Five key components of an effective flu shot program

SHEA outlines measures in recommendations

Health care-associated transmission of influenza has been documented in many different patient populations and clinical settings. In many of these outbreaks, infections occurred in non-vaccinated health care workers (HCWs), including workers who were linked epidemiologically to the transmission of influenza, the Society for Healthcare Epidemiology (SHEA) of America states in a new position paper.1 Key SHEA observations and recommendations are summarized as follows:

  • Health care-associated outbreaks of influenza may result in increased patient morbidity, mortality, length of hospitalization, and costs, and may disrupt the essential services of a health care facility during a season when patient census and worker absenteeism are high.
  • Despite existing recommendations, overall influenza vaccination rates in HCWs remain unacceptably low, with only 40% of HCWs receiving influenza vaccination in 2003. It has been suggested that coverage of 80% of HCWs may be necessary to provide herd immunity to prevent health care-associated transmission of influenza.

An effective program to increase HCW vaccination rates must contain the following components:

1.) provide targeted education annually to all HCWs about the severity of influenza, particularly among high-risk patients, and about the safety of influenza vaccination;

2.) inform HCWs of the importance of influenza vaccination in promoting patient and employee safety;

3.) provide vaccine at no cost and at convenient locations and times;

4.) recommend that HCWs sign a declination each year if they refuse influenza vaccination after participating in an educational program or if they have medical contraindications to the vaccine;

5.) perform surveillance of rates of vaccine uptake by medical unit as well as identification of patients with health care-associated influenza to assess the impact of the vaccination program.

The educational component of any HCW vaccination program must explain the rationale for vaccination of HCWs and provide specific messages directed at dispelling myths about influenza vaccination, such as the perceived risk of post-vaccination influenza-like illness, which has not been substantiated by clinical trials. Vaccination should be convenient and easily accessible to minimize the impact on the daily activities and duties of HCWs.

Proven tools, such as mobile vaccination carts, continuous educational campaigns, visible vaccination of key leaders, off-hours clinics, incentives, and targeted vaccination at departmental or staff meetings, should all be considered as part of a facility's influenza vaccination program.

While the use of active declination to increase influenza vaccination rates has not been tested specifically, it is currently a component of HCW hepatitis B vaccination programs as required by the Occupational Safety and Health Administration's bloodborne pathogen standard. As a result of enhanced vaccination programs that include active declination and the implementation of standard precautions, HCW vaccination rates have increased and health care-associated hepatitis B infection rates in HCWs have declined by 98%.

A recommendation for active declination as part of influenza vaccination programs will result in increased workload and record keeping for infection control and occupational health staff. The annual nature of influenza vaccination campaigns, which occur within a few targeted weeks each fall, also provides additional challenges; however, other types of annual HCW screenings may be used as models for influenza vaccination campaigns for HCWs.

Health care facility administrators must provide ample financial support and human resources to ensure the success of their programs, which may require seasonal hires of information technology, secretarial, and nursing personnel to accommodate the demands of the annual vaccination campaign. In times of vaccine shortage, active declination programs should be directed only at those HCWs targeted to receive vaccine through the facility's allocation plan based on the intensity and duration of contact with patients.


1. Talbot TR, Bradley SF, Cosgrove SE. SHEA Position Paper: Influenza Vaccination of Healthcare Workers and Vaccine Allocation for Healthcare Workers During Vaccine Shortages. Infect Control Hosp Epi 2005: In press.