Long-term care lags in HCW flu shots

Only half report getting flu vaccine

About one-third of health care workers fail to get their annual flu shot. But look behind those numbers and you’ll find the true disparity: Barely more than half of long-term care workers received the flu vaccine last year, while the rate for hospital employees reached an all-time high of 77%.

Yet by far, the focus of influenza vaccination efforts has fallen on the acute care sector. The Centers for Medicare & Medicaid Services (CMS) is requiring public reporting of flu vaccination rates for hospitals, but not for long-term care facilities.

While infection preventionists stress the need for better vaccination rates in long-term care, they acknowledge the challenges. “The resources and the manpower to address the safety issue are broader in an acute care facility” compared with long-term care facilities, notes Tom Talbot, MD, MPH, chief hospital epidemiologist at Vanderbilt University Medical Center in Nashville and chair of the Task Force for Healthcare Personnel Influenza Vaccination of the Society for Healthcare Epidemiologists of America.

The Joint Commission accrediting body is requiring long-term care to track vaccination rates and to seek improvements to a 2020 goal of 90%. And some state and local health department regulations include long-term care in requirements for employees to get the vaccine or wear a mask during the flu season.

“If a regulating organization or new law mandates vaccinations then we will certainly comply,” says Peggy Connorton, manager of Long-term Care Trend Tracker of the American Health Care Association, noting that the organization encourages flu vaccination.

Long-term care can take a page from the play-book of acute care, suggests Talbot, by building strong leadership support and a vaccination infrastructure. At the core, all health care facilities should make sure the vaccine is accessible and free, promote its importance, and emphasize the leadership support, he says.

Nurses’ aides decline vaccine

Who gets the flu vaccine, who doesn’t, and why? Those are questions that public health authorities have struggled to understand.

The clearest picture comes from an Internet-based survey conducted for the Centers for Disease Control and Prevention. Physicians reported the highest vaccination rates – of about 86%. Hospital-based nurses were not far behind at 78%. Some 72% of nurses in long-term care reported having received their flu vaccine.1

Yet vaccination rates diverged for other health care workers. In hospitals, 76% of them reported having the flu vaccine. But in long-term care, only 50% of these other health care workers received the vaccine. They are comprised largely of nurses’ aides – daily caregivers of elderly residents. And in the survey, these non-physician, non-nurse workers represented 82% of the respondents from long-term care.

“The real concern is that long term care facilities have not received enough attention, especially among their workers other than physicians and nurses,” says Gary L. Euler, DrPH, epidemiologist with the Assessment Branch of CDC’s Immunization Services Division.

A mild flu season last year may have contributed to the dip in vaccination by long-term care workers, says Euler. He stresses the importance of providing education about the flu vaccine.

But the survey also suggests that long-term care employers need to work harder on their flu vaccine efforts. About 84% of health care workers in non-hospital settings reported that their employers did not promote vaccination, such as through incentives, special events or invitations.

“There may have been some type of promotion that they didn’t know about,” says Euler. “At least to that person, the effect would be the same as having no promotion.”

Cost, education are issues

Education could help dispel some notions about influenza vaccination. The most common reason health care workers declined vaccination: they believed they did not need it. They also expressed concern about the effectiveness of the vaccine and about side effects.

In particular, non-clinical personnel need “a clear message that’s tailored to them,” says Euler.

Other surveys also demonstrate the challenges in non-hospital settings. Cost and access remain a barrier for many non-hospital employees, according to a survey of 3,188 health care workers by researchers at Saint Louis University in Missouri. Non-hospital workers also were more likely than hospital workers to have a fear of vaccine side effects.2

While the Internet-based survey for CDC provides an important snapshot of last year’s flu season, it has some limitations.

Some 2,518 health care workers responded to the survey through Medscape or SurveySpot, and the responses were weighted to reflect the demographic makeup of the health care workforce. However, the respondents were not a random sample, and the method differs from the panel sample used in the prior year’s survey.

The National Health Interview Survey, which includes in-person interviews, will be available in June 2013, Euler says.


  1. Centers for Disease Control and Prevention. Influenza vaccination coverage among health-care personnel — 2011–12 influenza season, United States. MMWR 2012; 61:753-757.
  2. Rebmann T, Wright KS, Anthony J, et al. Seasonal influenza vaccine compliance among hospital-based and nonhospital-based healthcare workers. Infect Control Hosp Epidemiol 2012; 33:243-249.