Infection Control Today - 06/2004: Perspectives

Improving Influenza Immunization Rates Among Healthcare Workers
A Public Health Imperative

By Jeanne Pfeiffer, RN, MPH, CIC, and Barbara Soule, RN, MPA, CIC Jeanne Pfeiffer Barbara Soule

Influenza immunization rates among healthcare workers remain unacceptably low. On average, only 36 percent are immunized each year, despite long-standing recommendations by the Centers for Disease Control and Prevention (CDC) for all healthcare workers to receive an annual vaccination.1

The Association for Professionals in Infection Control and Epidemiology (APIC) is taking a strong stand on this public health issue. APIC has issued new recommendations that call on healthcare facilities to develop and implement comprehensive influenza vaccination programs for employees. APICs recommendations (published in the May issue of the American Journal of Infection Control) also provide specific guidance on strategies that can help institutions improve their programs and immunization rates.

Research shows healthcare workers, in particular, are at an increased risk for contracting influenza due to contact with ill patients. Further, infected healthcare workers can spread the influenza virus to patients in their care, many of whom may be at high risk for influenza-related complications.1

Vaccination is the primary means of reducing influenza transmission and preventing infection by the influenza virus. Influenza causes an average of 36,000 deaths and 114,000 hospitalizations annually.1

Healthcare workers encounter patients throughout the influenza season in a variety of settings, including medical practices, general hospitals, specialty hospitals, pediatric hospitals, long-term care facilities, emergency departments, ambulatory care settings, rehabilitation facilities and home-care sites. Institutional influenza outbreaks can have serious consequences for both patients and healthcare workers.

Not only do outbreaks put patients at risk of contracting influenza, they can exacerbate existing staff shortages, limit admissions and increase healthcare costs. Healthcare workers also tend to work through or return to work sooner during illness, thus increasing the likelihood of transmitting the virus to patients and co-workers.

Infection control professionals can play a critical role in helping institutions improve healthcare workers influenza immunization rates, by educating staff regarding the CDC recommendations. At this time, many institutions do not have formal mandatory influenza control policies in place to ensure workers are immunized and to protect patients. This has been a voluntary program in hospitals for a number of years. APIC hopes this position paper will serve as a tool for implementing immunization plans in these facilities.

In January 2004, APIC initiated a multi-faceted initiative aimed at increasing influenza immunization rates among healthcare workers. As a key step in this initiative, APIC is completing a membership survey to assess the state of employee influenza immunization programs at members institutions across the country.

In addition, APIC is developing new resources for infection control professionals and other healthcare workers that will help facilitate the implementation of formal influenza control policies. APICs initiative, including the survey results and new professional resources, will be highlighted at its 31st Annual Educational Conference to be held in Phoenix on June 9, 2004.

APICs position statement on healthcare worker influenza immunization, as well as additional information on the program are available online at

Jeanne Pfeiffer, RN, MPH, CIC, is president of APIC. Barbara Soule, RN, MPA, CIC, is immediate past-president.

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