CDC: Extend HCW flu shots through January

Supply delays may be business as usual

Hospitals are striving to vaccinate more health care workers against influenza than ever before, but this fall they struggled to get their campaigns rolling because of vaccine supply delays. The lesson of the season: Get used to uneven delivery of flu vaccine.

Manufacturers planned to deliver about 110 million doses — significantly more than the 85 million doses available last year. But large contract orders from grocery and pharmacy chains apparently received preference over the orders of individual hospitals, and some hospitals did not receive their vaccine until early November.

Julie L. Gerberding, MD, MPH, director of the Centers for Disease Control and Prevention, paid a surprise visit to the Healthcare Infection Control Practices Advisory Committee meeting in November to urge infection control and employee health professionals to adopt a continuous immunization program that stretches into January.

"There's been a mismatch between the supply of the vaccine and the distribution," Gerberding said. "We really have to work this year on extending the immunization season. No matter how much vaccine we produce, we're always going to have this problem of not being able to get it out from the manufacturer in the month of October."

Distributing such a large quantity of vaccine is a tough logistical issue, and Gerberding noted that the CDC has no control over the distribution patterns.

Hospitals and other health care providers need to understand the decentralized system that affects vaccine distribution, says William Schaffner, MD, chair of the department of preventive medicine at Vanderbilt University in Nashville.

"Only half of the vaccine is distributed from the manufacturer directly to the end user," he notes. "The other half is distributed by biologics distributors. Each of them has their own customers and their own mechanisms. Some vaccine goes through two or three middlemen before it reaches the end user."

Because of that, "there will always be some medical providers who get vaccine before others," says Schaffner.

Hospitals ramp up for standard

This fall, supply problems created frustration and made it more difficult for hospitals to launch a flu vaccine campaign that they hoped would be their best ever. Hospitals are under increased pressure to improve vaccination rates.

The CDC first recommended influenza vaccination of all health care workers in 1981, but only about 40% receive the vaccine. About 36,000 deaths a year are attributed to complications from influenza.

This month, a new standard from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) becomes effective, requiring hospitals to evaluate why some employees do not receive the annual vaccine and to take steps to improve participation.

The Joint Commission is not requiring the use of declination statements, but hospitals are using various methods to determine who's receiving the vaccine, who's not, and why they're not.

Yale-New Haven (CT) Hospital was forced to postpone its flu vaccine fair by about a week due to supply delays, says Mark Russi, MD, MPH, director of occupational health. At the vaccine fair, approximately 2,000 employees received their vaccine within 12 hours.

Then vaccination teams went to individual units to offer the vaccine. Nurse managers also received lists of their direct patient care providers who hadn't yet received vaccine so they could counsel them individually and offer them vaccine, says Russi, who is also associate professor of medicine and public health at the Yale University School of Medicine.

While Yale seeks to boost its vaccination rate overall, an emphasis is placed on vaccinating employees involved in direct patient care, he says.

"I'm glad there is more scrutiny of flu vaccine rates by CDC and JCAHO. If you look at national rates of vaccination, there still is a lot of room for improvement," he says. "I think the best way for medical centers to improve their rates is to use several different strategies over the course of a vaccination season."

Intranet helps track vaccinations

The Cleveland Clinic has a mandatory reporting program to track flu vaccination that has helped raise awareness — and vaccination rates. Employees log on to the hospital's intranet and indicate whether they received the vaccine, did not receive it because of contraindications, or declined the vaccine for other reasons.

Although there are no sanctions for failing to participate in the reporting, the hospital has a participation rate of more than 90%, says Steve Gordon, MD, hospital epidemiologist. Participation rates — but not individuals' names — are reported to division administrators.

The reporting program has been well received, says Mary Bertin, RN, BSN, CIC, infection control practitioner. From 2004 to 2005, the Cleveland Clinic's vaccination rate rose from 32% to 55%, she says.

"One of the nice things about the program is that if you select 'I decline vaccine,' then you get an automatic pop-up screen that gives you information about why we think you should take the vaccine," she says. "Although we can't guarantee that anybody reads it, it is at least one way to try to educate people."

The hospital has other education and awareness efforts. For example, the CEO shows his support by visibly receiving the vaccine himself. An employee newsletter contains weekly notices about flu vaccination.

The Cleveland Clinic considered making influenza immunization mandatory, but then backed away from that plan, says Gordon. "From an ethics point of view, you've got to make sure you've exhausted other avenues [to raise rates]," he says.

Hospitals continue to combat flu vaccine myths, such as the belief that you can get influenza from the vaccine. Education should emphasize the importance of vaccination for patient and employee safety, says Schaffner.

"The single greatest motivator for influenza vaccination will be influenza. If it hits your city and it gets publicity, then it gets some notoriety and that provides some motivation for people to get vaccinated," he says.

But that should not be necessary to motivate health care workers, he says. "They should know by now the importance of getting vaccinated each and every year."