3 studies show ways to increase health-care worker vaccination rates

Health care personnel influenza immunization rates have remained low, despite recommendations from the Centers for Disease Control and Prevention and other leading health care organizations that all health care personnel receive annual flu vaccines, ScienceDaily reported March 22.

Experts say these levels are perilous. Increasing vaccination rates substantially improves patient safety, lowering flu deaths by 40 percent.

Three studies presented at the Fifth Decennial International Conference on Health care-Associated Infections in Atlanta examine ways to increase health care personnel vaccination rates through social networking, declination strategies and mandates.

"Immunization is one of the most important things that we as health care personnel can do to prevent the transmission of influenza and other diseases to our patients," said William Schaffner, a member of the Infectious Diseases Society of America's board of directors.

"We owe it to our patients to get vaccinated. These studies are very helpful because they demonstrate strategies that work to effectively reach and vaccinate health care personnel."

Epidemiologists and computer scientists at University of Iowa Health Care found that health care personnel are more likely to be vaccinated if their close contact co-workers, also referred to as neighbors in the study, are vaccinated.

Researchers found that unvaccinated health care personnel tended to be more isolated and have fewer vaccinated co-workers. By comparison, vaccinated health care personnel tend to have more interactions with co-workers and were more likely to be surrounded by more vaccinated co-workers.

"These findings suggest a strong association between higher vaccination rates and health care personnel who work closely with other health care personnel," said Philip Polgreen, assistant professor at University of Iowa Health Care.

The data hold implications for hospital-based flu vaccination campaign strategies specifically targeting health care personnel with a history of non-vaccination.

"It appears that vaccination campaigns consistently fail to influence a small cohort of health care personnel who are measurably more isolated from other health care personnel. Persistently unvaccinated health care personnel may benefit from better targeted vaccination campaigns," Polgreen said.

In a five-year span, Children's Mercy Hospital and Clinics in Kansas City improved their employee influenza vaccine rate from 63 percent to 90.5 percent by instituting a mandatory vaccination/declination policy.

In 2004, 63 percent of the hospital's health care personnel received influenza vaccine. At that time the vaccination strategy included free influenza vaccine and education about influenza.

Beginning in 2008, a mandatory vaccination/declination policy was instituted requiring employees to receive the vaccine or formally decline the vaccination in writing. The influenza vaccination rate increased to 85 percent that year. By adding consequences such as a forced leave of absence for noncompliance to the 2009- 10 policy, Children's Mercy Hospitals and Clinics was able to improve their vaccination rate to 90.5 percent, with 98.8 percent of employees complying with hospital policy.

"Our dramatic increase in vaccination participation over the last few years has been astounding," said Robyn Livingston, director of Infection Control and Prevention at Children's Mercy Hospital. "Even though this program has exceeded our expectations, we recognize there is still room for improvement. We are considering a fully mandatory influenza vaccination policy to begin next fall."

As part of its continual efforts to improve patient safety, Hospital Corporation of America established a mandatory vaccination policy across its 163 hospitals, 112 outpatient centers and nearly 400 physician practices. The goal of the strategy was to advance patient safety by helping to stem health care- acquired influenza.

The policy, implemented during the 2009-10 influenza season, required all health care personnel to receive the seasonal influenza vaccine.

Those who could or would not be vaccinated because egg allergy, history of Guillain-Barré, or religious or philosophical convictions were reassigned to non-patient contact roles or required to wear masks.

Almost 97 percent of HCA health care personnel, or more than 150,000 people, have been vaccinated, and the remaining 3 percent are wearing masks, supporting HCA's goal of 100 percent patient safety.

"For years, hospitals across the nation have been reporting poor rates of health care personnel immunization against influenza," said Jonathan Perlin, chief medical officer of HCA. "The fact that CDC reports a rate of 48 percent is particularly troubling considering influenza is the number one cause of vaccine-preventable death."

In previous years, HCA had used a combined approach of vaccination education, conveniently offered immunizations and declination strategies.

While these approaches achieved modest improvements annually, they were inadequate for complete patient safety.

The current policy was developed by representatives of numerous disciplines, including emergency preparedness, infection prevention and epidemiology, human resources, pharmacy and supply chain. Additionally, the campaign included prevention strategies such as promoting cough etiquette, proper hand hygiene, sick visitor guidelines and environmental cleaning.