Feb 13, 2006 (CIDRAP News) – The Centers for Disease Control and Prevention (CDC) issued new recommendations last week in an effort to push the percentage of healthcare workers who receive influenza shots above the 40% range, where it has been stalled for years.
Among other things, the agency recommended that healthcare facilities offer free flu shots annually to workers on every shift, monitor flu vaccination coverage regularly during the flu season, and obtain signed forms from those who give nonmedical reasons for refusing a shot.
"The new recommendations provide strategies to make vaccine more accessible to healthcare workers and to help facilities better determine coverage rates and the reasons their staff have for not getting vaccinated," the CDC said in a news release.
In the interest of protecting both patients and workers, the CDC routinely includes healthcare workers in the general flu immunization recommendations it issues each year. The new recommendations are intended to help healthcare facility administrators, infection control professionals, and occupational health specialists boost immunization rates in their institutions.
Flu immunization coverage among healthcare workers was only about 10% as recently as 1989, the report says. The rate improved to roughly 40% in the ensuing few years, but it has remained "relatively constant" since 1997, it states. One of the government's health objectives is to raise flu-shot coverage among healthcare workers to 60% by 2010.
The new recommendations were prepared by the Healthcare Infection Control Practices Advisory Committee and the Advisory Committee on Immunization Practices. They recommend that healthcare facilities:
- Educate employees about the benefits of flu immunization and the risks of flu for themselves and their patients
- Offer vaccine each year to all eligible employees in order to protect them, their patients, and family members and to reduce absenteeism
- Provide free flu shots on site during all shifts and use strategies such as mobile carts and modeling and support by leaders
- Obtain a signed "declination form" from employees who refuse a flu shot for reasons other than medical contraindications
- Monitor flu vaccination coverage and refusals at regular intervals during the flu season and provide staff and administrators with information on rates by wards, units, and specialties
- Use flu immunization rates "as one measure of a patient safety quality program"
The CDC document cites various studies to support most of the recommendations. But it says that the effect of signed declination statements on immunization rates has not been studied. Using such forms, the agency says, can help facilities identify workers "who might require targeted education or other interventions to overcome barriers to vaccine acceptance." The practice would also help facilities monitor how many employees are offered vaccine.
How many healthcare facilities currently offer free flu shots or ask for signed refusal forms is unclear. The CDC, the Association for Professionals in Infection Control and Epidemiology, and the Minnesota Department of Health (MDH) all said they were unable to provide such information.
Doug Schultz, a spokesman for the MDH, said the department sent a flu-shot declination form to healthcare facilities last fall and plans to do a follow-up survey to find out how many used the form.
The percentage of facilities that offer free shots "is probably something we need to get a handle on, because of the CDC recommendations and because we do want healthcare workers to get vaccinated," Schultz said.
Researchers have found that the leading reason healthcare workers refuse flu shots is fear of side effects, followed by inconvenience and perceived ineffectiveness of the vaccine, according to the CDC report.
The report says that as of January 2005, 13 states had passed laws concerning flu immunization for staff members in long-term-care facilities. But the effects of the laws are not yet clear, because only one state, Pennsylvania, has monitored them, the agency says.
Last October the federal government began requiring nursing homes that serve Medicare and Medicaid recipients to offer flu shots to all residents. But the rule did not require vaccination of staff members.
CDC. Influenza vaccination of health-care personnel: recommendations of the Healthcare Infection Control Practices (HICPAC) and the Advisory Committee on Immunization Practices (ACIP). MMWR 2006 Feb 9 (early online release) [Full text]
Feb 9 CDC news release