Health care workers play a vital role in providing influenza vaccinations, but too many of those workers don't protect themselves, their patients and their co-workers from a disease that kills an average of 36,000 Americans a year.
It's a longstanding problem that can persist even when health care institutions go on the offense, introducing a variety of immunization campaigns that specifically target health care personnel.
A June 2006 literature review of 32 influenza immunization programs conducted between 1985 and 2002 in the United States, Canada and Europe found that vaccination rates among health care workers ranged from as low as 2.1 percent to a high of 82 percent; the majority of such campaigns achieved rates of less than 50 percent.
A 2004 report(www.nfid.org) from the National Foundation for Infectious Diseases, or NFID, cited a 2003 CDC report stating that only 36 percent of the nation's health care workers were vaccinated against the annual flu, and that lack of immunization had been a source of flu outbreaks in health care settings.
The NFID report said health care workers should be provided convenient, affordable access to influenza vaccine, and employers should demonstrate that immunization is a safety priority for patients and workers.
When the NFID updated its report in 2008(www.nfid.org), flu vaccination coverage among health care workers showed only modest improvement at 42 percent in both 2004 and 2006.
Doug Campos-Outcalt, M.D., M.P.A., the AAFP's liaison to the CDC's Advisory Committee on Immunization Practices, or ACIP, said health care workers need to be educated and motivated.
"Vaccine is usually covered by insurance," said Campos-Outcalt, who is associate head of the department of family and community medicine and assistant dean for outreach and multicultural affairs at the University of Arizona College of Medicine, Phoenix. "The issue for health care workers is not usually cost. It is seeing it as important."
The updated NFID report said top managers and administrators of practices and health care facilities should be strong advocates of vaccination to improve infection control and reduce absenteeism.
AAFP President Ted Epperly, M.D., of Boise, Idaho, said the Family Medicine Residency of Idaho, where he is program director and CEO, has achieved annual influenza vaccination rates of more than 90 percent in each of the past two years among its 145 employees.
"We talk with them and educate them," Epperly said. "We do this with handouts, information on our FMRI Web site, and I personally talk with the group as a whole. Employers do not emphasize the importance of this enough. They do not advocate, educate and market enough internally to their people. All employers need to make this a priority as they approach flu season."
Education of health care workers includes dispelling myths about the flu and the flu vaccine. A study(cdc.confex.com) from the County of San Diego Health and Human Services Agency Public Health Services Immunization Branch found that health care workers reported several unfounded reasons for not receiving the vaccine, including that they
- thought they wouldn't get the flu because they were healthy;
- didn't know they were in a group recommended for vaccination;
- feared side effects or becoming ill from the vaccine; and
- thought the vaccine was ineffective.
According to the 2008 NFID report, immunization of health care workers significantly reduces the risk of outbreaks in all types of health care facilities and is 70 percent to 90 percent effective in preventing infection in healthy individuals ages 65 and younger.
But health care workers still don't appear to have embraced the message.
A study published in the March 2009 issue of Family Medicine(www.stfm.org) looked at three different family medicine practices. In one, the lead physician assumed his staff understood the importance of flu immunization, but none of the clinical support staff sought immunization. Four medical assistants told researchers that the vaccine was possibly harmful and certainly unnecessary.
Although all eight physicians in that practice were immunized, only one of the other seven staff members received the vaccine.
In a second practice, the vaccine was given to employees free of charge, immunization was promoted by the office manager, and the annual vaccinations were considered a routine part of working there. As a result, the vaccination rate was 100 percent.
In a third practice, immunizations were provided free to staff members who worked directly with patients but not to other employees. Still, only one of five clinical workers received the vaccine, and only one of six administrative workers was vaccinated.
Finally, a study(cdc.confex.com) from the Maryland Partnership for Prevention found that 90 percent of health care facilities surveyed in that state in 2007-08 promoted flu immunization to employees through posters, flyers or other means, and 95 percent offered free vaccinations. Sixty percent of the facilities had standing orders for vaccination, and 88 percent ask noncompliant employees to sign a declination form.
Campos-Outcalt said that declination forms can help increase vaccination rates, "but not as much as making it a requirement."