NZNO's Blog

Unmasking the evidence


Coughs_and_Sneezes_Spread_Diseases_Art.IWMPST14133Many DHBs have been talking about forcing staff who don’t get the flu vaccination to wear masks.

It’s one of those things that on first glance might seem like a good idea, but peel back a few layers and you’re left with the bitter taste of a purely punitive measure.

NZNO acknowledges the right of every person to vaccinate or not. We encourage it, of course; to the extent that we pay for our own staff to get the flu vaccination if they choose to. Healthy workplaces are a priority. We believe education and access are key to improving uptake but we do not think mandatory vaccination is the way forward.

DHBs want safe environments for their staff and patients too and we applaud that. What we’re saying is the DHBs are grabbing onto a “solution” that’s not evidence-based and seems to be designed to shame individuals rather than keep staff and patients safe from the flu.

We do not support the use of face masks to protect patients from unimmunised nurses.

For one thing, masks don’t work. Evidence shows masks are ineffective in protecting healthcare workers from patients with flu; so why do DHBs think the opposite would be different?

For another – a nurse with the flu would only be able to pass it on to a patient or colleague if he or she was at work. Nurses should not be working, or be made to feel that they should have to be at work, when they are sick. DHBs need to make sure enough staff are available to cover the inevitable rise in sick leave during “flu season”.

And it’s not just nurses. There must be clear information for patients, staff, contractors and visitors that sick people should stay away.

DHBs should also be promoting good hand washing and the use of tissues for coughs and sneezes.

Our motto is “Freed to care, proud to nurse” and we want that for every single NZNO member. Please don’t hesitate to give us a call if you are being treated unfairly 0800 28 38 48.

Here is NZNO principal researcher, Dr Léonie Walker’s analysis of the evidence for and against masks to protect against flu.

Health care workers have long relied heavily on surgical masks to provide protection against influenza and other infections. Yet there are no convincing scientific data that support the effectiveness of masks for respiratory protection. The masks we use are not designed for such purposes, and when tested, they have proved to vary widely in filtration capability, allowing penetration of aerosol particles ranging from 4 to 90%1.

The efficacy of any respiratory device depends on user compliance. Workers’ tolerance for wearing most types of respiratory protective devices is poor and often declines over the course of a work shift; in one study, no more than 30% of workers tolerated these devices consistently throughout an 8-hour workday, citing difficulties with speaking and communication, discomfort, and other physical problems2.

The Institute of Medicine committee has recommended that current Centers for Disease Control and Prevention guidelines for respiratory protection be maintained3. Until more data are available, the Institute of Medicine committee recommended the use of personally fitted, N95 respirator when confronting patients with influenza-like illnesses, particularly in enclosed spaces4.

1Oberg T, Brosseau LM. Surgical mask filter and fit performance. Am J Infect Control (2008);36:276-282

2Radonovich LJ Jr, Cheng J, Shenal BV,Hodgson M, Bender BS. (2009) Respirator tolerance in health care workers. JAMA ;301:36-38

4Kenneth I. Shine, M.D., Bonnie Rogers, Dr.P.H., R.N., and Lewis R. Goldfrank, M.D (2009) Novel H1N1 Influenza and Respiratory Protection for Health Care Workers N Engl J Med 361:1823-1825”


13 thoughts on “Unmasking the evidence

  1. What happened to the right to give or withhold consent? Or does that not apply to nurses? When I got my flu vaccination at CCDHB last month I had to sign a consent form – but it seems those forms may be just a hollow formality. I’m also interested in how privacy legislation and rules apply here, if DHBs consider they have the right to demand that staff disclose their health status.

  2. I believe that staff should have the right to choose whether to have the influenza vaccination or not. To make it compulsory is taking away their right to choose. As health professionals we do need to make every effort to protect ourselves and our patients from unwanted illness but we should be able to choose how to do this
    It seems that most places I know are asking for consent forms but individual health status should not be shared with an employer

  3. The Infection Prevention and Control Nurses College (IPCNC) would just like to iterate that it is still best practice to follow the evidence based guidelines of your organisation regarding the use of Personal Protective Equipment when caring for someone in isolation transmission based precautions. This includes the use of the appropriate mask when caring for any person suspected or known to have a droplet or airborne transmitted disease; and in conjunction with the 5 moments for hand hygiene. The IPCNC continues to strongly encourage healthcare workers to have the influenza vaccination to reduce the risk to themselves and their patients/clients from developing influenza – a potentially very serious disease. Please read .

  4. I strongly disagree with the statements that the surgical masks do not work. Your evidence is very dated in this matter and many more studies since the pandemic strain and even SARS have demonstrated that this level of respiratory protection does indeed work. It is disappointing that the NZNO have not consulted with their own College on this matter who are the experts (IPCNC) prior to posting incorrect information and thereby undermining all the work done in IPC throughout our country (and indeed the world).. Of course if you really don’t want to catch influenza outside of the work environment then have the vaccine. The surgical/droplet masks are well supported by research that they provide protection against influenza (with the exception of aerosol-generating procedures). as for the choice of vaccination, where is your duty of care to protect your patients?

    • The duty of care principle should not mean nurses’ rights in terms of health choices and privacy are diminished. Nurses are health consumers, too, and are entitled to all the rights provided to every other health consumer, including the right to privacy regarding their health status re vaccinations.

    • Thanks for your comment. We’d just like to clarify that the masks DHBs are talking about forcing unimmunised staff to wear are paper masks with ear loops that theoretically stop you sneezing onto your patients. There is no evidence to support the efficacy of paper masks against the spread of flu. We absolutely endorse the wearing of appropriate protective masks when caring for patients with droplet-spread infectious diseases.

      • So if the DHB was requiring ‘proper’ masks would your position change? It seems somewhat ironic that you cite lack of evidence when there are plenty of nurses basing their decision to not immunise on no evidence whatsoever. You’ve paid lip service to immunisations. You could have condemned the unprofessional non-evidence-based attitude of nurses but instead you took the easy option.

    • Thanks Ruth and I agree with you. It is disappointing that the mask effectiveness has been judged as ineffective by such an influential body as the NZNO. For all the naysayers this would be a comfortable reason to opt out of not only their duty of care but to not uphold the principle of “do no harm” and
      “beneficence”. Clearly, horribly, a hospital acquired epidemic of flu, or even a patient story about hospital acquired flu is required to catapult the skeptical view into some form of sensibility. In this blog discussion the reference to privacy and rights appears to support the healthcare workers’ rights as more important than that of the patient ( who is already vulnerable by being in hospital in the first place!). Understandably this raises controversy. However, as healthcare workers we have an obligation to provide safe care and we all know that many healthcare workers do come to work sick. The “stay away” recommendation is admirable and correct but it is not the reality. I suggest when using literature to support the NZNO
      (industrial) view, rather than pull out dated clinically based literature that has indeed moved on, robust analysis of published literature supporting the industrial view about healthcare workers’ rights and choices about flu vaccination should be quoted and referenced. Does this exist?

  5. Given the doubts over the efficacy of the masks, perhaps it woudl be cheaper and achieve the DHB’s real goal (forcing staff to have a medical procedure whether they want it or not) to simply force staff to wear a large scarlet letter.

  6. Then DHBs should be made accountable for the hoards of antibiotics they feed patients over minor illnesses that in turn lower people’s resistance to these bugs… From experience I would say clostridium difficile would be a much bigger problem. Patients will get sick regardless when their immunity is so low.. The flu is only one piece of the puzzle… Oh and last I heard if you actually had influenza you could barely leave your bed let alone come to work and spread it.. The flu is a different kettle of fish to a bad cold.

  7. Re the comments by freshairprince, many nurses are objecting not to vaccinations, but to a proposal to force anyone to undergo a procedure against their consent, and objecting, too, to the idea that staff, unlike patients or visitors, should be forced to disclose their medical information, despite privacy legislation and health consumer legislation. The nurses I know who have not been immunised have certainly not based their decision on “no evidence whatsoever”. How offensive to describe this as “unprofessional non-evidence-based attitude”. And, just for the record, I usually do get the flu vaccination, but I will not be made to.

    • Thanks for the reply Erin. Based on the comments on the NZNO facebook pages, all of whom claim to be nurses, the level of understanding of disease transmission is very poor, and I consider that lack of knowledge unprofessional. Nurses believing they might be naturally immune to the flu, that they’ve never had the flu despite never having had the vaccine (and are therefore safe), or that because they do not show symptoms they are not a risk to patients. How professional is it for a nurse to say “I’ve never had the flu jab …and never will…” ? Is that an evidence-based approach? Am I surprised that the NZNO has acted the way it has? Not particularly, but by supporting it I have to align with some wacky ideas. Unless a healthcare worker has a life-threatening allergy to a vaccine component they should line up for their jab (and lollipop.) Thanks, Paul Prince (freshairprince)

      • I know many nurses and doctors who do not get immunised and who have researched their decisions. They have that right. I would consider it unprofessional for any nurse to pick and choose which patients they deal with are entitled to basic rights such as the right to give or withhold informed consent and the right to privacy.

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