Seasonal influenza immunization for healthcare workers gains attention

Although seasonal influenza (flu) is the number one vaccine-preventable illness, it results in 36,000 deaths and more than 226,000 hospitalizations each year. Despite the devastation it can cause, only 38% of registered nurses (RNs) and other healthcare workers providing direct patient care get flu shots annually. Efforts are underway to increase this percentage.

By getting flu shots, healthcare workers not only protect themselves but help guard patients against infection. Because adults may be infectious for 1 day before (and 5 days after) symptom onset, healthcare workers with asymptomatic, subclinical flu may transmit the virus to patients. In one study, 23% of healthcare workers had documented serologic evidence of influenza; yet 50% did not recall having influenza symptoms and 28% could not recall having any respiratory illness. Failure of healthcare workers to get flu shots also can increase staff illness and absenteeism.

New JCAHO standard

A new standard established by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requires healthcare organizations to:

   establish an annual flu vaccination program that covers at least staff and licensed practitioners

   educate staff and independent practitioners about flu vaccination, nonvaccine infection control measures and diagnosis, and flu transmission and impact

   annually evaluate vaccination rates and reasons for nonparticipation in the immunization program

   implement enhancements to the program to further increase participation.

The standard, which becomes effective July 1, 2007, was developed after the Centers for Disease Control and Prevention (CDC) recommended making reduction of nosocomial flu transmission from healthcare workers to patients a priority. For the past few flu seasons, CDC has designated healthcare workers as a priority group for flu shots.

ANA’s flu-fighting campaign

A 2005 survey by the American Nurses Association (ANA) revealed reasons why some RNs don’t get flu shots. They include the perception that a flu vaccine shortage exists, inconvenient times or locations for vaccine administration, vaccine not offered at the workplace, fear of getting the flu from the vaccine, lack of time to get the vaccine, a belief that one isn’t vulnerable to contracting the flu, and concern about the vaccine’s side effects.

To encourage nurses and other healthcare workers to accept the seasonal vaccination, ANA launched its “Everyone deserves a shot at fighting flu” campaign. Although ANA and some other associations don’t endorse mandatory flu shots for healthcare workers, they are concerned about the low vaccination rates and encourage all healthcare workers with direct patient contact to get flu shots.

In 2006, the board of directors of the Association for Professionals in Infection Control voted to endorse mandatory flu vaccinations for healthcare personnel with direct patient contact. Seven states have enacted legislation requiring seasonal vaccinations of healthcare workers or the signing of a declination form; 15 states have regulations related to flu vaccination of healthcare workers in long-term care settings.

Bottom line—flu shots save lives. RNs and all other healthcare workers who have direct patient care in any setting should get them. Both healthcare workers and patients will reap the benefits.O

Selected references

Approved: New infection control requirement for offering influenza vaccination to staff and licensed independent practitioners. Joint Commission Perspectives. 2006;26(6):10-11.

Centers for Disease Control and Prevention. Prevention and control of influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP) [Electronic Version]. MMWR. 2006;55(RR10):1-42.

Ignorance 1: Education 0 Time to mandate flu shots. Hosp Infect Control. 2006;33(7):76.

Immunization Action Coalition. (October 2005). Ask the experts: Influenza. Available at: www.immunize.org/catg.d/p2021e.htm. Accessed June 16, 2006.

Joint Commission on Accreditation of Healthcare Organizations. (June 13, 2006). News release: Joint Commission establishes infection control standard to address influenza vaccines for staff. Available at: www.jointcommission.org/NewsRoom/NewsReleases/nr_06_13_06.htm. Accessed June 13, 2006.

Nancy L. Hughes, RN, MHA, is Director of ANA’s Center for Occupational and Environmental Health.

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