Flu Vaccination Rates Tied to Hospital Practices

SAN DIEGO — Health care worker influenza vaccination programs with high coverage rates emphasized accountability to the highest levels of the organization, provided weekend access to the vaccine, and used train-the-trainer programs, a survey of 50 hospitals showed.

The researchers found surprising variation from hospital to hospital in the definition of heath care worker. “A uniform definition of health care worker is essential if and when health care worker vaccination rates are reported publicly,” lead investigator Dr. Thomas R. Talbot said at the annual meeting of the Society for Healthcare Epidemiology of America.

In August and September of 2008, he and his associates sent a 45-question survey about health care worker vaccination practices to 50 hospitals in 33 states that were members of the University HealthSystem Consortium, a group of academic medical centers that conducts multiple benchmarking studies each year. The 50 hospitals ranged in size from 2,603 to 26,000 health care workers and represented a total of 368,969 health care workers, said Dr. Talbot, chief hospital epidemiologist at Vanderbilt University, Nashville, Tenn.

Nearly all vaccination programs (98%) included nursing staff, but only 68% targeted attending and faculty physicians, 54% included volunteers, 46% included agency staff, and 34% included medical students. Although 94% of hospitals tracked health care worker vaccination rates, the remainder tracked the number of doses of vaccine administered.

Of all health care workers at the hospitals surveyed, 57% were vaccinated during the 2007–2008 influenza season. The rate per facility ranged from 26% to 81%.

The vaccine was provided free of charge to all employees at all sites. It was also provided at no charge to 96% of volunteers, 62% of students, 60% of visiting health care workers, and 14% of employee family members.

Reported times and locations where the influenza vaccine was provided included clinical units (96%), satellite facilities (92%), at group meetings (92%), on night shifts (90%), and on weekends (78%). In addition, 76% of the hospitals used mobile carts, 70% had a train-the-trainer program, 34% provided incentives or raffles for prizes, and 18% rewarded units or areas with high vaccination rates.

More than one-third of hospitals (38%) require health care workers who refuse vaccination to formally decline vaccination. Of those, 79% require a signed declination form.

The majority of hospitals (82%) report their vaccination rates to facility administrators, and 62% provide them to department chairs or service chiefs, but only 20% provide them to the hospital board of trustees.

None of the hospitals reported that they had ever dismissed an employee because of failure to follow the facility's influenza vaccination policy.

Two-thirds of hospitals (66%) reported that administrators send a letter or communication to their health care workers emphasizing the importance of the influenza vaccination campaign.

Certain vaccination program components were associated with significantly higher vaccination rates when compared with hospitals that did not use such components. These included provision of vaccine on weekends (59% vs. 44%), use of train-the-trainer programs (60% vs. 47%), report of vaccination coverage rates to the hospital board of trustees (64% vs. 53%), and visible support from hospital administrators (58% vs. 37%), such as administration sending a letter to health care workers emphasizing the importance of influenza vaccination.

Dr. Talbot disclosed that he has received research funding from Sanofi Pasteur.

At the hospitals surveyed, 57% of health care workers were vaccinated during the 2007–2008 influenza season. DR. TALBOT