Long-term care staff continue to have lower rates of influenza vaccination coverage (67.4 percent) than staff working in all other health care settings, according to “Influenza Vaccination Coverage Among Health Care Personnel — United States, 2017–18 Influenza Season,” a panel survey conducted by the Centers for Disease Control and Prevention (CDC) that was published in the Sept. 28, 2018, Morbidity & Mortality Weekly Report. In comparison, flu vaccinations among healthcare workers achieved a high of 91.9 percent in hospitals, followed by 75.1 percent in ambulatory care, and 74.9 percent in other clinical settings.
“The lagging vaccination coverage in long-term care is a significant problem, because increasing the rate of employee immunizations has been shown to decrease the occurrence and transmission of influenza within a facility,” says Evelyn Cook, associate director for the Statewide Program for Infection Control and Epidemiology (SPICE) at the University of North Carolina at Chapel Hill.
“Requiring employees to sign a declination form and identify why they have chosen not to take the influenza vaccine can be very helpful,” she suggests. “The goal isn’t to be punitive. You need to gather data so that next year you can evaluate those forms and determine, for example, ‘Fifty percent of staff who didn’t get vaccinated declined because they don’t think it works.’ So then you will know where you want to direct your education for the upcoming year.”
While other options are available, the CDC has developed a free resource: A Toolkit for Long-Term Care Employers: Increasing Influenza Vaccination Among Health Care Personnel in Long-term Care Settings. “This toolkit has data and findings from the latest literature, information on common barriers and strategies for improving influenza vaccination among your staff, and best practices identified by long-term care facilities who have successfully increased their staff flu vaccination rates,” explains Cook.
Here are some common issues that discourage staff flu vaccinations:
Myths and misinformation
“Like the general public, health care staff still believe a lot of myths about flu vaccinations,” says Cook. “For example, sometimes staff think, ‘I took the flu shot last year, and I got the flu.’ But they may be using the term flu very generically and talking about a gastrointestinal bug that they call the flu. Or they may think, ‘I am healthy and young, and I don’t need the flu shot,’ not realizing that if they get the flu and come to work infectious, a resident they care for may die as a result.”
So providers need to have a strong education program, says Cook. “Staff should be educated on the benefits of flu immunization. Once they really understand the value of getting vaccinated, most health care personnel are pretty compliant about trying to do the right thing.”
“Providers need to offer on-site vaccinations whenever it is convenient for the employees—not when it’s convenient for the facility,” says Cook. “That means you may need to offer free vaccinations at multiple times and locations, including departmental meetings and staff meetings.” Note: Providers can often recoup their costs through reduced absenteeism and the ability to use staff flu vaccinations as a marketing tool, according to the CDC.
Leadership not taking the lead
Senior leadership should be involved from the beginning of the annual vaccination campaign, says Cook. “For example, if the DNS and the administrator get the first shots, you can photograph that event and market the fact that senior leadership was first in line to get the influenza vaccine.”
Incentives can impact a staff vaccination campaign. “Incentives don’t have to be anything cost-prohibitive,” notes Cook. “For example, if you have multiple halls within the facility, give the hall with the highest staff compliance rate a free pizza lunch.”
Failure to make compliance a condition of employment
While providers can take steps to boost voluntary staff immunizations, “making compliance with influenza immunization a condition of employment is one of the strongest factors in high staff immunization rates,” says Cook.
The CDC panel survey found that “vaccination coverage was highest (94.8 percent) among health care personnel working in settings where vaccination was required. … Numerous professional medical associations, including the American Medical Directors Association, the Society for Healthcare Epidemiology of America, the American Hospital Association, the American College of Physicians, the American Nurses Association, and the American Pharmacists Association support mandatory influenza vaccination requirements for health care personnel.”
“Many acute-care hospitals now require staff to receive annual flu vaccinations, but it’s still fairly uncommon in long-term care—possibly due to the ongoing staffing crisis,” points out Cook. “However, if the hospitals in your community have made flu immunizations mandatory, that makes it more difficult for your staff to job-shop.”
When facilities decide to make flu immunization a condition of employment, they should offer some allowances for declining the vaccine (e.g., medical contraindications and religious concerns), says Cook. “But in the absence of those reasons, providers should educate individuals about the importance of immunization and the facility’s commitment to employee and patient safety, informing staff at the time of hire that they must have the flu vaccine by an appropriate time during flu season or they can no longer be employed at the facility.”
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