Pa Pat Saf Advis 2017 Mar;14(1):36-38.
Data Snapshot: Improving Influenza Vaccination Rates of Healthcare Personnel in Pennsylvania Long-Term Care Facilities
Gerontology; Infectious Diseases
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​Author

Terri Lee Roberts, BSN, RN, CIC, FAPIC
Infection Prevention Analyst,
Pennsylvania Patient Safety Authority

Data Snapshot

Influenza is a contagious respiratory illness that can cause mild to severe illness and can lead to death. Elderly people (65 years or older) are at greater risk of serious complications from influenza than younger individuals because human immune defenses become weaker with age.1 In the 2012–2013 influenza season, about half of the 12,336 reported influenza-associated hospitalizations occurred in elderly people.2 An estimated 5,500 influenza-associated deaths occur annually in elderly people, accounting for about 90% of deaths from influenza infections in the United States.2 In 2014, the Centers for Disease Control and Prevention (CDC) listed influenza and pneumonia combined as the eighth leading cause of death in elderly people.3 Respiratory tract infection was the second most frequent healthcare-associated infection reported to the Pennsylvania Patient Safety Authority by Pennsylvania’s long-term care (LTC) facilities from 2013 through 2015.4-6    

CDC recommends annual influenza vaccination for all healthcare personnel, especially those who work in LTC, as the best way to prevent influenza infection among healthcare personnel and their patients.2 Influenza vaccine effectiveness is generally lowest in the elderly, making vaccination of healthcare personnel working with elderly residents in LTC settings critical.7

National Data

As reported in the September 18, 2015, Morbidity and Mortality Weekly Report, influenza vaccination coverage for the 2014–2015 influenza season was highest among healthcare personnel working in hospitals (90.4%) and lowest among healthcare personnel working in LTC settings (63.9%). Healthcare personnel working in LTC settings have had the lowest reported influenza vaccination coverage for the past five influenza seasons.7 In comparison, Healthy People 2020 recommends increasing the percentage of healthcare personnel who are vaccinated annually against seasonal influenza to a target goal of 90%.8 Healthcare personnel who were required by their employers to be vaccinated had the highest influenza vaccination coverage (96.0%). Healthcare personnel who were not required by their employers to be vaccinated had a 73.6% coverage rate when vaccination was offered on-site at no cost for one day and an 83.9% coverage rate when vaccination was offered on-site at no cost for multiple days. Healthcare personnel working in settings in which vaccination was not required, promoted, or offered on-site had a 44.0% coverage rate.7

Pennsylvania Data

The Pennsylvania Department of Health reports LTC healthcare personnel vaccinations rates of 57.6% in 2013 and 66.8% in 2014, well below the Healthy People 2020 target goal of 90% for healthcare personnel8,9 (Figure 1). The Authority found in its 2015 Annual Long-Term Care Survey that mandatory staff influenza vaccination programs are in place in 47.8% (120 of 251) of the Pennsylvania LTC facilities that responded. In addition, 91.2% (229 of 251) of the Pennsylvania LTC facilities that responded provide annual staff influenza prevention education programs.10

Figure 1. Pennsylvania Long-Term Care Healthcare Personnel Influenza Vaccination Rates

Figure 1. Pennsylvania Long-Term Care Healthcare Personnel Influenza Vaccination RatesSources: Adapted from Healthy People 2020: immunization and infectious diseases, objective IID-12.9. Increase the percentage of health care personnel who are vaccinated annually against seasonal influenza. [Internet]. Washington (DC): U.S. Department of Health and Human Services; [accessed 2016 Aug 8]. Available: https://www.healthypeople.gov/node/4668/data_details#revision_history_header; Adapted from annual long-term care facility surveys. Harrisburg (PA): Pennsylvania Department of Health; 2013, 2014.
Note: Data as reported by Pennsylvania Department of Health; Healthy People 2020 target goal is 90% of healthcare personnel vaccinated annually against seasonal influenza.

Barriers to Influenza Vaccination Compliance 

Efforts are needed to improve vaccination coverage among healthcare personnel in LTC settings. LTC facilities can promote influenza vaccination each season by reducing barriers to healthcare personnel vaccination. Barriers may include lack of access to influenza vaccine, personal beliefs, misconceptions, fear, lack of enthusiasm about influenza vaccination, and high staff turnover.11

Strategies to Improve Vaccination Coverage Rates

The ease of access to influenza vaccine can influence vaccination rates (Figure 2).

Figure 2. National Healthcare Personnel Influenza Vaccination Rates, 2014-2015

Figure 2. National Healthcare Personnel Influenza Vaccination Rates, 2014-2015Source: Adapted from Black CL, Yue X, Ball SW, Donahue SM, Izrael D, de Perio MA, Laney AS, Williams WW, Lindley MC, Graitcer SB, Lu PJ, Bridges CB, DiSogra C, Sokolowski J, Walker DK, Greby SM. Influenza vaccination coverage among health care personnel-United States, 2014-15 influenza season. MMWR. Morbidity and mortality weekly report. 2015 Sep 18;64(36):993-9. Also available: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6436a1.htm.

 

Steps that can increase access to influenza vaccination are as follows:

  • Provide free vaccine in the workplace
  • Offer vaccine at multiple times and locations convenient to all workers on all shifts during the flu season
  • Use a mobile vaccination cart to take influenza vaccinations to staff
  • Offer vaccination at meetings

Address personal beliefs, misconceptions, and fear:

  • Provide education for staff
    • Focus on protecting healthcare personnel, their families, and residents
    • Review the seriousness of influenza, including the risk to young or healthy people
    • Review the influenza vaccine’s effectiveness and possible side effects

Encourage enthusiasm about influenza vaccination with the following steps:

  • Promote vaccination via communication tools, such as posters, facility intranet, e-mails, newsletters
  • Have contests or provide incentives for vaccination, such as raffles, gift cards, a pizza party, cake
  • Vaccinate leaders in front of the staff

Address high staff turnover:

  • Educate and vaccinate staff as part of new employee orientations
  • Offer influenza vaccination education multiple times during the flu season

Although influenza vaccination coverage for Pennsylvania LTC healthcare personnel is slowly increasing, it is well below the Healthy People 2020 target. Comprehensive vaccination strategies demonstrated to improve coverage among LTC healthcare personnel include providing and promoting information about the benefits of influenza vaccination, ensuring convenient access to vaccine in the work setting, and providing the vaccine free of charge to healthcare personnel.

Notes

  1. Centers for Disease Control and Prevention (CDC). What you should know and do this flu season if you are 65 years and older. [internet]. Atlanta (GA): Centers for Disease Control and Prevention (CDC); [accessed 2016 Aug 08]. [3 p]. Available: http://www.cdc.gov/flu/about/disease/65over.htm.
  2. Centers for Disease Control and Prevention (CDC). The importance of influenza vaccination for health care personnel in long-term care. [internet]. Atlanta (GA): Centers for Disease Control and Prevention (CDC); [accessed 2016 Aug 08]. [4 p]. Available: http://www.cdc.gov/flu/toolkit/long-term-care/importance.htm.
  3. Health, United States, 2015 - Individual charts and tables: spreadsheet, PDF, and PowerPoint files. [internet]. Atlanta (GA): Centers for Disease Control and Prevention (CDC); 2016 Apr 27 [accessed 2016 Aug 08]. Available: http://www.cdc.gov/nchs/hus/contents2015.htm#020.
  4. Pennsylvania Patient Safety Authority 2013 annual report. Harrisburg (PA): Pennsylvania Patient Safety Authority; 2014 Apr 30. Addendum F: healthcare-associated infections. p. F1-F22. Also available: http://patientsafety.pa.gov/PatientSafetyAuthority/Documents/annual_report_2013.pdf.
  5. Pennsylvania Patient Safety Authority 2014 annual report. Harrisburg (PA): Pennsylvania Patient Safety Authority; 2015 Apr 30. The Authority’s HAI reduction efforts. p. 9-10. Also available: http://patientsafety.pa.gov/PatientSafetyAuthority/Documents/Annual_Report_2014.pdf.
  6. Pennsylvania Patient Safety Authority 2015 annual report. Harrisburg (PA): Pennsylvania Patient Safety Authority; 2016 Apr 29. Healthcare-associated infections. p. 33-52. Also available: http://patientsafety.pa.gov/PatientSafetyAuthority/Documents/annual_report_2015.pdf.
  7. Black CL, Yue X, Ball SW, Donahue SM, Izrael D, de Perio MA, Laney AS, Williams WW, Lindley MC, Graitcer SB, Lu PJ, Bridges CB, DiSogra C, Sokolowski J, Walker DK, Greby SM. Influenza vaccination coverage among health care personnel--United States, 2014-15 influenza season. MMWR. Morbidity and mortality weekly report. 2015 Sep 18;64(36):993-9. Also available: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6436a1.htm. PMID: 26389743
  8. Healthy People 2020: immunization and infectious diseases, objective IID-12.9. Increase the percentage of health care personnel who are vaccinated annually against seasonal influenza. [internet]. Washington (DC): U.S. Department of Health and Human Services; [accessed 2016 Aug 08]. Available: https://www.healthypeople.gov/node/4668/data_details#revision_history_header.
  9. Annual long-term care facility surveys. Harrisburg (PA): Pennsylvania Department of Health [unpublished]; 2013, 2014.
  10. Annual long-term care facility survey. Harrisburg (PA): Pennsylvania Patient Safety Authority [unpublished]; 2015.
  11. Centers for Disease Control and Prevention (CDC). Barriers and strategies to improving influenza vaccination among health care personnel. [internet]. Atlanta (GA): Centers for Disease Control and Prevention (CDC); [accessed 2016 Aug 08]. [4 p]. Available: http://www.cdc.gov/flu/toolkit/long-term-care/strategies.htm
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