Intervention increased vaccination rates by nearly 20% in HCWs

Cadena J. Infect Control Hosp Epidemiol. 2011;32:616-618.

A quality improvement project led to an almost 20% increase in influenza vaccination rates among health care workers at the University Health System in San Antonio, according to new findings published in Infection Control and Hospital Epidemiology.

“Rates were consistently below 60% at University Health System (UHS) during the previous three influenza seasons (45% between 2006 and 2007; 58.5% between 2007 and 2008; and 58.8% between 2008 and 2009), despite educational programs, free vaccination in the work place, and yearly vaccination campaigns,” the researchers wrote in the study.

Jose Cadena, MD, of the department of medicine at the University of Texas Health Science Center, and colleagues created a quality improvement team of employee health, infection prevention, corporate communications, nursing, and medical executive board leadership to increase rates among 5,155 health care workers (HCWs).

Approximately 83% of HCWs received vaccination and 17.1% declined, according to the researchers.

The HCW vaccination rate increased from 58.8% to 76.6% — a 17.8% increase during the 2008 and 2009 influenza season (OR=2.7; 95% CI, 2.5-2.97). Although the researchers’ goal of increasing vaccination rates by 80% was not achieved, the increase placed UHS above the national average for HCW vaccination, according to a press release.

Of those who declined vaccination, 2.3% were concerned about getting influenza; 1.4% were concerned about adverse events; 1.1% had doubts about the effectiveness of the vaccine; and 10.2% reported “other reasons.”

The team created an intervention to combat these common reasons for declination:

• Extended distribution of vaccine kits to UHS units (kits included instructions, vaccines, syringes, gloves, and other supplies; consent and screening forms; vaccine information sheets; and employee list; and educational fliers).
• Grand-round presentations.
• Campaign announcements to unit directors.
• Development of a UHS influenza website.
• Screensavers.
• Emails.
• Phone messages.
• Enhanced staff awareness.

“The quality improvement tools and techniques the team used led to a significant improvement of vaccination rates,” Cadena said in the release. “Our methodology allowed us to adapt and modify interventions over time, adjusting to challenges and opportunities for improvement that emerged.” – by Ashley DeNyse

Disclosure: The researchers report no relevant financial disclosures.

This is an example of a stellar program designed to increase influenza vaccination rates at a major university medical center. A comprehensive array of quality improvement activities were employed, at a substantial cost of time and effort. The results were both gratifying and unsatisfying. Gratifying because the vaccination rate was increased from a previous best of 59% to a new high of 77%. Indeed, the success was such that Dr. Jan Patterson received the Outstanding Educational Program Award on behalf of this program from the Association for Prevention Teaching and Research (APTR) in a ceremony in Washington in March. However, the results, ultimately, were unsatisfying because fully one-quarter of the medical center's staff evaded vaccination. Despite the extensive educational program, the reasons given were the same old, tired drivel (flu from the flu vaccine; concern about side effects, etc.) The goal of comprehensive patient safety had not been reached. The researchers concluded, "Mandatory influenza vaccination of the HCWs is likely needed." I concur strongly.

– William Schaffner, MD

President of the National Foundation for Infectious Diseases

Disclosure: Dr. Schaffner reports no relevant financial disclosures.

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