Flu deputies,’ mobile carts boost vaccine rates
Nationally, only about a third of health care workers receive influenza vaccinations, even though this is a simple way to protect vulnerable patients and prevent nosocomial outbreaks.
Why don’t health care workers get vaccines? They may be misinformed, believing the vaccine will give them the flu or serious side effects, or they may just be too busy. Here are the strategies that two hospitals used to significantly boost their vaccination rates among staff:
At Memorial Sloan Kettering Cancer Center in New York City, getting a flu vaccine once required a visit to the off-site employee health service. But as the cancer center made the vaccines more accessible, the rate of immunization skyrocketed.
First, infection control nurses visited units at scheduled times and made appearances at meetings. For example, by taking the vaccine to grand rounds and to new house staff orientation meetings, infection control nurses greatly increased the vaccination of physicians.
Meanwhile, two nurse managers piloted a program of serving as "flu vaccine deputies," providing vaccines to all employees on their units.
"One nurse manager, [working on her unit] improved the staff vaccination rate from 12% to about 50%," says Janet Eagan, RN, MPH, CIC, infection control manager. "One person can do this." Eagan gave the nurse managers packets with information about the flu and flu vaccine, including consent forms. The next year, she expanded the program to all units and asked nurse managers to either provide the vaccines
or to designate a "flu deputy."
With the extra efforts, flu vaccination rose from about 1,400 employees in the 1997-98 season to 1,956 in 1998-99 and then to 2,450 in 1999-00. "It got to be a friendly competitiveness" between units about raising vaccination rates, says Eagan.
The cancer center has about 6,000 employees. The vaccine is offered to all staff, and figures were not available on the percentage of those involved in patient care who were vaccinated. Eagan also doesn’t know how many additional employees received a vaccine in another setting, such as a doctor’s office.
It took a lot of legwork to get the new program started, Eagan says. "When you want people to do extra, you really have to spoon-feed them in the beginning. I was ordering the vaccine and bringing it up to the units [from the pharmacy]. You have to make it easy. That’s what makes [the program] effective."
Employees have seen the impact of making the vaccines more accessible, and they are growing accustomed to the new system. Cases of nosocomial influenza have declined at the cancer center, and during the last flu season, no cases were detected. No employees had documented cases of influenza.
Eagan is concerned that the delay and possible shortage of flu vaccine this fall could derail her efforts to further improve vaccination rates. If not enough vaccine is available, she plans to begin with the units that treat the center’s most vulnerable, such as bone marrow transplant, pediatric, and leukemia patients.
"We’re all set to go," says Eagan. "Every year, we’ve tried to top the year before, but if we can do the same as last year, I’ll be happy."
86% vaccine rate creates a flu-free zone’
St. Mary’s Hospital in Kitchener, Ontario, Canada, is a "flu-free zone." With a staff vaccination rate of 86%, including physicians and volunteers, that assertion is no exaggeration. Flu experts say a vaccination rate of 80% or more provides "herd immunity" that prevents the spread of the virus. The hospital’s success story emerged not just from an effective flu vaccine campaign, but also from an awareness of the seriousness of nosocomial outbreaks.
Two years ago, a nursing home in the region had a well-publicized influenza outbreak that led to several deaths. Television reports noted the low vaccination rates of staff. Meanwhile, the ministry of health became even more vigilant, recommending strict measures if nosocomial cases were identified.
St. Mary’s adopted a new policy that could potentially restrict unvaccinated employees who had been exposed to known cases of influenza. "If there was an outbreak and you were exposed and not vaccinated, you could only work in the outbreak area," says Brenda Klochnyk, MLT, ART, CIC, infection control practitioner. With employees routinely floating among units, that restriction is difficult for both staff and the hospital, she notes.
If you needed to work elsewhere, the hospital could ask you to get a flu shot, take amantadine — a chemoprophylaxis — and go on leave without pay for up to three days until the antiviral took effect, she says.
With that policy as a backdrop, Klochnyk organized a flu campaign that began like a celebration. "Whenever we celebrate anything here in our hospital, we always have cake and coffee. For some reason our staff will flock anywhere for cake and coffee. I figured, this works for everything else. Why not try it?"
In October, she invited the staff to come to the cafeteria for cake, coffee — and a flu shot. Shots came at the end of the line, after employees picked up their piece of cake.
Local businesses donated prizes, and one lucky employee received a day off with pay. Everyone who received a shot that day was entered into the raffle. A reporter from the local television station came and featured the hospital’s flu vaccine campaign on the evening news.
She supplemented that campaign launch with educational sessions to dispel myths about the vaccine, hospitalwide e-mails with influenza fact sheets, and a mobile vaccination cart. Staff who received the vaccine also got a "flu-free zone" sticker.
Klochnyk was delighted when she discovered that the hospital’s vaccination rate had risen from 30% to 40% in prior years to a record 86%.
This year, St. Mary’s will repeat the campaign with just a few enhancements, including a costumed character dressed like the "flu-free zone" sticker. And she will have lots of extra support. The Ontario government is offering free flu vaccines to everyone 1 year of age and older in a major push to immunize the entire population.
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