The Importance of - and Strategies for - Ensuring That
All Long-Term Care Staff Are Immunized Against the Flu

More than 32,000 older Americans die of complications due to influenza every year -- and many of them are residents of long-term care facilities. Because frail older adults are at particular risk of complications from the flu, the Centers for Disease Control and Prevention (CDC) recommends that all facilities offer residents flu shots. Since 2005, the Centers for Medicare and Medicaid Services (CMS) has required all nursing homes participating in Medicare and Medicaid to offer residents both influenza and pneumococcal vaccinations.

In addition to vaccinating residents, there's another way to lower risks of influenza among long-term care residents -- by vaccinating staff and others who come in close contact with them. In two trails in long-term care faculties, comprehensive vaccination efforts reduced resident fatalities by more than 40%. Such efforts can also reduce the number of staff work days lost to illness, and save money. According to a 2001 analysis, comprehensive immunization yields a net savings of $13.66 per person vaccinated. The CDC's Advisory Committee for Immunization Practices recommends annual flu vaccinations for long-term care staff and volunteers, and the Joint Commission requires that all long-term care facilities offer their employees influenza vaccination. Unfortunately, though, healthcare worker vaccination rates are disappointingly low. According to the U.S. Department of Health and Human Services (HHS), just 42% got vaccinated in 2006. This is particularly worrisome in light of research finding that at least 70% of healthcare workers continue to go to work when ill with the flu.

The Infectious Diseases Society of America has recommended mandatory staff vaccination (with provisions allowing staff to decline based on religious or medical reasons). But only four states require that staff either get vaccinated or provide a religious, philosophical or medical reason for foregoing immunization.

When flu vaccination is voluntary, the majority of healthcare workers who opt not to get immunized tend to decline for a handful of reasons: They have concerns about the safety or efficacy of the vaccine; don't fully understand how the flu is transmitted; are "afraid of needles;" or find getting vaccinated inconvenient, the HHS reports.

Fortunately many of these objections can be addressed with staff education and other strategies, according to an encouraging study in last November's Journal of the American Geriatrics Society. In the study, 13 U.S. nursing homes participated in a CDC quality improvement project aimed at boosting staff influenza immunization rates. Of the 13, 10 increased rates more than 10% and seven increased rates more than 55% as a result. Participating facilities, which ranged in size from 50 to 2,000 beds, came up with their own strategies, based on what they identified as barriers to immunization in their homes, and on existing research. Many employed a combination of these strategies -- which other long-term care facilities may find equally effective:

• Making it convenient In addition to offering free vaccines, on-site, during all shifts, many nursing homes in the study also loaded the vaccine and needles on a cart and brought them straight to staffers
  
  
• Educating staff To dispel misunderstandings about immunization, most facilities scheduled in-service programs that provided an overview of the risks influenza poses and of vaccination efficacy and safety. Some served lunch during the sessions. Others discussed these subjects during regularly scheduled, mandatory staff meetings. A number of facilities also put up posters and distributed flyers and mailings addressing common misconceptions about flu shots.
  
  
• Requiring those declining vaccinations to sign "reverse consent" forms These forms state that the person signing realizes that, by a foregoing a flu vaccine, he or she risks his own "health and financial well being, the health of the residents, and the work load of colleagues."
  
  
• Ensuring leadership involvement In many cases, both administrators and leaders among direct care staff encouraged immunization. In one participating facility, a staffer described a serious bout with the flu the preceding year. In another, once-reluctant staffers described their "not bad" experiences getting immunized. In some cases, administrators volunteered to be immunized first -- in front of staff.
  
  
• Offering incentives These included free lunches; lottery tickets; raffles tickets for large prizes, such as plasma screen televisions; small gifts, such as flashlights and radios; and cash.

To help older adults and their caregivers understand the importance of getting flu and other vaccinations, the American Geriatric Society's Foundation for Health in Aging has published an easy-to-understand immunization "tip sheet." Available at www.healthinaging.org/public_education/vaccination_tipsheet.php, it lists vaccinations generally recommended for older adults, explains exactly who should get these, why, and when. Like the all of the authoritative, easily-understandable public education materials on the FHA site -- www.healthinaging.org -- the tip sheet can be downloaded, printed and distributed at no cost.