Health Care Personnel Initiative to Improve Influenza Vaccination Toolkit- Summary of activities by HHS agencies during the 2008-2009 influenza season

Background

One Healthy People 2010 goal is to achieve 60% influenza vaccination coverage among healthcare personnel (HCP). In 2007, coverage for HCP nationally was less than 50%. In 2008, the Department of Health and Human Services announced an initiative to improve influenza vaccination coverage among healthcare personnel. The National Vaccine Program Office (NPVO) and the Assistant Secretary for Health believed this objective could be achieved by partnering with other organizations to promote vaccination. As part of this initiative, they requested that all HHS agencies develop a mechanism to track and report on HCP influenza vaccination coverage within their agencies. NVPO and the partner agencies and offices developed a toolkit and website to promote this initiative (http://www.hhs.gov/ophs/programs/initiatives/vacctoolkit/index.html).  HCP were defined as all paid and unpaid persons working in health-care settings who have the potential for exposure to patients and/or to infectious materials, including body substances, contaminated medical supplies and equipment, contaminated environmental surfaces, or contaminated air.

The summaries listed below represent success stories using varying methods from five agencies that have increased influenza utilization at their respective sites. 

Centers for Disease Control and Prevention (CDC)- Summary of Influenza Activities 2008-2009

Background

The 2008-2009 influenza immunization campaign planning began early in the January 2008 calendar year with an order for 7,000 doses of influenza vaccine with the manufacturer. A cancellable contingency order was also placed with a vendor for a smaller amount. Room reservations at the various buildings on the Atlanta CDC campuses were made in late spring/early summer. The influenza vaccine was offered during clinic visits, and encouraged for those with impending extended international travel plans. A total of twenty dedicated immunization sessions were held at ten different locations in Atlanta between 14 October and 2 December, with 5275 doses of vaccine given

Highlights

• The first three large-scale “open house” influenza clinics were held the week of October 13-17 at the Executive Park and Chamblee clinic locations and at the Century Center (leased space) complex, with 1,083 doses administered.
• The following week, a total of 1,193 doses were administered on consecutive days at the main CDC campus, with 390 more given at an off-campus site
• By the end of October, 4,078 doses of trivalent inactivated influenza vaccine (TIV) had been administered to Atlanta CDC workers.
• Each of the three Atlanta area CDC Occupational Health clinics hosted a one-week “walk-in” influenza vaccine session, one in late November and the other two in mid-December. 311 doses of vaccine were administered during these sessions. One hundred forty-seven additional doses of vaccine were given during clinic visits or other small-scale events, for an Atlanta total of 5,733 doses of TIV. A total of 1,245 does of TIV were distributed to six different non-Atlanta CDC locations, bring the total for TIV up to 6,978. In addition, 32 doses of live attenuated influenza vaccine (LAIV; Flu-Mist) were given upon request to eligible recipients
• The 2008-09 seasonal total of influenza vaccinations given to CDC employees was 7,010 as of mid-March 2009.

Federal Occupational Health (FOH)- Summary of Influenza Activities 2008-2009

Background

Federal Occupational Health encouraged its healthcare worker staff at its 300 locations across the country to be vaccinated to help protect themselves as well as family, friends and co-workers.  Messages regarding the initiative were sent via email from the Division Director during the fall of 2008, providing links to additional information and various resources from the HHS “toolkit”. The topic was also discussed regularly on regional and national conference calls.  In early February 2009, an online survey was sent to healthcare providers, requesting demographic information, whether they had received the vaccine and if not, why not.

Highlights

• Three hundred forty nine (349) surveys were received from all full and part-time people in health units for a 64.4% response rate. 
• Ninety five percent (95%) of the respondents were female and 98% were nurses. 
• Of those who responded, nearly 71% indicated that they had received the vaccine and of those, 18% said information and encouragement from FOH management was a factor in getting the vaccine. 
• When adjusted for those who indicated allergy or other contraindications to vaccination, the utilization rate increased to 74.4%. 
• Of those who did not receive the vaccine, the reasons cited were the following:
  • 18.7%
    Allergy/contraindication
  • 6.6%
    Concern that the flu shot will make you sick
  • 9.9%
    Concern about the safety of the vaccine
  • 14.3%
    Concern about the efficacy of the vaccine
  • 25.3%
    I am healthy and do not need the vaccine
  • 15.4%
    Inconvenient access to vaccine
  • 6.6%
    Not enough time
  • 3.3%
    Cost/can’t afford
• When asked what would change their mind about getting the vaccine the responses were:
  • 12.2%
    Reassurance I will not get sick from the vaccine
  • 6.7%
    Studies showing improved safety
  • 8.9%
    Studies showing improved efficacy
  • 17.8%
    Improve convenience/access to it
  • 4.4%
    Reduce cost/make it free
  • 50.0%
    Nothing would change my mind
• Sixty nine percent (69%) of responders said they had received the vaccine in 2007, and 63% indicated they had received it for the last 3 years, showing a trend of increased utilization in this cohort.

Health Resources and Services Administration (HRSA)- Summary of Influenza Activities 2008-2009

Background

HRSA sent a message to all federally qualified health centers on July 18, 2008, requesting they strongly encourage their health care workers and workers who interact with the public to receive the influenza vaccination.  HRSA asked that grantees, particularly those involved in providing preventive and health care services, develop an initiative to increase the rates of influenza vaccination for their health care personnel. FQHCs employ a variety of methods to try to increase the number of employees receiving the vaccination such as offering the vaccination at no cost, providing educational materials, sending reminder messages and holding department-wide meetings. Some specific examples from health centers to inform and encourage staff to obtain influenza vaccines include:

1. Email blasts.
2. Posting signs.
3. Providing specified times for staff to obtain vaccines at work.
4. Providing influenza vaccines at individual clinic locations.
5. A web-based influenza vaccine declination form.  This web-based form provided information about the importance of the vaccine.  Employees designate on the web-based form whether they intend to receive the vaccine at the workplace, receive it through their own efforts, or choose to decline the influenza vaccine (and if so, why) this season.

Highlights

• Based on the Federally Qualified Health Center’s (FQHCs) that provided data to the Primary Care Associations (PCAs), an average of 72.7 percent of health care personnel received the influenza vaccination.
• All PCAs (except Puerto Rico) which responded reported that FQHCs intheir state offer the influenza vaccination free to all employees. (Puerto Rico Department of Health (DOH) offers the vaccination free to all residents so the FQHCs refer employees to DOH sites).
• Most FQHCs who reported to the PCAs identified no significant problems relating to cost or funding vaccinations for health care personnel.
• Few FQHCs who responded to the PCAs have specific policies in place regarding influenza vaccination of health care personnel.
• Overall, FQHCs appear to be making strides in insuring that health care personnel receive the influenza vaccination. FQHCs seem to understand the correlation between the vaccination of health care personnel and the reduction in staff illnesses and absenteeism during the influenza season and the reduction in the spread of influenza to and from workers and patients.
• While more can be done to improve the vaccination rates of health care personnel, most FQHCs who responded to the PCAs have exceeded the Healthy People 2010 goal and are continuing to develop innovative ways to improve the health care personnel influenza vaccination rate.

Indian Health Service (IHS), Tribal and Urban Indian Facilities- Summary of Influenza Activities 2008-2009

Background

IHS launched its effort with an Open Door Forum on October 25th, 2008 which included an internet seminar (“webinar”) with speakers on influenza transmission, influenza vaccination, employee health records, and strategies for vaccinating HCP. Each IHS Area was asked to designate a person to serve as the coordinator for this initiative, and to disseminate information to and receive reports from the facilities and aggregate them into an Area level report. Presentations on the importance of HCP influenza vaccination were developed for clinical and non-clinical HCP, as well as for facility administrators. These presentations, as well as guidance on tracking HCP influenza coverage and reporting forms for the Area coordinators and individual facilities, were broadly disseminated throughout IHS and were also posted on the IHS website. Participation by IHS facilities was required; tribal and urban programs were also invited to participate.

Highlights

• All 12 IHS Areas submitted reports, representing 137 facilities and 23,413 HCP.
• A breakdown of coverage by facility type (Table 1) is included below, as well as percent refusals (which included those with medical contraindications), and the percent for whom vaccination status was unknown.
• While IHS as an agency surpassed the HP 2010 goal of 60%, coverage varied between IHS Areas. Coverage for ALL facilities (IHS, Tribal and Urban) by IHS Area is shown below (Table 2, Figure 1).
• As an agency, IHS surpassed the HP 2010 goal for HCP influenza vaccination, and has established a baseline HCP influenza coverage of 71% for all facility types. There is, however, variation between Areas and facility type; efforts to identify and disseminate best practices and to improve overall data collection are important next steps.   

Table 1. 2008-2009 Influenza Vaccination Coverage of HCP IHS, Tribal, and Urban Facilities

Table 2. 2008-2009 Influenza Vaccination Coverage of HCP for All IHS Facilities by Areas

Figure 1. 2008-2009 Influenza Vaccination Coverage of HCP for All IHS Facilities by Areas

• Next Steps
  • Send follow up survey to sites to better understand their strategies and best practices
  • Update IHS employee manual on immunization policy
  • Develop goals for next influenza season
    • Increase number of facilities reporting
    • Decrease percent reported unknown vaccination status
  • Discuss data collection for next year
    • Break out refusals into medical contraindications plus refusals

National Institutes of Health (NIH)- Summary of Influenza Activities 2008-2009

Background

• NIH developed an electronic immunization tracking system for its Clinical Center and instituted mandatory immunization program for all staff who have patient contact
• Staff who did not get vaccinated were mandated to sign a declination form specifying the refusal reason
• Employees who were non compliant had to appear before the Clinical Center’s governing medical board
• Historical data suggest that between 40-60 percent of all NIH personnel (23,500) had been vaccinated against influenza prior to 2008.
• A department questionnaire was used to generate a database of staff who had patient and patient specimen contact
• The Occupational Medical Services (OMS) at the NIH Clinical Center used electronic medical records to track employees who were vaccinated. After being vaccinated, employees simply had to swipe their badge which is encoded with their personnel information (e.g. employee ID number)
• Compliance reports were periodically sent out to supervisors

Highlights

• OMS administered 9740 doses, an increase by 10.7% percent over 2007-08.
• By February 2009, 100% of the 2754 patient care employees had complied with the policy- 88% were vaccinated, 1.3% had medical contraindications and 10.7% declined vaccination 
• The most cited reasons for declination included:
  • Concerned about side effects (39.1%)
  • Did not feel at risk for contracting influenza (20.7%)
  • The vaccine is not effective (17.7%)

Next Steps

• Further enhance the system to accurately identify employees with patient contact
• Develop employee education targeting reasons for declination
• Implement vaccination of contractors working in the Clinical Center