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Immunization of Healthcare Workers
Case for Change
The Centers for Disease Control for many years has recommended an annual influenza immunization for health care workers (HCWs). The Joint Commission on Accreditation of Healthcare Organizations recently announced the approval of an infection control standard that requires accredited organizations to offer influenza vaccinations to staff, volunteers, and licensed independent practitioners with close patient contact. The standard became an accreditation requirement beginning January 1, 2007, for the Critical Access Hospital, Hospital and Long-Term Care accreditation programs. Despite the overwhelming support, the national annual influenza immunization rate for HCWs remains around 40%.
Studies show that influenza causes an average of 36,000 deaths and over 200,000 hospitalizations in the United States each year. Furthermore, healthcare-associated transmission of influenza has been documented among many patient populations in a variety of clinical settings, and infections have been linked epidemiologically to unvaccinated health care workers. With recent increased awareness of influenza due to worries about a possible pandemic, the time is right to continue to strongly promote the immunization of all HCWs.
The Iowa Healthcare Collaborative (IHC) currently has a web-based reporting tool for tracking Influenza Vaccination Among Health Care Workers (contact is Kathy Trytten, Director, Information and Quality Management, tryttenk@ihaonline.org). The aggregate total percentage of hospitals reporting this metric will be included in the 2007 Iowa Report. The employee influenza vaccination target with this measurement technique is 95% by 2010. The 2007 measurement will serve as a baseline for increasing Iowa influenza vaccination among healthcare workers.
Project Description
Objectives
The objective of this program is to increase healthcare worker annual influenza immunization rates to 95% by 2010. The program will consist of many components including the recommendation of the Association for Professionals in Infection Control and Epidemiology's (APIC) "Protect Your Patients. Protect Yourself" program to expand health care worker immunizations.
Critical Success Factors
- Leadership buy-in
- Endorse and promote APIC Influenza Toolkit
- Make vaccination easily accessible
- Develop a physician/clinical champion
- Accurately track immunizations given and declination of participation
- Develop an organizational plan to coordinate all critical success factors
Project Team
The work group included the efforts of many dedicated professionals. IHC wishes to thank the following:
- Terry Flander, DO, Principal Financial Group and Des Moines University MPH student
- Kathy Trytten, Iowa Hospital Association
- Dixie Kramer, RN, Waverly Health Center
- Iowa Immunization Coalition
- Bill Farmer, Allen Memorial Hospital
- Tom Evans, MD, Iowa Healthcare Collaborative
- Infection Control Professionals from Iowa Hospitals
- Sandy Peno, Iowa Methodist Medical Center
- Brenda Schwan, BSN, Winneshiek Medical Center
- Christie Milligan, RN, BSN, Skiff Medical Center
Tool Kit
Association for Professionals in Infection Control and Epidemiology (APIC) “Protect Your Patients, Protect Yourself” Influenza Vaccination Toolkit
Declination Form (PDF 65KB)
A statewide consent/declination form was created based upon a variety of hospital organizations who shared their consent/declination forms. Organizations are urged to adopt this form as a standardized measuring tool for health care worker influenza immunization rates.
Resources
Websites
Success Stories
Winneshiek Medical Center, Decorah, IA
At a meeting of our Medical Staff in March of 2006, I had reported that 67% of our healthcare workers had been vaccinated during the fall of 2005. Although this % was very good compared to the national average, we had a few physicians that wanted it higher. As a result, our Medical Staff recommended all employees of Winneshiek Medical Center (WMC) be required to receive the influenza vaccination in the fall of 2006.
I felt encouraged to have the support of the medical staff, but was also concerned about my approach to the employees without a specific mandate from either CDC or IDPH. After discussion with the Eastern Iowa APIC group, the HR Manager and the Chief Nursing Officer, I went back to a Medical Staff meeting in September of 2006 asking for a revision in the recommendation given in March.
After much discussion regarding concern for the patients we care for and our employees, the revised recommendation was put in to place. The new recommendation was that anyone giving direct patient care or working in a direct patient care department would be required to receive an influenza vaccination or sign a declination form.
The declination form required them to acknowledge facts about the influenza vaccination as well as report their reason for refusal of the vaccination. The declination form was completed in my office in a one-on-one visit with the employee. This gave me a great opportunity to provide further education and to answer any questions. Dr Brian Dougan requested that he be able to present his Infuenza Risk power point and question and answer time for anyone wanting to sign the declination. Dr. Dougan's information and power point were very good and he presented in such a way that it was humorous and , light but very serious. He did a great job!
As a facility, we provided many opportunities.
- Employees could receive a vaccination in any of the patient care areas at any time of day.
- Influenza vaccination clinics were available in the cafeteria and overlapped with lunch and shift changes.
- Each person receiving the influenza vaccination got a keychain with our logo on one side and the CDC logo on the other side that had the triangle with the "I got my flu vaccine" words.
- Each person got a sticker that said, "I got my flu vaccine." It worked like a billboard for others and was a good reminder when someone would see them wearing the sticker.
- Each department that reached 100% participation (if there was an allergy or doctor's excuse it did not count against them) was put in a drawing for a pizza party. (Housekeeping won!)
- All department managers were sent letters outlining expectations and the rules for the pizza party contest.
- Information was readily available about how we can protect our patients by getting the influenza vaccine, where and when the vaccine is available, etc.
- Posters were hung in all departments.
- All department managers were given weekly updates on their numbers (did not include specific names of employees although some tried to get it out of me).
- We had a big poster in the cafeteria where I recorded, on a weekly basis, the number of employees receiving the vaccination and our percentage. The public was allowed to see this also.
- WMC's marketing department ran an article in the local newspapers about the importance of influenza vaccination and what our expectations were for our employees.
- We ran an article at the end of the campaign that reported our 96% stat and how much our employees care about our patients.
Our final result was that 247 out of 257 direct patient care givers received the influenza vaccination for a total rate of 96% of healthcare workers. 91% of all WMC employees received the vaccination.
Dr Dougan wants mandatory vaccination to be a requirement of employment for the direct patient care worker. However, we are not quite there yet. Dr. Dougan says, "If we are going to protect our employees from Hep B, Measles, Mumps, and Rubella, chicken pox, why would we not want to protect them from influenza?" He has a point.
Key Factors:
- Education for employees
- Providing vaccinations everywhere for the employees
- Medical Staff involvement
- Physician Champion
- Competition-pizza party
I am proud of our accomplishments here at WMC! It took the support of many people, Medical Staff, Administration, Board of Trustees, Dept. Managers, HR etc. Dixie Kramer from Waverly Health Center was my mentor in the process and a great help to me especially in the time between March 2006 and September 2006. In the past years, I had been out there by myself promoting this but this year the pressure was off because our employees knew it was the right thing to do. It really was easier this year once we were up and running - they all knew the expectations.
Brenda Schwan BSN
Winneshiek Medical Center
Infection Control and Prevention
Employee Health
Skiff Medical Center, Newton, IA
We have implemented numerous programs over the past several years including Influenza Immunization clinics at various times throughout the day and weeks and roaming Influenza Immunization carts. We worked with Infection Control and handed out token gifts to all participants and gave hand sanitizers only to employees who did not take the influenza vaccine. All of these efforts included education through flyers, posters, and articles in our hospital newsletter.
Our highest success rates were in the past 2 years. Skiff Medical Center had an influenza immunization rate of 81% of all healthcare workers for the 2006 season. All employees were required to sign a consent form for the vaccine as usual but we added the requirement to sign a declination form if not receiving the vaccine. The most beneficial change included in this process was our practice to allow employees to give the vaccine to each other in their own departments/on their shift. This was very well received and we were given very positive feedback with a result of increased immunization rate. Each department was given a sign-up sheet to determine how many vaccines and supplies to send out.
We assisted non- nursing departments in identifying a potential nurse in their area who was willing to administer the vaccine and then worked with that nurse on the process. If there was not a nurse available in their vicinity, we offered options of coming to a department meeting. Other options included reserving a time for their department to get their vaccines in the Occ Health Clinic. Peer pressure is a benefit. One department even held a potluck in their department during their shot week.
This year we hosted a tailgate party theme. Our posters and communication revolved around this theme also. We designed a big scoreboard in the hallway with the teams "Skiff Medical Center vs the Flu." We updated the score periodically with the number of employees that were receiving the flu vaccine. If an employee received a flu shot, they were given a coupon to be redeemed at the tailgate party held at the end of the campaign. We worked with Nutrition Services and had a chili bar in the cafeteria with all the fixings. Their coupon was redeemed for a bowl of chili and also entered into a drawing. The OHS staff carried the theme out with decorations and set up a table with munchies and served the employees. The snacks were shared with all shifts and coupons could be redeemed later if they could not attend that day. Captions along with facts about the flu were used on posters. The posters included phrases such as: "Does our team have what it takes to beat the flu?", "The best offense is a good defense – get your flu shot!", "Join the Skiff Team in the fight against the flu!" We also had pennants that said, "GO SKIFF! BEAT THE FLU!" We turned it into a party and celebration.
Christie Milligan, R.N., B.S.N.
Director,Occupational Health & Infection Control Women's Health Services Coordinator
cmilligan@skiffmed.com
Phone:641-791-4880
Fax: 641-787-3093
Waverly Health Center, Waverly, IA
WHC Recognized in 2007 National Immunization Excellence Awards
The National Influenza Vaccine Summit has announced the recipients of the first Annual National Influenza Vaccine Summit (NIVS) Immunization Excellence Awards. The awards recognize individuals and organizations that have made extraordinary contributions towards improved adult and/or child influenza vaccination rates within their communities.
Waverly Health Center (WHC) received runner-up recognition in the Healthcare Worker Campaign category for demonstrating an innovative approach to increase influenza vaccination rates through their 2006 FluBuster Employee Vaccination Campaign.
"Waverly Health Center is fortunate to have an excellent infection control department who actively takes control of influenza," said Dr. David Rathe, infection control committee director. "I commend all staff members at Waverly Health Center for their commitment in keeping themselves well and in protecting the patients they serve."
WHC's FluBuster committee members teamed up with employee health to create a "Vaccine Mobile" which traveled to all departments throughout the week offering both the injectable flu vaccine and the FluMist (nasal) vaccine. Detailed vaccine information sheets were posted and "Myth Buster" cards were made available in every department to help dismiss any concerns regarding flu vaccinations. Staff members were photographed and included on posters which were displayed throughout the health center encouraging others to be a FluBuster.
Paycheck stuffers were inserted into all paychecks with stickers that contained the "Be a FluBuster!" campaign logo. After staff members received their vaccination, they each received a sticker that said "I'm a FluBuster!" A caramel apple sundae party was given for all staff members who received a flu vaccination.
"This recognition is a tremendous honor and I know Waverly Health Center can achieve a voluntary 98% staff vaccination rate with more education," stated Dixie Kramer, infection control and occupational health manager. "In the future, I would like to have a physician from our Infection Control committee present information to help educate staff about the influenza vaccine, including its effectiveness and safety, to dismiss any myths individuals may have."
Virginia Mason Medical Center (Healthcare Worker Campaign award winner) had instituted a mandatory influenza immunization policy and achieved a 98% staff vaccination rate while Waverly Health Center achieved a voluntary 94.8% staff vaccination rate. The recognition is a great honor for WHC and exemplifies their commitment to protecting the patients they serve.
Montgomery County Memorial Hospital, Red Oak, IA
The rate for our hospital was the best it has ever been. Here are some of the things that worked for us:
- We offered the vaccine 24 hours per day in our E.D. for anyone who couldn’t come to one of the clinics.
- We ran clinics several hours a day in the conference room by our cafeteria and offered the influenza vaccination to employees and volunteers for a 2-3 week period.
- We offered fun size candy bars to all individuals who got their vaccine.
- Each vaccinated person received a sticker that said, "I got my flu shot today."
- Names of those who got their vaccines were put in a drawing for $25 gas cards, Chamber of Commerce bucks, or a gift certificate to a favorite local restaurant.
- Multiple reminders were put in the employee newsletter.
- We sent e-mails to all employees about the importance of flu vaccines with facts about why getting the vaccine is important.
- A visual was provided so employees could see our progress. A bulletin board with a big syringe drawn on it tracked employee immunization rates each day. The syringe was colored as we reached our goal.
- We conducted an e-mail survey asking those who do not usually get the vaccine why they did not get it. We targeted education efforts in those areas.
- One-on-one counseling and education was offered to those who did not get the vaccine.
Submitted by: Holly Crowell, RN, CPHQ
Mentor Hospitals
The following professionals have agreed to serve as mentors for organizations developing a health care worker influenza immunization program. These organizations currently have successful programs. Please utilize these mentors for questions or advice in developing a program. The IHC sincerely thanks these mentors for undertaking this role.
Waverly Health Center, Waverly, IA
Dixie Kramer
Infection Control, Employee & Occupational Health
(319) 352-4948
Dkramer@WaverlyHealthCenter.org
Iowa Health Des Moines
Sandy Peno, RN, CIC
Infection Control Department
Nurse Epidemiologist
(515)-241-6619
penosm@ihs.org
Allen Memorial Hospital, Waterloo, IA
Bill Farmer
(319) 235-3941
farmerbw@ihs.org
Winneshiek Medical Center, Decorah, IA
Brenda Schwan, BSN
Infection Control Professional
Employee Health Nurse
(563)-387-3133
schwanb@winmedical.org
Skiff Medical Center, Newton, IA
Christie Milligan, R.N., B.S.N.
Director Occupational Health and Infection Control
(641)-791-4880
cmilligan@skiffmed.com
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