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Feedback and follow-up strategy for vaccinating HCWs

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Feedback and follow-up strategy for vaccinating HCWs . Jonathan A. McCullers, MD Associate Member Department of Infectious Diseases St. Jude Children’s Research Hospital Memphis, TN. Vaccination of HCWs.

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feedback and follow up strategy for vaccinating hcws
Feedback and follow-up strategy for vaccinating HCWs

Jonathan A. McCullers, MDAssociate MemberDepartment of Infectious DiseasesSt. Jude Children’s Research HospitalMemphis, TN

vaccination of hcws
Vaccination of HCWs
  • CDC, ACIP, AAP, AAFP, SHEA, and HICPAC recommend vaccination be given free of charge through an at-work program to all personnel in health care facilities
  • particular emphasis should be placed on those taking care of high risk patients
  • Overall vaccination rate in the U.S. was only 34% in 1997, 36% in 2001, and 42% in 2005

ACIP, MMWR, 2007;56:1-54

flu vaccination at st jude
Flu vaccination at St. Jude
  • I took over Infection Control in 2002
  • Intensive education campaign in 2003
why are hcw vaccination rates so low
Why are HCW vaccination rates so low?
  • is there recognition of the problem?
  • convergence of Occupational Health and Infection Control; are we protecting the employee or the patient?
  • has not made the transition to being a “mandatory” control measure such as measles vaccine, Hepatitis B vaccine, TB skin tests
  • in an environment where employee choice rather than institutionally mandated compliance dictates acceptance rate, do attitude towards and education about the vaccine matter?
reasons for rejecting the vaccine
Reasons for rejecting the vaccine

General Medical Staff

- the vaccine will make me sick

- I don’t get sick and don’t need the vaccine

- the shot is painful

- the vaccine doesn’t work

M.D. Housestaff

- too busy

- offered at inconvenient time

- fear of side effects

- I don’t get sick and don’t need the vaccine

Steiner M et al., Infect Cont Hosp Epidemiol 2002;23:625-7.

Manuel DG et al., Infect Cont Hosp Epidemiol 2002;23:609-14.

Lester RT et al., Infect Cont Hosp Epidemiol 2003;24:839-44

reasons for accepting the vaccine
Reasons for accepting the vaccine

General Medical Staff

- I do not want to miss work

- It was convenient

- It’s free

- I do not want to put patients at risk

M.D. Housestaff

- I do not want to get the flu

- I do not want to put patients at risk

- I do not want to put my family at risk

- I do not want to put colleagues at risk

Steiner M et al., Infect Cont Hosp Epidemiol 2002;23:625-7.

Manuel DG et al., Infect Cont Hosp Epidemiol 2002;23:609-14.

Lester RT et al., Infect Cont Hosp Epidemiol 2003;24:839-44

attitudes about the vaccine
Attitudes about the vaccine
  • reasons for health care workers accepting or rejecting the vaccine are centered around the employee, not the patient
  • general staff are more likely to base the decision on incorrect information or beliefs
  • doctors are more knowledgeable about the vaccine, are in general more willing to get the vaccine, but frequently cite time and convenience constraints
hcws improving compliance
HCWs – Improving compliance

Three keys to a successful vaccination program:

1) Education

2) Accessibility

3) Feedback and follow-up

McCullers JA, et al., Inf Cont Hosp Epi, 2006;27:77-9..

hcws improving compliance10
HCWs – Improving compliance

Three keys to a successful vaccination program:

1) Education

  • Facility wide campaign
  • Focus on general staff, on benefit to employee
  • Book time at every meeting possible (faculty, clinical staff, nursing administration, “town hall meeting,” etc.)
  • Email, newsletters, posters, buttons, etc.

McCullers JA, et al., Inf Cont Hosp Epi, 2006;27:77-9..

hcws improving compliance11
HCWs – Improving compliance

Three keys to a successful vaccination program:

2) Accessibility

  • Extended availability - season long effort (August start?)
  • Go to the HCW (meetings, all shifts, weekends)
  • Take advantage of intermediaries
  • Make allowances for difficult groups (doctors)

McCullers JA, et al., Inf Cont Hosp Epi, 2006;27:77-9..

hcws improving compliance12
HCWs – Improving compliance

Three keys to a successful vaccination program:

3) Feedback and follow-up

  • Review list of non-vaccinated employees weekly
  • Weekly reminders to supervisors with list of non-vaccinated employees (iterative process)
  • Central authority figure to add pressure to comply; buy-in from administration is key
  • Put pressure on employee to make active decision, instead of allowing passive avoidance
  • Continue until goals are met

McCullers JA, et al., Inf Cont Hosp Epi, 2006;27:77-9..

st jude vaccination rates
St Jude Vaccination Rates
  • Implemented feedback and follow-up program in 2004
  • Now expanding to use in TB screening program

McCullers JA, et al., Inf Cont Hosp Epi, 2006;27:77-9..

changes this year and next
Changes this year and next
  • Declination statement with reason for refusal added this year (state law)
  • Altered contract for all new hires 3 years ago to include statement that all employees must abide by all Infection Control and Occupational Health Policies and Procedures or be subject to termination
  • Planning to make vaccination mandatory next year
  • Planning to offer FluMist as soon as available each season (July/August?); Flu shot administration to start in October each year
final thoughts
Final thoughts
  • Vaccination rate is directly related to amount of energy put into the program
  • Buy-in from administration is key!
  • Culture of acceptance will tend to pull good rates up over time making them better rates
  • Take advantage of the live attenuated intranasal vaccine (FluMist) to increase compliance
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