Access and Autonomy Boost Level of NICU Staff Influenza Immunization
TORONTO — A 24/7 program allowing health care workers to vaccinate each other against influenza can dramatically increase staff immunization rates, bolstering the “cocoon effect” in the neonatal intensive care unit, Dr. Shetal Shah said in a poster presentation at the annual meeting of the Pediatric Academic Societies.
“I think it speaks to physician, nurse, and staff autonomy—the more control you give them over their need to be immunized, the more success you're likely to have,” he said in an interview.
“I think the risk-benefit ratio is clearly in favor of letting the nurses and physicians immunize each other. The steps to not adopting this are really just the fear of trying something new, and the fear of ceding some control.”
Dr. Shah, a neonatologist at State University of New York, Stony Brook, compared immunization rates among neonatal intensive care unit (NICU) health care workers before and after the implementation of a NICU vaccination program.
The program was originally designed to improve influenza vaccine access for parents of NICU patients.
“Because we have a captive audience of the parents who spend so much time in the NICU, we started immunizing them to provide protection for their high-risk children.
“But during the first year of the program, we noticed that nurses were immunizing not only the parents, but also each other,” he commented, crediting the intensive educational efforts that had been directed at nurses to equip them to explain the benefits of vaccination to parents.
“There was also 100% constant access to immunization for the staff, which removed a major obstacle. Even when people understand that they need to be vaccinated—if they have to take time off and go downstairs for it, or if they have to wait for a flu cart that comes up only once or twice a week—it's better than nothing, but it's still a rather limited opportunity.”
With improved access to influenza vaccination under the program, 67% of the NICU health care workers were immunized (45% in the NICU and 22% elsewhere), compared with 32% before the program was implemented.
Among the reasons cited for refusal of immunization were fear of injections and belief in “never getting sick” (nurses), and side effects (physicians).
To increase compliance, educational efforts for nurses should emphasize the likelihood of viral transmission, and physician-directed efforts should include tolerability of side effects, Dr. Shah recommended.
“When you consider the [NICU] where all the workers are in extremely close contact with immunocompromised newborns who are at risk for serious consequences should they contract influenza, this becomes a particularly urgent issue,” he noted.
