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Healthcare worker influenza declination form program

  • Sherri L. LaVela
    Correspondence
    Address correspondence to Sherri L. LaVela, PhD, MPH, MBA, Edward J. Hines, Jr. VA Hospital (151H), 5000 S 5th Ave, Office D312, Hines, IL 60141.
    Affiliations
    Department of Veterans Affairs, Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines Jr. VA Hospital, Hines, IL

    Center for Healthcare Studies, General Internal Medicine and Geriatrics, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
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  • Jennifer N. Hill
    Affiliations
    Department of Veterans Affairs, Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines Jr. VA Hospital, Hines, IL
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  • Bridget M. Smith
    Affiliations
    Department of Veterans Affairs, Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines Jr. VA Hospital, Hines, IL

    Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL
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  • Charlesnika T. Evans
    Affiliations
    Department of Veterans Affairs, Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines Jr. VA Hospital, Hines, IL

    Center for Healthcare Studies, Department of Preventive Medicine Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
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  • Barry Goldstein
    Affiliations
    Department of Veterans Affairs, Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines Jr. VA Hospital, Hines, IL

    VA Spinal Cord Injury and Disorders Services, Puget Sound Health Care System, Seattle, WA

    Department of Rehabilitation Medicine, University of Washington, Seattle, WA
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  • Richard Martinello
    Affiliations
    VA Office of Public Health, Clinical Infectious Diseases, Washington, DC

    Department of Internal Medicine, Yale School of Medicine, New Haven, CT

    Department of Pediatrics, Yale School of Medicine, New Haven, CT
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Published:March 20, 2015DOI:https://doi.org/10.1016/j.ajic.2015.02.013

      Highlights

      • • The declination form program was compatible, flexible, easy to use, and supported by leadership.
      • • Declination form program facilitators included complementary ongoing strategies and leadership engagement.
      • • One-on-one attention and education at the time of vaccination led to health care worker accountability.
      • • An influenza declination form program is of minimal cost, but it requires some dedicated staff and resources.
      • • Vaccination rate improved from 53.5% to 77.4% pre- to postdeclination form program implementation.

      Background

      Health care worker (HCW) vaccination rates have been low for many years (approximately 50%). Our goal was to implement an influenza declination form program (DFP) to assess feasibility, participation, HCW vaccination, and costs.

      Methods

      This was a prospective interventional pilot study using mixed methods to evaluate the DFP implementation processes and outcomes. We conducted a formative evaluation and interviews; data were transcribed and coded into themes. Secondary outcomes included self-reported HCW influenza vaccine uptake (pre-/postsurvey) and program costs; data were evaluated using descriptive and bivariate analyses.

      Results

      The DFP was compatible with ongoing strategies and unit culture. Barriers included multiple hospital shifts and competing demands. Facilitators included complementary ongoing strategies and leadership engagement. HCW vaccination rates were higher post- versus preimplementation (77.4% vs 53.5%, P =.01). To implement the DFP at site 1, using a mobile flu cart, 100% of declination forms were completed in 42.5 staff hours over <2 months. At site 2, using a vaccination table on all staff meeting days, 49% of forms were completed in 26.5 staff hours over 4.5 months. Average cost of staff time was $2,093 per site.

      Conclusion

      DFP implementation required limited resources and resulted in increased HCW influenza vaccine rates; this may have positive clinical implications for influenza infection control/prevention.

      Key Words

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