Convenience, persistence up HCW vaccination rates

'Persistence just short of annoyance' works

In October, influenza vaccination campaigns will start up once again as hospitals try to improve on a generally dismal performance in immunizing health care workers. Facilities have used various strategies to make the flu vaccine more accessible and convenient and to educate health care workers about its importance. Here are two examples from hospitals that were scheduled to present information about their programs at the annual conference of the Association of Occupational Health Professionals in Healthcare, scheduled for Sept. 27-29 in Savannah. More information about the conference is available at

When occupational health nurse Don Dush, RN, COHN, walks down the halls of Parkland Health Center in Farmington, MO, employees often don't even bother to say hello. They just say, "I've already gotten my flu shot, thank you."

Dush admits that he is "persistent to a point just short of annoyance" when flu vaccination season comes around. But that persistence led to an 80.6% vaccination rate in 2006 — the best in the BJC Healthcare system.

Dush chuckles when he recalls one employee who didn't really want to get the flu shot but quipped, "If you give it to me at 3 o'clock in the morning, I'll take it." When Dush showed up at 3 a.m. with the flu vaccine, the employee was too shocked to decline.

"A lot of people said, 'The only reason you got this done is because you were hunting people down and making a nuisance of yourself.' Maybe so, but it's that important," he says.

E-mails, postcards, in-person reminders

That kind of attention to individual employees is possible at a 600-employee hospital but wouldn't be at one that was 10 times bigger, Dush concedes. He followed up with e-mails, postcards, and even in-person reminders. For the laggards, he sent certified letters so that every employee either had the flu vaccine or signed a declination.

But Dush also employed techniques that any employee health service could use. For example, the hospital leadership agreed to donate $1 for every flu vaccine delivered to employees for an incentive program. He drew the names of three vaccinees in the days before Christmas to share the "kitty."

"It created peer pressure among the employees to get the flu shot," he says.

Dush, who is the only employee health professional at the hospital, used a per diem nurse to help with the vaccinations. If a manager was planning to send home a nurse on a unit that had a low patient census, he asked for the nurse instead to be diverted to assist him.

In fact, in some units, managers administered the vaccines. "That's leadership support," says Dush. "Some of the first people to come in here and get their flu shot were managers."

This year, he will use incentives again but he'll change them. After all, he wants to keep things interesting as he engages the staff with his enthusiasm — and persistence.

Campaign rides on the 'bus stop'

Vaccinating 29,000 employees is a daunting prospect. Yet that's what the Mayo Clinic in Rochester, MN, has managed to do, including vaccination of 69% of the 6,500 nurses in 137 units.

How did they deliver that much vaccine? Employee health nurses brought their flu "Bus Stop" to the units with rolling vaccination carts. The "bus stop" had a posted schedule, and a huge poster with a red stop sign alerted employees when the vaccinations would take place.

The schedule encompassed early morning hours — 6 a.m., for example — as well as evening stops to accommodate workers on night and evening shifts. Nurses appreciated the convenience, which meant they didn't have to leave their post to get the vaccine, says Laurie Barnes, RN, BSN, lead RN in preventive medicine. Flu vaccine also was available at stations set up outside the cafeteria.

An element of peer pressure

Having the flu vaccine readily available on the unit created other dynamics, as well, she says. For example, there was an element of peer pressure. "It was more likely more people would have the vaccination if there were others getting it on the unit," says Barnes.

Units engaged in friendly competitions. Units would challenge one another to have the best vaccination rate. The winner would receive a pizza party hosted by the other unit or units.

Meanwhile, Barnes and her colleagues created "e-posters" that ran continuously on computers throughout the system. They also developed an educational slideshow with statistics about the flu and reasons for getting the flu vaccine. The Mayo Clinic home page contains a link to education and information on the flu and flu vaccine.

By focusing on accessibility and education, the Mayo Clinic improved its vaccination rate of nurses from 45% in 2002-2003 to 69% in 2006-2007. The "bus stop" program has become a familiar part of life at Mayo. Employees began signing up on the schedule even before summer ended.

"We're hoping this year to see an even higher increase [in flu vaccinations]," says Barnes.