Annual Influenza Immunization Among Health Care Workers: An Imperative We Must Work Toward Now

While this imperative is directed largely at the general public, a startling audience segment—health care workers—is seemingly tuning it out. One might think that the rate of influenza vaccination among health care workers would be extremely high, if not close to 100%. Yet surprisingly, less than half of all health care professionals in the United States—an astoundingly low 42%—actually take measures to receive a flu shot each year.4

Why is this rate so low? Why, among a segment of the population that should “know better,” would so many choose to forego a flu shot? Apathy may be to blame. It seems counterintuitive: Health care workers are often no different from the general public in terms of their knowledge of influenza vaccine recommendations, or their adherence to them. Health care workers cite reasons similar to the general public for not getting vaccinated, including inconvenience, a fear of needles, and the mistaken belief that getting a flu vaccine can actually cause influenza. Unfortunately, health care workers—nurses in particular—have a significant influence over the behavior of their patients when it comes to influenza vaccination. If staff members in a patient’s own primary care office either fear the flu vaccine or don’t prioritize it for themselves, why would the patient be expected to think differently?

Health Care Worker Vaccination Impacts Patient Safety and Infection Control

Clearly, health care workers, like consumers, need more education. They need to understand that by avoiding flu immunization, they put patients, themselves, their families, and others at risk. Getting the flu vaccine not only helps to protect health care workers but helps reduce the risk of their spreading the virus to susceptible people. This seems like common sense, yet it is logic that is clearly not being embraced. Health care workers are frequently implicated as the source of influenza in health care settings. Outbreaks have been documented in high-risk patient care areas, including organ transplant units, long-term care facilities, and neonatal intensive care units.

The Centers for Disease Control (CDC), along with numerous infection control groups and health care organizations, have long realized the benefits of immunization for health care professionals—a diverse audience consisting not only of physicians and nurses, but of emergency medical personnel, dental professionals, medical and dental students, laboratory technicians, hospital volunteers, and administrative staff. In fact, the Advisory Committee on Immunization Practices (ACIP) recently added “health care workers” to its list of populations it recommends receive an annual influenza vaccination.5

ACIP recognizes that health care worker vaccination is one important measure of a patient safety quality program. The Committee also urges health care administrators to implement policies to encourage health care worker vaccination, such as obtaining signed statements from health care professionals who decline influenza vaccination.

Working Toward Change

Numerous organizations—the Joint Commission on Accreditation of Health care Organizations (JCAHO), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Medical Association (AMA), and the National Foundation for Infectious Diseases (NFID), to name a few—have joined the CDC’s crusade to increase influenza vaccinations among health care professionals.

This year, JCAHO announced its new infection control policy that requires accredited organizations to offer influenza vaccination to staff, including volunteers and licensed practitioners with close patient contact. JCAHO's standard aims to establish an annual influenza vaccination program and improve access to vaccinations on-site. The standard applies to its Critical Access Hospital, Hospital and Long Term Care accreditation programs.

The American Hospital Association has endorsed the concept of immunization programs for both hospital personnel and patients. Any medical facility or health department that provides direct patient care is encouraged to formulate a comprehensive immunization policy for all health care workers.

Meanwhile, NFID has initiated ongoing efforts to encourage health care institutions to implement policies and programs to increase vaccination rates among its workers. NFID’s initiatives include a comprehensive Call to Action initiative launched in 2003, which is supported by more than 20 of the nation's leading medical groups, including JCAHO. In addition, NFID published a comprehensive report, Improving Influenza Vaccination Rates in Health Care Workers: Strategies to Increase Protection for Workers and Patients, which outlines the serious implications low influenza immunization rates have on patient safety, and calls on health care institutions to ensure influenza vaccine is available and offered to every health care worker annually. NFID's efforts brought the issue to the attention of policymakers and fueled discussion on the issue within the health care community.

Individual companies, too, are championing this cause. For example, CSL Biotherapies, a subsidiary of CSL Limited, which operates one of the world’s largest influenza vaccine manufacturing facilities, is entering the US flu vaccine marketplace in 2007. CSL Biotherapies recently gave an unrestricted educational grant to the NFID in support of the Foundation’s Best Practices Initiative to increase influenza vaccination coverage among health care workers. According to Paul Perreault, Executive Vice President of CSL Biotherapies Worldwide Commercial Operations, “As a flu vaccine manufacturer, CSL Biotherapies feels that targeting health care professionals is key to increasing overall influenza immunization and protection against flu. Health care workers are in a unique position not only to do right by their patients, but to become role models in their own communities by encouraging flu immunization. We would like to see all health care workers get an annual flu vaccination during the fall and winter months. We will make every effort to facilitate flu vaccine access and help them succeed in doing so.”

Strategies for Increasing Health Care Worker Immunization

So what’s the magic formula for encouraging health care professionals to seek out a flu shot? There’s no single easy answer to this question. In truth, there are several.

One place to start is with the health care worker’s employer. Administrators and managers in health care facilities need to become strong advocates of immunization programs for staff members. When employees hear a message being delivered fervently by the leaders of their workplace, that message becomes harder to dismiss. Often, getting this message out requires an individual to champion the cause and top management to clearly voice its ardent support of it. If appealing to these leaders’ sense of promoting greater public health fails to motivate them, perhaps they should focus on the economic reasons to back such an initiative. Better infection control has been shown to reduce employee absenteeism, reduce antibiotic use among health care workers, and lead to greater cost savings.

Another way to encourage influenza vaccination among health care professionals is to make it convenient, both from a cost and an availability standpoint. Convenience is often cited as a reason that the general public gives for not seeking a flu shot. Consumers are often too busy to make time to take preventative care measures. In addition, the cost of getting a flu shot can become prohibitive. Health care professionals are no different in their demand for greater convenience. By taking the vaccine directly to health care workers, by making it affordable, or by offering vaccine clinics at various times, major barriers to getting immunized are removed.

As mentioned earlier, educating health care workers and dispelling myths about the flu and flu immunization can also be a strong motivator. It’s essential that every health care worker know some basic facts about flu immunization: 1) influenza virus is easily transmitted and by avoiding immunization, health care workers put their patients at unnecessary risk; 2) injectable vaccine cannot cause influenza; 3) the CDC specifically recommends influenza vaccination for health care workers.

Flu vaccination among health care workers makes sense from both a public health and an economic point of view. In getting an annual flu vaccine, health care workers not only protect their vulnerable patients, they also protect themselves and their families from the serious morbidity and mortality associated with influenza.

With 60 million Americans succumbing to flu each year, getting a flu shot is a simple and highly effective way to help safeguard your health. Health care workers need to be advocates of this serious and important cause, not just by encouraging their patients to get immunized but by stepping up to the plate themselves.

About CSL Biotherapies

CSL Biotherapies is a subsidiary of CSL Limited, which operates one of the world’s largest influenza vaccine manufacturing facilities for supply to global markets. CSL Limited has more than 90 years of experience in developing and manufacturing vaccines, with over 40 years’ influenza vaccine experience. With US corporate offices located in King of Prussia, Pennsylvania, CSL Biotherapies is a new name in the US influenza vaccine market. For additional details on CSL Biotherapies in the United States, visit www.cslbiotherapies-us.com.

Paul Perreault, Executive Vice President of Commercial Operations,
CSL Biotherapies

References:

1. Fact sheet: Key facts about influenza and the influenza vaccine. Centers for Disease Control website. Available at: http://www.cdc.gov/flu/keyfacts.htm. Accessed September 22, 2007.
2. Estimated cancer deaths for selected cancer sites by state, US, 2007. American Cancer Society web site. Available at: http://www.cancer.org/downloads/stt/CFF2007EstDthSelSiteByState. Accessed September 22, 2007.
3. Basic statistics. Centers for Disease Control web site. Available at: http://www.cdc.gov/hiv/topics/surveillance/basic.htm#ddaids. Accessed September 22, 2007.
4. National Health Interview Survey (NHIS), United States, 2004.
5. Fiore AE, Shay DK, Haber P, et al. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices. MMWR. 2007;56 (Early release):1–54.