the CDC asked health care providers to limit the shots to certain high-risk groups: people older than 65; those with certain types of chronic illness; children aged 6 months to 2 years; women who will be pregnant during the flu season; caregivers of children younger than 6 months; and health care workers involved in direct patient care. State guidelines mirror those of the CDC.

California was particularly hard-hit because the state ordered all of its flu vaccines from Chiron Corp., which had to cancel its deliveries after its flu stock was quarantined by British and U.S. health authorities Oct. 5. Through a CDC redistribution program of vaccines from the only other U.S. supplier, Aventis Pasteur, the state will have about half of what it had planned to distribute to county health departments. The counties provide shots to nursing homes and low-income residents.

As a result of the shortage, Sacramento County is asking health care providers with limited amounts of vaccine to give flu shots first to the “frail elderly,” people with chronic illnesses such as diabetes or lung disease, and health care workers who work directly with severely immunocompromised patients.

As more vaccine becomes available, the county will expand its guidelines, says Glennah Trochet, MD, public health officer for Sacramento County. “We would like to see it reserved for the patients now,” she says, adding that the guidelines were not set in stone, and every provider should use clinical judgment in deciding who would most benefit from getting the shot.

Los Angeles County has no plans yet to further restrict the state recommendations for patients or health care workers, says Alvin Nelson El Amin, MD, MPH, medical director of the Los Angeles County immunization program. But county health officials are advising healthy health care workers younger than 50 to consider getting a nasal mist flu vaccine developed last year or using antiviral medications if they cannot get a flu shot.

UCSF Medical Center, which ordered from Chiron and came up short, plans to offer flu shots to physicians, nurses, and other health care workers who provide direct patient care in the emergency department, acute care clinics, intensive care units, and hematology and oncology services, says hospital spokeswoman Carol Hyman.

Workers in areas such as med/surg and outpatient services will not be able to get vaccinations through the hospital, at least initially, she says. “We’re hoping to get more vaccine and as we do, more workers and more patients will be getting vaccinated,”Hyman says.