The first line of defense: 10 steps to boost influenza vaccinations among healthcare workers

Although vaccination has been shown to be an effective deterrent against influenza, many people still do not get it every year. Even health care workers.

In most states, including Minnesota, it is highly recommended, but not mandatory, for health care workers to get the vaccine. After all, few populations are more vulnerable to this highly contagious and severe viral infection than hospitalized patients. This includes infants too young to be immunized, immune-compromised children, the elderly or people who are already fighting an infection or disease.

Yet last year the Centers for Disease Control and Prevention (CDC) found the vaccination rate was 64.3 percent among healthcare workers – and 78.7 percent among hospital workers.

Children's Hospitals and Clinics of Minnesota believes it's in the best interest of our patients, families and other employees that everyone on our staff receives the influenza vaccination. We must do all we can to protect our patients against exposure to illness, especially from those who have pledged to "first, do no harm."

That's why Children's Minnesota has worked tirelessly over the past decade to raise employee vaccination rates. Our vaccination rate among employees has gone from 64 percent in 2006-07 to an overall rate of 91 percent during the 2014-15 season at our Minneapolis and St. Paul hospitals, without a mandate in place. Children's Minnesota nursing staff are unionized, yet are vaccinated at 94 percent. Our professional staff, who do have a vaccine requirement for privileges, are at 100 percent. We are one of a few large hospital systems recognized by the Minnesota Department of Health as a blue ribbon FluSafe Facility for employee influenza vaccine rates greater than 90 percent.

It's critical to educate employees about why they should get vaccinated. We should not assume that all health care workers are well-informed on this issue. False perceptions about vaccination persist, even among knowledgeable people.

Our success is the result of an evidence-based, multipronged approach to an employee influenza vaccination program. Here are 10 key steps for implementing a successful employee influenza vaccination program:

1. Organizational leadership should take ownership of the employee influenza vaccination rate. They can do so by identifying employee influenza immunization as a top patient and employee safety priority intervention.

2. Invest in a system to track rates; at Children's Minnesota we use we developed FluVaxTrax, a system which tracks employees who receive the influenza vaccination each year. It sends an email "thanks" to those when they get it and a reminder to employees (and their department managers) who still have not. It has an online declination that is required for those electing not to receive the influenza vaccine, which is generally 2 percent of staff at our institution. In real time, the system updates a "success thermometer" on the company home page so everyone can monitor progress.

3. Transparency is important, so share department rates among hospital leaders to motivate medical directors and other leaders to address lower performing departments and praise high performers.

4. Make it mandatory when possible because scientific evidence shows that the influenza vaccine reduces the chances of our patients becoming severely ill and that hospitals with mandated influenza vaccine policies have higher rates of compliance.

5. Motivate behavior change through messages sent to staff at the individual, departmental and organizational levels.

6. Offer the influenza vaccine free of charge and make it easily accessible to all, no matter their shift. Create a unit-based vaccinator program so employees can get vaccinated by a coworker, making it more convenient.

7. Make the case through actual stories from within the hospital. For instance, the teenaged girl who gets influenza after 10 days in the hospital despite only getting visits from her healthy parents. The source could be a caregiver, who pledged to first do no harm. Share that hospital acquired influenza can and does happen.

8. Advocate on state and national levels to support transparently sharing influenza vaccine immunization rates among hospitals – or establish a public health or national accrediting body annual requirement for health care professionals to receive the influenza vaccine.

9. Make it visible by giving every employee who gets vaccinated a colored clip for their identification badge (the color changes each year). Employees can then identify those who are opting out of the vaccine and hold them accountable to wear masks while in patient care areas. While wearing a mask is far from perfect protection against influenza, it does make the statement that we are all responsible to do what we can to prevent its spread.

10. Reward and recognize units with 100 percent compliance and publish names of vaccinated staff members who are winners in a random drawing. Have a patient and/or family advisory council member write an open thank you letter to employees for doing their part to keep patients safe while hospitalized.

By developing a clear plan to educate employees on the importance of getting vaccinated and holding them accountable, hospitals can increase rates of employee vaccination and sustain them year-over-year, lower hospital-acquired infection rates, reduce staff absenteeism and, above all, protect the patient.

Patsy Stinchfield, MS, RN, CPNP,CIC is the Director of Infection Prevention and Control and the Children's Immunization Project at Children's Hospitals and Clinics of Minnesota. With more than 30 years of experience, Patsy is a practicing infectious disease nurse practitioner, licensed by the Minnesota Board of Nursing. She is also an adjunct clinical faculty member at the University Of Minnesota School Of Nursing, a board member of the National Foundation for Infectious Diseases and a liaison member to the CDC's Advisory Committee on Immunization practices.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.​

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