CDC supports education to boost flu vaccination rates

Provide free vaccine at work

The Centers for Disease Control and Prevention (CDC) has issued new recommendations aimed at increasing influenza vaccination coverage among health care personnel as a way to protect patients and staff from influenza. The recommendations are partially at odds with some medical associations that do not want health care workers to have to sign documents indicating they refused the vaccine.

The CDC Healthcare Infection Control Practices Advisory Committee (HIPAC) and Advisory Committee on Immunization Practices (APIC) recommend that health care facilities provide strategies to make vaccine more accessible to health care workers and to help facilities better determine coverage rates and the reasons their staff have for not getting vaccinated.

"Currently, fewer than half of health care workers get vaccinated for flu each year. When people who work in hospitals and health care facilities don't get vaccinated, they can pose a serious health risk to their patients," says CDC Director Julie Gerberding, MD. "These recommendations are designed to highlight the importance of health care personnel getting vaccinated each year."

The guidelines recommend that:

  • Facilities offer influenza vaccine annually to all eligible personnel, including students.
  • Vaccine be offered at the workplace during all shifts and at no cost to employees.
  • Hospitals use strategies proven to improve vaccination coverage. These include education to combat fears and misconceptions about influenza and influenza vaccines, use of reminders to staff, and having leadership set an example by getting vaccinated.
  • Facilities obtain a signed form from staff who decline vaccination for reasons other than medical. This tool is designed to help facilities better monitor who is offered vaccine, employee concerns, and barriers to vaccination so appropriate strategies can be designed to improve vaccination coverage.

The recommendations ask facilities to monitor influenza vaccination coverage at regular intervals during influenza season and provide feedback of ward-, unit-, and specialty-specific coverage to staff and administration. Influenza vaccination coverage should be one measure of the quality of an institution's patient safety programs. The recommendations also reiterate an earlier recommendation of CDC's HICPAC that influenza vaccination coverage of health care personnel be used as a health care quality measure in states that mandate public reporting of health care facility-associated infections.

"We want health care facilities to be even more aggressive in protecting their staff and patients from influenza," says Denise Cardo, MD, chief of the CDC's Division of Healthcare Quality Promotion. "Improving influenza vaccine coverage among health care personnel is vital to patient safety and protects staff, as well."

Nurses approve; some in occ-med disagree

The American Nurses Association (ANA) applauded the CDC's recommendations, which echo the ANA's efforts to improve annual influenza vaccination rates among health care workers. In late 2005, ANA launched its "Everyone Deserves a Shot at Fighting the Flu" campaign with the goal of encouraging more nurses and other health care workers to get vaccinated against influenza every year.

Neither the ANA nor the CDC recommend mandatory vaccinations.

Nearly all registered nurses surveyed by the ANA prior to November 2005 (97%) agree that one health care worker infected with influenza in a health care setting puts all patients and co-workers at risk. The survey revealed 95% of nurses believe health care workers should get vaccinated against influenza each year, but only 5% of those polled said they believe that all their co-workers received an influenza vaccination last year.

The American College of Occupational and Environmental Medicine (ACOEM) issued a position statement in late 2005 on the flu vaccine for health care workers, as well, and while strongly supporting education and vaccine availability for health care workers, the group opposes the use of declination statements. ACOEM's position statement on the subject applies to "seasonal influenza" and is not necessarily applicable during a pandemic situation, it stated.

The Association of Occupational Health Professionals (AOHP) issued a statement in response to the recommendation of the Joint Commission on Accreditation of Healthcare Organizations guidelines for vaccination of health care workers. Like ACOEM, AOHP endorses vaccinations for health care workers, but opposes requiring declinations for health care workers who do not wish to be vaccinated for influenza.

AOHP President Denise Strode, RN, BSN, COHN-S/CM, wrote in the statement that there are legitimate reasons for employees to refuse the vaccine (allergy to eggs, severe past reactions), and "occupational health nurses [OHNs] have limited resources, especially at this time of the year. Let the OHN spend the time to educate and counsel on benefits of vaccination," rather than collecting declination forms.

Requiring employees who refuse the shot to sign forms indicating that they were offered the chance to be vaccinated, says William Buchta, MD, MPH, FACOEM, chair of ACOEM's medical center occupational health section, "not only impacts the employer-employee relationship in a negative way, but diverts resources from activities known to increase compliance and devotes them to enforcement of a policy with no proven benefit."

See the entire CDC guideline on flu vaccinations for health care workers at