The national average for flu vaccination among healthcare personnel is 64 percent, according to the CDC.
Loyola University Medical Center in Maywood, Ill., was able to achieve and maintain over 99 percent compliance through mandated vaccinations. A study analyzing the hospital's successful approach was presented at the 40th Annual Conference of the Association for Professionals in Infection Control and Epidemiology in Fort Lauderdale, Fla., on June 9.
"Everyone was required to get vaccinated," says Jorge Parada, MD, the study's lead author and a professor at Loyola University Chicago Stritch School of Medicine. "Not just hospital medical and nursing staff, but also ancillary staff and contracted personnel such as housekeeping, nursing students, medical students and even volunteers — everyone in hospitals and clinics was required to do it," he says.
To reach near total compliance, in 2009 Loyola University Medical Center launched an initiative that made vaccination a requirement of employment, and instituted a comprehensive vaccination program for current employees.
The first step was to compile a complete list of everyone who should be vaccinated, which required a team effort to create a master database. Data was needed from the medical school, from the nursing school, from each medical group associated with the hospital and many other sources. "Putting this database together was a challenge," says Dr. Parada, but was essential to reaching near-universal compliance.
When vaccinations started, Dr. Parada's team began an internal marketing campaign to raise awareness and encourage compliance. New flat-screen monitors that the hospital had recently purchased were used to show videos encouraging vaccination. The videos explained the risks of the flu, some featured physician leaders and top administrators receiving the shot and we even produced an entertaining "flu safety dance" video, says Dr. Parada.
"The videos caught a lot of attention," says Dr. Parada, and helped increase both awareness and compliance.
Dr. Parada also attributes the program's success to the administration's efforts to address as many of the staff's concerns as possible. "We wanted it to be perceived as more than just marching orders," he says. A link was put on the internal Loyola website with information and answers to common questions about the program. The program's staff outreach efforts also included "town hall type meetings and other chances for staff members to come ask questions at all hours so everyone had the opportunity," says Dr. Parada.
"You have to been seen as trying to respond to people's concerns, because they are valid concerns" he says. "Even if at the end of the day, [the reason a staff member needs to be vaccinated] might be just 'because I told you so,' it's seen totally differently if you try to do it nicely," says Dr. Parada.
Exceptions for medical and religious reasons were also made more stringent. To claim a medical exception, a staff member was required to bring a letter from his or her physician with contact information, and the hospital's administration reserved the right to ask for additional information from the physician, says Dr. Parada. "We also reserved the right to have the staff member tested for a [claimed] egg allergy," he says.
Religious or personal exceptions required a detailed letter from a staff member's preacher or other religious leader along with contact information, says Dr. Parada.
It was also made known that anyone granted an exception would have to wear a surgical mask throughout flu season. "Suddenly, all the egg allergies disappeared," says Dr. Parada. During the program's first year, only 0.7 percent of staff members were granted medical or religious exemptions.
Dr. Parada says the stringent policies in place were necessary to help get the program started: "Especially during the first year, you've got to be tough," he says. The hospital later removed the requirement for exempted staff members needing a mask. "Since we had such high adherence, we didn't want to be seen as punishing people who had a valid exception," he says. "If we had gone easy in the beginning, we would have had more people asking for exemptions. In the first year it is especially important to set the rules and hold the line — you can always go back and loosen rules later."
Dr. Parada also stresses the importance of having the support of senior hospital leadership: "Hospital leaders have to be 100 percent behind it," he says. "We had that and everyone knew it." He says that while some of the hospital's vice presidents started out unconvinced, "but as soon as they saw the conviction of the hospital's number one, two and three, they immediately toed the party line," he says.
Dr. Parada recommends that other hospitals, and the healthcare industry in general, implement similar vaccination programs. "Other professions have similar safety requirements," he says. "People in construction have to wear hardhats, even though Joe Schomoe on street doesn't have to — it's no different for healthcare workers and the flu vaccine," he says. “No one was forced to be a healthcare professional, we chose this calling. As a healthcare professional we have a special responsibility to the patients we care for, and first and foremost is not to make others sick. Getting the flu shot helps minimize risks to staff and patients alike.”
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