In the 2016–17 flu season, government investigators found a series of promising statistics: In hospitals, vaccination coverage reached roughly 90% or more for various occupational groups, from physicians and nurse practitioners to assistants, aides, and nonclinical staff. The study1, published in the US Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report, also found that employer requirements and complimentary vaccinations were connected to greater vaccination rates.
But still, by that study’s numbers, vaccination coverage failed to reach roughly 10% of personnel. Outside hospital settings, the figures were even larger depending on the specific occupational group.
So, how can infection preventionists build a strategy to ensure that their healthcare workers—and, by extension, their patients—are prepared to ward off infection and illness? To find out, we spoke with Alma Jackson, PhD, RN, COHN-S, education director for the American Association of Occupational Health Nurses, who shined a light on where vaccination efforts are falling short and how infection prevention teams can improve the outlook.
Infection Control Today: What’s at stake when healthcare workers fail to receive vaccinations or prepare for respiratory season?
Alma Jackson: They get sick, and then they get everybody else sick.
For people who work in a hospital with acute care and even long term, there are certain vaccinations that are mandated by the health department. And I think it’s pretty equivalent between the states as far as the need to get measles, mumps, and rubella and a hepatitis B fighter or vaccination series. That way, you’re protected at least against hepatitis B if you get stuck with a dirty needle, but not HIV because there’s nothing else out there.
Since we’re ramping up for flu season, that’s the biggest concern right now. And so, the US Centers for Disease Control and Prevention extended the mandate that if you are working around patients and you don’t get the flu shot, you have to wear a mask all the time when you’re around patients, delivering patient care, because the flu is so easy to transmit.
ICT: What do infection preventionists need to incorporate into their strategy to ensure that healthcare workers are up to date on their vaccinations and beyond?
AJ: Sometimes it’s really just the mandates that get people in.
The last time I was doing the whole flu vaccine program at a hospital, people were given until Dec. 31 to get it or they could not work. You would be surprised at the number of people who just don’t take the time to get it. So, if you do the adult learning theory—what’s in it for me?—it’s not always the fact that you’re going to be well, but you also get to work.
And then it’s critical to provide updates, which happen all the time during the flu season, like from the CDC on the prevalence of flu in your area. Depending on how motivated people were, we would have drawings for things.
ICT: Hospitals face unique challenges heading into respiratory illness season. How can infection prevention teams stay ahead of the game?
AJ: Ironically, you have to order the flu vaccine months and months and months in advance to be able to get enough doses for your employees. We don’t really have control over whether it’s the right vaccine because we’re not the ones who create the makeup of how much is influenza A or B or any of the strings that are out there. So, I think just getting everything ready, announcing it months in advance, is key.
The Occupational Health Association is doing a webinar on flu that we’re already working on for next year in September. You need to ramp up people’s information and get them thinking about it, because otherwise they’ll forget to get a flu shot.
ICT: What common oversight have you seen in infection prevention plans for occupational safety regarding vaccinations and respiratory illnesses? What can we be doing better?
AJ: We’re actually not doing a bad job. The thing that sometimes falls through the cracks with vaccinations in general, is if there’s a series of three, like the hepatitis B, often people will fail to get the second or third one. And if they don’t get it on a timely basis, then they’re not going to develop the immunity for it. So, if you’ve got a large hospital system and you have some computer malfunction, then it’s pretty hard to track some of that stuff. Same thing with measles, mumps, and rubella and chicken pox.
And then with the flu shot, a lot of people don’t know that there is a different shot for people who are over the age of 65, and it boosts the immunity more. The AAP recommends FluMist Quadrivalent as a vaccination option for the 2019-2020 influenza season and advises families to vaccinate their children against influenza with either the flu shot or the nasal spray vaccine. So, sometimes it’s also really hard to keep current and keep up to date with the latest information that comes out.
ICT: So how can infection preventionists overcome the challenges that you just described?
AJ: Sometimes it’s pulling teeth to get people to return for vaccines. In a hospital, after two emails, we notify the supervisor. And then, if that doesn’t work, then they can’t work.
I don’t know why some people are cavalier about it. If you look at epidemiology maps of places that are not in agreement with vaccines, like Boulder, Colorado, there are obviously more cases of measles, mumps, and rubella. You’ve heard of chicken pox outbreaks on the news. So, there’s that way of thinking, where people just don’t want to get them or get them for their kids.
The other part of it is that they just dismiss it as being unimportant. But if you’re going to work with patients, you’ve got to keep yourself healthy.
ICT: What does a strong infection prevention education campaign for healthcare worker vaccinations look like?
AJ: Policies and procedures, which sound very boring, but they work. Also, of course, guidelines change, not often but often enough that to have an algorithm for what kind of vaccines people need is helpful. So, you have to have that first in order to be able to give the right stuff.
Say that they got the hepatitis B vaccine, and you draw it tighter because it’s been a while since they had it, and then they’re negative again. How many doses do you need to give them in order for them to boost their immunity? That algorithm can help.
And then, people on units can encourage each other to get vaccinated. Hospitals can also launch incentive programs where the first unit that has everyone vaccinated gets something.
Even if people aren’t cavalier about it, they still have to leave the unit to go get a shot or go visit their local Walgreens to get a shot. A lot of times, what we ended up doing was taking a flu cart to the floor for people who could never get away. Then we would give vaccines on the unit where they were working.
ICT: How should infection preventionists personalize their educational messaging to suit specific target audiences, whether it be certain specialties or, say, environmental services workers?
AJ: A lot of the educational information is still delivered on a sixth-grade reading level, because it has to be, which is unfortunate.
Often around here and probably a lot of the United States, it can also be translated in Spanish or another language, depending on whatever your minority population is speaking, like navigational signs in an airport. If you can offer a class to your minority population—which is usually maintenance workers and housekeeping—offer it in Spanish so that they understand it better. And then we also have the consent forms and the information about it in Spanish, too.
ICT: Do you have any final advice for infection preventionists as they head into this flu season?
AJ: Have plenty of stock of vaccines, masks, Band-Aids, alcohol wipes, and intramuscular needle sizes if they use the multidose vial. And just be ready for long days.
1.Black CL, Yue X, et al. Influenza Vaccination Coverage Among Health Care Personnel — United States, 2016–17 Influenza Season. MMWR Morb Mortal Wkly Rep 2017;66:1009–1015. DOI: http://dx.doi.org/10.15585/mmwr.mm6638a1