Declinations boost HCW flu vaccine rates
Yet some nurses complain of 'coercion'
Education alone will not boost your influenza vaccination rates, but a dogged campaign that includes declination statements can produce higher rates.
That is the conclusion of recent research published in Infection Control and Hospital Epidemiology (ICHE).
The Wisconsin Division of Public Health compared hospitals that vaccinate at least 50% of their health care workers and those with vaccination rates below 50%. "We found that declination forms were significant in getting more people vaccinated," says Gwen Borlaug, CIC, MPH, infection control epidemiologist. "The declination forms appear to be the single most important factor."
Borlaug reported that finding in ICHE,1 and then found the relationship between declination statements and higher vaccination rates to be even greater during the subsequent influenza season. The Wisconsin Division of Public Health is encouraging hospitals to track their rates and to use declination statements, which require employees to sign a form saying they were offered the vaccine and understand its benefits to patients and employees but chose not to have the vaccine.
Other factors, such as delays or shortages in vaccine supply, influenced vaccination rates, Borlaug reported. The Wisconsin Division of Public Health also recognizes hospitals that achieve high rates. Hospitals and nursing homes with a rate of 80% or greater become part of the "80 Percent Club."
Almost all of the Wisconsin hospitals used an education campaign to promote flu vaccination or employees. Yet education alone does not seem to have a consistent impact on vaccination rates, according to a study at the Mayo Clinic in Rochester, MN.
Despite extensive education programs, 19% of nurses still incorrectly stated that the influenza vaccine contains live viruses that can cause disease. More than a third (37.5%) confused the symptoms of the "stomach flu" with influenza. And only 68% of nurses who said they had all the information they needed about influenza and the vaccine said they intended to be vaccinated.2
"Education as a strategy to achieve and maintain high rates of immunization does not work," says Gregory Poland, MD, professor of medicine and infectious diseases, director of the Mayo Vaccine Research Group, and an author of the article. "People sometimes misinterpret me when I say that. It's not that I don't believe education is helpful. The problem is that for many organizations they rely solely on education and they never get past the 40% to 60% rate."
In general, people are reluctant to change their habits based on education alone, notes Poland. After all, almost everyone knows that it's unhealthy to smoke or to be obeseand yet both remain a significant cause of disease in the United States.
A push-back from declinations?
However, the path to higher influenza vaccination rates isn't so simple. Hospitals that boosted rates by using declination statements combined them with other measures, such as incentives, better access to vaccination, and high-profile administrative support.
That sort of multipronged approach enabled Emory Healthcare in Atlanta to raise vaccination rates from 43% in 2005-2006 to 66.5% in 2006-2007. Nurses had the lowest rate of declination (13.2%).
However, almost half of the nurses who declined (47.8%) wrote a comment about the reason for declination; a majority of those mentioned feeling "pressured" or "coerced," the authors stated.3
William Buchta, MD, MPH, medical director of the Employee Occupational Health Service at the Mayo Clinic, urges employee health professionals to act with caution when considering the use of declination statements. He conducted a pilot test of a declination statement sent by email; in a subsequent survey, 22% of the nurses indicated they had been irritated by the request to complete a declination statement.
"I think people need to think strongly about what they're doing when they're going to twist people's arms," he says. Mayo decided against using declination statementsand has a vaccination rate of 79%.
Flu vaccination should become a part of the institutional culture, he says. Mayo also puts extra resources into an Enhanced Flu Vaccine Program, targeting units with vulnerable patient populations, such as the bone marrow transplant unit and intensive care unit.
However, for hospitals that have struggled to move their vaccination rates beyond 40%, declination statements may provide a much-needed boost, he acknowledges.
Pandemic drill also boosts rates
Another strategy emerged from the University of Iowa Hospitals and Clinics in Iowa City. The hospital system conducted a pandemic influenza drill that coincided with the annual influenza vaccine campaign.
A peer vaccination program created a vaccination "blitz" as part of the 2005 drill. Nurses vaccinated each other, allowing most vaccinations to occur within a six-day period. The vaccination rates for nurses rose from 39% to 63%.4
Although the drill wasn't repeated in 2006, hospital administrators had a greater appreciation for the resources needed to improve flu vaccination rates, and the peer vaccination program kept rates at a higher level, the authors reported.
References
1. Borlaug G, Newman A, and Pfister J. Factors that influenced rates of influenza vaccination among employees of Wisconsin acute care hospitals and nursing homes during the 2005-2006 influenza season. Infect Control Hosp Epidemiol 2007; 28:398-1400.
2. Ofstead CL, Tucker SJ, Beebe TJ, and Poland GA. Influenza vaccination among registered nurses: Information receipt, knowledge, and decision-making at an institution with a multi-faceted educational program. Infect Control Hosp Epidemiol 2008; 29:99-106.
3. Ribner BS, Hall C, Steinberg JP, et al. Use of a mandatory declination form in a program for influenza vaccination of healthcare workers. Infect Control Hosp Epidemiol 2008; 29:302-308.
4. Kuntz JL, Holley S, Helmes CM, et al. Use of a pandemic preparedness drill to increase rates of influenza vaccination among healthcare workers. Infect Control Hosp Epidemiol 2008; 29:111-115.
Education alone will not boost your influenza vaccination rates, but a dogged campaign that includes declination statements can produce higher rates.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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