Will harsher flu season raise rates of health care worker vaccination?

Hospitals make a second push for influenza shots

An early and widespread outbreak of influenza prompted hospitals to make an even greater push to immunize health care workers — with variable results.

It’s too early to know whether hospitals immunized significantly more than 36% of health care workers, the rate of vaccination found in past national health surveys. Health care workers are in the high priority category for influenza vaccines, but hospitals typically have struggled to improve the dismal rates of immunization.

This year, Julie L. Gerberding, MD, MPH, director of the Centers for Disease Control and Prevention (CDC), made a specific plea for health care workers to receive their vaccine. Flu outbreaks in the fall may have bolstered her advice. By early December, the CDC reported widespread influenza activity in 24 states.

By mid-December, Children’s Medical Center of Dallas had treated 225 patients, 32 of them in the intensive care unit. About 75% of the hospital’s health care workers had received the vaccine, an increase from the usual rate of about 65%, says Jane D. Siegel, MD, infectious disease specialist at the medical center.

There only have been four cases of nosocomial transmission, and two of those can be linked to sick visitors, she says. "I think the media has really helped us this year. I think people are aware that there is a lot of disease around, and it can be bad disease even in healthy individuals. I think just having that word out helps people," says Siegel, who also is professor of pediatrics at the University of Texas Southwestern Medical Center in Dallas and a member of the Healthcare Infection Control Practices Advisory Committee (HICPAC).

Children’s Medical Center uses "flu deputies" — specially trained floor nurses — to provide the vaccine in the units on mobile carts. The hospital puts up posters and educates employees about the importance of the flu vaccine. This year, Siegel analyzed the areas of lower flu vaccination and sent flu deputies back with the cart. The extra push may have boosted the vaccination rates. "I think having an ongoing assessment with how you’re doing [with immunization] is helpful," she says.

Two years ago, Children’s Medical Center had 17 cases of nosocomial influenza. Siegel relates that in her education sessions with health care workers, explaining why it’s important for them to be vaccinated.

Some unvaccinated health care workers did develop the flu this fall. The hospital emphasized infection control techniques, including "cough etiquette," and urged health care workers not to come to work sick.

At Vanderbilt Medical Center in Nashville, TN, the outbreak of influenza didn’t exactly send health care workers streaming in for their flu shots. "It’s nothing like the response of the general public [who have driven up demand for the vaccine]," says William Schaffner, MD, chair of the department of preventive medicine at Vanderbilt University School of Medicine.

"We have sent out an advisory to our health care workers refocusing the message that they don’t want to be the vehicle of transmission of the influenza virus to their patients," he says. "Frankly, we need them to stay healthy to help care for those who are ill."

The hospital’s infection control committee has been reviewing the immunization rates. Only about 35% of the hospital’s health care workers received the vaccine. "There are some units that do better. I think those units are characterized by strong leadership that establishes a culture where immunization is expected," Schaffner says.

In December, the hospital made another push to increase immunization. The chief administrator sent out a message promoting the vaccine, and occupational health set up immunization sites. "We’re doing essentially our initial campaign all over again," he adds.

Meanwhile, the hospital has promoted cough etiquette among patients in the emergency department and clinics. Coughing patients receive tissues, small bottles of alcohol-based gel, and surgical masks.

Although there are signs alerting patients to the cough-etiquette concept, "everybody understands what it’s all about. In the context of influenza, you don’t need to explain it very much," Schaffner states.