Leadership support boosts flu vaccination
Leadership support boosts flu vaccination
Joint Commission shares flu shot strategies
Can strong hospital leadership supporting flu immunization be as successful — and less divisive — as mandating the seasonal shots?
The Joint Commission has published a lengthy monograph detailing the most recent research about influenza transmission in health care facilities and flu vaccination. It also provides a comprehensive review of effective strategies to improve vaccination rates.
The Joint Commission's Infection Control Standard requires hospitals to provide flu shots and influenza education to employees and licensed independent practitioners, and to track vaccination rates and establish an improvement program.
"There is truly no one strategy alone [that works]," says Linda Kusek, RN, BSN, MPH, CIC, associate project director in The Joint Commission's Division of Quality Measurement and Research and primary author of the report. "With the involvement and support of hospital leadership, organizations should look at their own culture, the educational needs of staff, and the resources available to determine which strategies to employ and how they should be implemented."
However, successful hospitals do appear to share one trait, she says. They all have strong, visible support from top leadership.
"No matter what strategies are involved, it's very important to have the buy-in and support from the organization's leadership," Kusek says. "Many organizations make this part of their patient safety culture, policies, and statements. Some organizations have board members involved, making it an organizational goal. When that happens, I think it sets the stage for the organization to be successful."
The monograph presents information from published articles that favor or oppose mandatory vaccination, but it does not take a position on it. Other issues discussed in the monograph include:
• Carefully consider how you define "health care personnel" in calculating vaccination rates. Most hospitals include physicians; some include volunteers and medical students. "This is a particularly important concept to keep in mind when comparing influenza rates over time within a health care organization (that is, were groups of HCP added or removed from an organization's definition?) and between organizations (that is, are the same groups of HCP included in each organization's definition?)," the monograph states.
• Health care workers need to understand that they can shed virus even if they don't have symptoms. "I never get the flu" is one common reason health care workers offer when asked why they didn't get the flu vaccine. But as many as half of influenza infections can be asymptomatic, according to research cited in the monograph. "It's a very serious infection that they can transmit to their patients even if they have no signs or symptoms," says Kusek.
• Reasons for failing to get the vaccine vary by locale and demographics. This is another reason why a one-size-fits-all strategy doesn't work. It is important for hospitals to determine the particular reasons their health care workers decline the vaccine, the monograph suggests. At one hospital, employees may be more likely to decline the vaccine due to concerns about adverse reactions, while at another, employees may question the effectiveness of the vaccine. Employee health professionals can then tailor their educational message, says Kusek. Also, different employee groups may respond differently to the vaccination campaign. For example, studies have found lower vaccination rates among health care workers younger than 50.
• Multifaceted flu vaccination campaigns are most successful. No single strategy is as effective as a combination of strategies. Those could include letters from hospital leadership or other visible signs of leadership support; convenient access to vaccines, such as using mobile carts or peer vaccinators and use of declination statements. A mandatory program such as the one at Virginia Mason Medical Center in Seattle, which requires the flu shots as a condition of employment for most employees, can attain vaccination rates as high as 99%. But even Virginia Mason launches its annual campaign with a marketing blitz, including a party and small giveaways.
• Convenience is an important factor for health care workers. Every year, a portion of health care workers fails to get the flu vaccine simply because they didn't get around to it. "Whatever approaches you use to make the vaccine more accessible, offer it as many times as possible and at varying times over all shifts, rather than once or a small number of times, to help reach the most staff," the monograph advises.
(Editor's note: The Joint Commission flu report is available at www.jointcommission.org/.)
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