Increase Influenza Vaccination Coverage among your Health Care Personnel

Best Practices for Increasing Health Care Personnel (HCP) Influenza Vaccination

In a national survey looking at the 2018–19 influenza season, the highest vaccination coverage, at 98%, was among HCP subject to workplace vaccination requirements [7]. Yet, only 30% of HCP in LTC facilities report that influenza vaccination is required by their employer [13]. The lowest vaccination coverage, at 42%, was among HCP working in settings where vaccination was not mandated, promoted, or offered on-site. Among HCP who did not have to abide by a workplace requirement, 83% reported receiving influenza vaccine when it was offered for no cost at their worksite for more than one day [7].

The National Adult and Influenza Immunization Summit (NAIIS) has specific guidance for LTC administrators planning to increase influenza vaccination through a workplace vaccination requirement. Employer-sponsored workplace vaccination is often cost-saving as vaccinated employees are less likely to miss work due to illness [14]. Additional strategies for improving HCP influenza vaccination are described below.

Planning for an Influenza Season

It is recommended that post-acute and LTC facilities establish solid plans for vaccinating HCP working at their facilities. Ideally, facilities should outline plans during the summer prior to the influenza season that cover educating HCP on influenza vaccination, promoting influenza vaccination, and administering and tracking vaccine. This may also be a good time to establish an influenza vaccination policy for HCP if one is not already in place.

To assist facility administrators and other staff who are involved in the planning process (e.g., occupational health or infection control specialists), a series of questions to consider and some suggested strategies are provided. Facilities can decide which strategies are most appropriate to their situation and can develop action steps on how to implement them.

Vaccine Education

Should my facility implement an educational campaign for HCP?

If HCP influenza vaccination coverage is sub-optimal, consider using the materials/information below to address the following topics:

• Belief that influenza is not a serious illness:
  • Show the video: “How Does Flu Make You Sick?”
  • Share information from the CDC on “Misconceptions about Seasonal Flu and Flu Vaccines”
  • Share a question and answer document on influenza from the Immunization Action Coalition.

Educating staff about influenza vaccination may include showing them “How Does Flu Make You Sick?” on YouTube

• Belief that influenza vaccine is not effective or will cause illness/side effects:
  • Emphasize the benefits of influenza vaccination.
  • Share data from the CDC’s Seasonal Flu Vaccine Effectiveness Studies
  • Refer to the following information on how influenza vaccination is an important preventive tool for people with chronic health conditions:
    • Influenza vaccination has been associated with lower rates of some cardiac events among people with heart disease, especially among those who had had a cardiac event in the past year
    • Influenza vaccination can reduce worsening and hospitalization for flu-related chronic lung disease, such as in persons with chronic obstructive pulmonary disease (COPD).
    • Influenza vaccination has been shown in separate studies to be associated with reduced hospitalizations among people with diabetes and chronic lung disease.
• Fear of injection:
  • Emphasize that there is a nasal spray vaccine (‘FluMist’) for eligible individuals preferring to avoid injection.

Incorporate culturally competent materials:

• Provide educational materials in multiple languages:
  • Seasonal Flu Factsheets
    
  • CDC’s Vaccine Information Statements:
    • Inactivated Influenza Virus
    • Live, Attenuated Influenza Vaccine
  • MedlinePlus provides influenza information in multiple languages, tutorials, and videos that may be helpful to low literacy groups (refer to section four of this document for other materials)
  • Conduct listening sessions with HCP to talk through potential barriers to influenza vaccination such as fears surrounding vaccination and influenza vaccine safety

Vaccine Promotion

How can my facility best promote influenza vaccination?

• Publicize a “vaccine day” offering influenza vaccination in combination with education
• Provide contests or incentives to get vaccinated (small gift cards, raffle prizes, pizza parties, etc.)
• Designate influenza vaccine ‘champions’ (such as nurses and/or residents) to set the tone for the importance of vaccination. These champions may represent various cultural and ethnic backgrounds.
• Vaccinate facility administrators and managers in front of staff
• Encourage HCP to obtain influenza vaccination through communication tools such as e-mail, posters, and newsletters (refer to section four of this document for materials)
• Remind and encourage unvaccinated HCP to get a flu vaccine via e-mail, letters, telephone calls, and in person
• Consider using CDC’s Digital Media Toolkit as a resource to promote influenza vaccination

Vaccine Administration and Tracking

How will influenza vaccine be administered to HCP at my facility?

• Contact community organizations (e.g., local hospitals, pharmacies, or nurse associations) to develop partnerships for administering influenza vaccine to HCP
• Offer influenza vaccine at mandatory trainings, orientations for new staff, departmental conferences, and other meetings
• Offer influenza vaccine at multiple times and locations convenient to HCP on all shifts during the influenza season
• Use a mobile vaccination cart to vaccinate HCP working in various locations of the facility

Will my facility provide influenza vaccine to HCP for free?

• If yes, this may encourage vaccination uptake
• If no, consider the following:
  • Provide staff with a voucher for vaccination at another location, such as a pharmacy or clinic
  • Share information with HCP on other options:
    • Employee health insurance plans may cover influenza vaccination
    • Other health insurance plans that staff may participate in (such as a spouse’s insurance plan) may cover influenza vaccination
    • Staff who do not qualify for employer-provided insurance may be able to get insurance through state Health Insurance Marketplaces

How will influenza vaccination be tracked at my facility?

• Establish a process to record influenza vaccination status of each healthcare worker throughout the influenza season (use a spreadsheet or electronic tracking system)
• Provide a declination form to learn why HCP are declining vaccination and tailor any educational messages
• Review data periodically to identify unvaccinated HCP and follow-up with them as the influenza season progresses
• Adjust vaccine promotion strategies to reach unvaccinated HCP