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Improving influenza vaccination to health care workers

      To the Editor:
      Influenza vaccination of health care workers (HCW) is important for patient safety and general infection control. The Centers for Disease Control and Prevention (CDC) has recommended annual influenza vaccination for all HCWs.
      • Bolyard E.A.
      • Tablan O.C.
      • Williams W.W.
      • Pearson M.L.
      • Shapiro C.N.
      • Deitchmann S.D.
      Guideline for infection control in healthcare personnel, 1998. Hospital Infection Control Practices Advisory Committee.
      • CDC
      Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP).
      • CDC
      Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Hospital Infection Control Practices Advisory Committee.
      Considering the fact that the highly contagious flu virus can be transmitted from infected HCWs to the patients in their care, it is important for hospitals to develop a comprehensive employee influenza campaign. In hospitals in which few HCWs consent to influenza vaccination, there is a greater challenge. The dismal screening and vaccination rates at North General Hospital prompted an overhaul of its employee influenza vaccination techniques. When employee education and roving clinics were implemented, influenza screening and vaccination rates increased considerately.
      In 2006, the influenza screening and vaccination rates at North General were 15% and 9%, respectively. The employees within the institution did not feel confident with influenza vaccination, and many myths and misconceptions regarding the flu vaccine were an obstacle to vaccination. Following a guideline by the National Foundation for Infectious Diseases,

      National Foundation for Infectious Diseases. Improving influenza vaccination rates in health care workers: strategies to increase protection for workers and patients. Bethesda, MD. 2004.

      a special focus was placed on making the flu vaccine more accessible and utilizing educational tools to dispel vaccination myths.
      Education was provided during the vaccination campaign period through the distribution of posters and newsletters. During the campaign, biweekly education was provided with handouts, newsletters, or public announcements of flu vaccine distribution. Also, the use of declination statements during an influenza campaign can provide information on why workers are not being vaccinated that can be used in future campaigns. The top reasons why the staff was refusing flu vaccination at North General were that they would receive the vaccine from their primary care clinician, they usually do not get the flu, they did not want the vaccine, and they were afraid of a bad reaction.
      Roving clinics bring the vaccine to the employee at their workstation. It is not enough these days to just have the vaccine available at Employee Health Services. Health care workers are busier these days, and it is often impossible for them to take breaks. By going to their work area, it is more convenient and gives opportunity for further education. It was shown in North General that when compared with other modes of vaccine delivery, mobile clinics yielded the highest number of employee response (Fig 1). The roving clinics were tailored to the various shifts that HCWs work. An increase in roving clinics in 2008 yielded an increase in screening and vaccination rates to 70% and 44%, respectively. Eighty-four percent of influenza vaccines were distributed at sites other than the Employee Health Services office.
      Improving dismal vaccination rates among HCWs requires having a comprehensive influenza vaccine campaign that not only provides the vaccine but also provides educational support. Employee and occupational health clinicians must continue to provide education and demonstrate that the benefits of vaccination outweigh the risks. Implementing roving clinics for influenza vaccination can increase vaccination rates, if utilized correctly. Influenza campaigns can only continue to be effective if the HCW understands their role in the transmission of the flu virus and that influenza can be a deadly disease to the very young, immunocompromised, and elderly populations.

      References

        • Bolyard E.A.
        • Tablan O.C.
        • Williams W.W.
        • Pearson M.L.
        • Shapiro C.N.
        • Deitchmann S.D.
        Guideline for infection control in healthcare personnel, 1998. Hospital Infection Control Practices Advisory Committee.
        Infect Control Hosp Epidemiol. 1998; 19: 407-463
        • CDC
        Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP).
        MMWR. 2003; 52: 1-34
        • CDC
        Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Hospital Infection Control Practices Advisory Committee.
        MMWR. 1997; 46: 1-45
      1. National Foundation for Infectious Diseases. Improving influenza vaccination rates in health care workers: strategies to increase protection for workers and patients. Bethesda, MD. 2004.