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Feedback and follow-up strategy for vaccinating HCWs

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

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  1. Feedback and follow-up strategy for vaccinating HCWs Jonathan A. McCullers, MDAssociate MemberDepartment of Infectious DiseasesSt. Jude Children’s Research HospitalMemphis, TN

  2. 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

  3. Flu vaccination at St. Jude • I took over Infection Control in 2002 • Intensive education campaign in 2003

  4. 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?

  5. 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

  6. 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

  7. 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

  8. 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..

  9. 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..

  10. 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..

  11. 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..

  12. 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..

  13. 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

  14. 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

  15. THANKS!

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