Influenza Vaccination of Health Care Workers: A Patient Safety Imperative

By Linda R. Greene, RN, MPS, CIC, FPIC, Association for Professionals in Infection Control and Epidemiology (APIC)

The importance of seasonal influenza vaccine for health care workers and high risk groups has been well documented, yet health care worker (HCW) influenza vaccination rates have risen only minimally over the past 20 years and are far short of U.S. Department of Health and Human Services Healthy People 2020 goals whose target is a 90 percent vaccination rate.

One of the fundamental tenets of health care is to care for patients while protecting ourselves from harm. Because HCWs work in an environment where frequent contact with infectious patients is routine, we are at risk for exposure to influenza with possible transmission to other patients, their families, and other HCWs. The situation calls for a review of attitudes and beliefs toward influenza vaccination with a focus on the successful strategies associated with increased HCW vaccination rates.

Linda R. Greene, RN, MPS, CIC, FAPIC, President of Association for Professionals in Infection Control and Epidemiology

Mandatory Influenza Vaccination
One of the most successful strategies for increasing influenza vaccination of HCWs is mandatory vaccination. In 2011, the Association for Professionals in Infection Control and Epidemiology (APIC) drafted a position paper in which they recommended that facilities employing health care workers require annual influenza immunization as a condition of employment unless there are compelling medical contraindications. Chapter 7 of the National Action Plan to Prevention Health Care-Associated Infections: Road Map to Elimination supports the influenza vaccination of health care personnel to protect health care personnel and their patients, as well as to reduce disease burden and health care costs. By 2013, multiple organizations had stated support for universal immunization of health care personnel as recommended by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC).

In recent years, an increasing number of hospitals and health care organizations have adopted policies making seasonal influenza vaccinations mandatory for employees, affiliated medical staff, students, volunteers, and contract workers. Dr. Jorge Parada, MD, MPH, FACP, FIDSA, from the Loyola University Medical Center in Chicago shared his facility’s experience with mandatory flu vaccination at the 2013 APIC conference. In 2009, Loyola chose to mandate flu vaccination as a condition of employment, and extended this mandate to students, volunteers, and contractors. In the first year of the mandatory policy (2009–2010), 99.2 percent of employees received the vaccine, 0.7 percent were exempted for religious or medical reasons, and 0.1 percent refused vaccination and chose to terminate employment. The results were sustained: in 2012, 98.7 percent were vaccinated, 1.2 percent were exempted, and 0.06 percent refused vaccination.

“Near-universal flu immunization is achievable and sustainable with a mandatory vaccination policy,” Dr. Parada said in a press release about the findings. “Our employees and associates now understand that this is the way we do business. Just as construction workers must wear steel-toed boots and hard hats on job sites, healthcare workers should get a flu shot to work in a hospital. We believe that patient and staff safety have been enhanced as a result.”

Beyond the Mandate
Although mandatory policies have improved vaccination rates, they fall short — in the absence of other strategies — of embedding the importance of influenza vaccination into our internal beliefs, values, and sense of duty of care. The APIC position paper clearly acknowledges that mandatory vaccination should be part of a comprehensive program that includes education and other infection prevention measures such as hand hygiene, respiratory etiquette, and standard precautions.

One example of successful strategies to motivate staff was highlighted by Mary Ellen Scales, RN, MSN, CIC, FAPIC, who was recognized as a Hero of Infection Prevention by APIC in 2009. She is Chief Infection Control Officer for Baystate Health System in Springfield, Massachusetts. Seeing that only 40 percent of the facility’s staff had been vaccinated prior to the fall of 2006, she developed the Flu Vaccine Champion Program to improve staff participation. The program consisted of 68 unit-based staff members who motivated fellow employees in their areas to sign up and administer the vaccine. Within 2 years, the center’s participation rate doubled to 80 percent. Her flu immunization compliance rate this past year was 97 percent. Mary Ellen received an award for achievement in adult immunization from MASSPRO, a state organization dedicated to improving health care quality.

The stories of Mary Ellen and other champions are numerous and continue to inspire and motivate us. Hopefully, we will take this opportunity to stop and think about our duty of care to protect our patients from harm. Those entrusted to our care deserve no less.