Low flu vaccine rates leave hospitals at risk

Campaigns improve vaccination rates of HCWs

Dismal rates of influenza vaccination of health care workers are leaving many hospitals vulnerable to nosocomial outbreaks. With the United States overdue for a flu pandemic (one usually occurs every 30 years), there’s even greater reason for hospitals to aggressively improve their flu vaccination, say officials at the Centers for Disease Control and Prevention (CDC) in Atlanta.

Only about 38% of health care workers received the flu vaccine in the year 2000, according to the National Health Interview Survey. That’s only a small improvement from the rate of 34% in 1997.

Too often, health care workers consider the flu vaccine just an option that would protect their own health, says Jim Singleton, MS, acting chief of CDC’s adult vaccine preventable diseases branch in the National Immunization Program. Often they even question that benefit, ascribing to common myths that they can get the flu from the vaccine or that the vaccine doesn’t work.

"It may be they haven’t heard or aren’t convinced of the nosocomial risk," Singleton says. "This past season, there was an outbreak in a neonatal intensive care unit. We know it does happen."

Outbreaks in nursing homes have led to deaths, notes Elizabeth Bolyard, RN, MPH, technical information specialist for CDC’s Division of Healthcare Quality Promotion, who is developing a campaign to improve health care worker vaccination rates.

Even in a moderate flu season, influenza can be responsible for 20,000 to 30,000 excess deaths, the CDC reports.

Bolyard recalls her own time as a young nurse, when a flu outbreak led to massive absenteeism among the nursing staff. "It’s devastating for the hospitals," she says.

The key to improving vaccination rates is convenience, she says. Many hospitals are finding ways to make the vaccine as convenient as possible for employees.

At Johns Hopkins Medical Institutions in Baltimore, Gerri Moler, RN, COHN-S, manager of occupational health services, does everything she can to get attention for her flu vaccination campaign. She puts notices with paychecks, sends out e-mails, and gives candy to each person who gets the shot. "That’s gotten to be a big deal," she notes.

For a two-week period, Moler sets up a vaccination station near the escalator where employees enter the medical center.

While some hospitals have found success by taking vaccine carts to each unit, Moler often found that the employees were too busy and didn’t want to leave their duties to get the shot. Instead, she trained nurses in the units to deliver the vaccines and fill out the paperwork.

That was especially effective for staff on night shifts, who didn’t finish until 7 a.m. "Even though we were open at 7 a.m. to be here to give the vaccine when they got off, they’re tired, and they just want to go home," she says. "If somebody on the unit is there and can do it, then you can fit it whenever. It only takes a few minutes, but they don’t have to spend that 15 minutes traveling to our office."

The results last year were impressive, and Moler hopes for a repeat this year. "The numbers for flu vaccine went up to 8,000 last year out [an employee] of a population of 10,000 to 11,000, which is a fantastic amount of people," she says. "Last year, the number of people we were seeing who were claiming they were out with the flu was very small, vaccinated or unvaccinated. I don’t know if it was because of the flu vaccine or if it just wasn’t a bad flu season," she says.

At Tampa (FL) General Hospital, JoAnn Shea, director of employee health services, also makes as much of a splash as she can with her flu vaccination campaign. Every employee who has the flu vaccine receives a raffle ticket, with a chance to win prizes from the wellness center, including T-shirts, water bottles, and fitness room memberships. Everyone vaccinated also gets a piece of candy.

Bringing the vaccine to the employees is a strategy that has worked well for Tampa General. Employee health nurses take the carts at least twice to the high-risk units, such as oncology or the intensive care unit.

"We give 80% of our vaccines outside of our [employee health] clinic," Shea says. "That’s what the employees tell us they appreciate most, going to their units."

Employee health also sets up a vaccination station in a hallway near the entrance to the garage, to catch employees as they pass by on the way to their cars.

Shea estimates that 40% to 50% of the staff in high-risk units received the flu vaccine last year, a figure she hopes to improve upon this year. "Last year, the shortage affected us quite a bit," she says. "By the time we got a second batch [of the supply], some people lost their interest."