Ready for flu season? Follow new guidelines

It’s that time of year again: Around this month, you can expect numbers of flu patients to steadily increase. This year, you’ll need to comply with new flu guidelines from the Atlanta-based Centers for Disease Control and Prevention (CDC), which call for free, on-site influenza vaccinations to all ED staff, including night and weekend staff, beginning in October of each year.1

In addition, with only 36% of health care workers vaccinated for flu each year, the Bethesda, MD-based National Foundation of Infectious Diseases (NFID) has published strategies to increase flu immunization rates. (To obtain the CDC and NFID guidelines, see resource box below.)

To comply with current recommendations, you should take the following steps:

  • Start early.

At Brigham and Women’s Hospital in Boston, ED staff begin receiving information about the flu program in September; and in October, dates and sites of vaccination are announced, says William T. Briggs, RN, MSN, CEN, ED nurse.

  • Bombard ED staff with information.

"We provide lots of education during the key period for immunizing staff," says Briggs. When sending e-mail messages to staff, keep them short and concise, he recommends. "We emphasize that while the flu may not kill them, they can give it to a patient in a vulnerable category, such as elderly or immunocompromised, and it may kill them," he says.

Information also is given on the safety of the vaccine and rate of reactions from the CDC, state health department, or vaccine manufacturer. "These e-mails must have the main message in the first few lines, because that may be all busy people read," he says. "I like to use a bulleted format, with easy-to-read font and color."

Brochures and articles also are placed in staff members’ mailboxes and mailed to their homes, where they may have more time to read the material, says Briggs. "We really dog it until everyone has the message."

  • Make it easy for ED staff to get the shot.

The NFID recommends making vaccination convenient, educating staff, and selecting a leader to plan and administer a vaccination program.

At Brigham and Women’s, staff may receive the vaccine in one of the hospital lobbies from 7 a.m. to 7 p.m. for nine consecutive days. "This is in order to get all three shifts and the people who only work weekends," says Briggs. "This same strategy was very successful for [tuberculosis] testing."

All staff flu shots are free to the employee, and the paperwork is very simple, says Briggs. "The whole process only takes a couple of minutes, as staff consider their time to be very important," he says.

  • Give the shot in the ED.

In addition to the flu immunization clinics, all the ED nurse practitioners are authorized to give the flu shot right in the ED, says Briggs. "Staff love this, as so many nurses procrastinate to do it later," he says. "When an occupational health nurse approaches them, they are thrilled."

At the ED for the Lawrenceville, GA-based Gwinnett Medical Center, the flu shot was offered to staff during night and weekend hours as well as day shifts, says Denise Proto, RN, nurse educator for emergency services. "I was here one weekend myself to help give them," she says. "We also have ED staff who routinely volunteer to administer the flu vaccines to the public at certain times and dates, such as churches."

  • Compare notes with other EDs.

During the worst part of last year’s flu season, there were regular conference calls between many EDs in the area, says Proto. "People shared information about how many adults and pediatric patients with flu-related symptoms they had seen, the status of critical care beds and floor beds, and any other pertinent pieces of information," she says.

The calls helped the ED to realize that everyone was being hit hard, says Proto. "If someone reported seeing a large volume of flu-related visits, we would know it was coming and took precautions to help control it," she says.  


1. Harper SA, Fukuda K, Uyeki TM, et al. Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2004; 53:1-40.


For more information on reducing flu exposure, contact:

  • William T. Briggs, RN, MSN, CEN, Emergency Department, Brigham and Women’s Hospital, 75 Francis St., Boston, MA 02115. Telephone: (617) 732-8508. Fax: (617) 278-6977. E-mail:
  • Denise Proto, RN, Nurse Educator, Emergency Services, Gwinnett Medical Center, 1000 Medical Center Blvd., Lawrenceville GA 30045. Telephone: (678) 442-4414. E-mail:
  • The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices has issued revised recommendations for the prevention and control of flu. To access the new recommendations, go to: Under "May 28, 2004," click on "Prevention and Control of Influenza Recommendations of the Advisory Committee on Immunization Practices (ACIP)."
  • The National Foundation of Infectious Diseases has published strategies to increase influenza immunization rates in health care settings, available at Click on "Improving Influenza Vaccination Rates in Health Care Workers: Strategies to Increase Protection for Workers and Patients."