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Up Front: Persistence can pay off to improve staff flu vaccine rates in patient care settings

Come the annual season for flu shots at Pioneer Valley SurgiCenter in Springfield and Kelly Snell, RN, is a ubiquitous presence. The ambulatory surgery center’s clinical coordinator and infection control coordinator, she’s on the floor coaxing the staff of 34 to get vaccinated. She reminds colleagues that the shot does not contain a live virus. She posts articles in the staff room about the benefits of flu shots. The result? Pioneer Valley SurgiCenter has posted staff vaccination rates of 94-96 percent since 2014-15, the first year that ambulatory surgery centers were required to report their vaccination rates.

Capture Flu Shot
Flyer posted at New England Surgery Center

At a time when average yearly vaccination rates for health care workers at facilities other than acute care hospitals fall short of the state’s goal of 90 percent coverage, some places, such as Pioneer Valley, post consistently high rates or report marked improvement. The state’s goal aligns with the federal Healthy People 2020 campaign’s target of 90 percent of the nation’s health care workers vaccinated annually against the flu by 2020. Meeting these goals, experts say, will not only protect the health of employees, patients and communities, but will also improve the quality of health care and reduce costs.

While Massachusetts acute care hospitals, many of which require flu shots for all employees, achieved an average staff influenza vaccination rate of 94 percent last flu season, rates are lower at other types of health care facilities.

Flu Shot Close Up
Health care professional receives her annual flu shot

Peer facilities meet with success using variety of strategies

Strategies employed by Pioneer Valley and others offer guidance for facilities struggling to meet the state and national goals, as well as those who aim to exceed it.

Salmon Adult Day Health in Northbridge vaccinated 87 percent of its staff of 16 last year, up from 75 percent the year before. In addition to offering shots in a variety of locations, Salmon held a raffle for staff who had flu shots, with the winner getting a $50 gift card.

“People can make the connection,” says program director Lisa Pontbriand. “The flu can be so detrimental or deadly for the people we care for. It humanizes the need to get it done.”

In Beverly, the staff vaccination rate at the New England Surgery Center has improved from 70 percent in 2014-15 to 86 percent of its staff of 32 last year.

Sarah Lembo, RN, the New England Surgery Center’s infection control coordinator, is another persistent presence. She hangs light-hearted posters urging health care workers to get vaccinated. She posts a weekly list of staff members still missing their flu shots. And, Lembo adds, “I’m constantly hounding everybody.” 

Flu Chart 2016 17
Data source: Massachusetts Department of Public Health
Flu Shot Bethany
Terry Moran, RN, gives a flu shot to Carol Collette at Bethany Health Care Center, a Framingham nursing home.

Going 'floor to floor' helps

Walk around the Brockton Neighborhood Health Center and look closely at the identification badges that employees are required to wear. Since 2015, a sticker on the badge identifies those workers who’ve had flu shots. This is one way the clinic has boosted its staff influenza vaccination rate from 85 percent in 2012-13 to 99 percent of its 467 health care professionals in 2016-17.

The Brockton clinic utilizes a multi-pronged approach that, since 2014, has included requiring all employees who have not been vaccinated to wear masks, says Karen Mark, RN, the clinic’s director of nursing.  The clinic also displays posters during flu season.  It debunks common myths on its internal website and in an email to staff, reminding employees, for instance, that the flu vaccine is made with inactive viruses and any sickness following the shot indicates that the person was already becoming ill or the staff member’s body was making the antibodies needed to fight off the flu. The clinic’s employee health nurse uses a payroll list to keep track of – and track down – staff members who have not been vaccinated.

Brockton Building
Brockton Neighborhood Health Center

“She knows where people work and knows their hours,” Mark says. “She goes floor to floor, and if people aren’t in, she goes back.” 

Although no studies have definitively shown that mask use by either infectious patients or health care personnel prevents transmission of influenza, the requirement has proved an effective additional incentive for getting vaccinated, along with staff members' interest in protecting themselves and others from the flu.

“A lot of staff didn’t like wearing the mask,” Mark says. “And they learned that all the concerns they had about the flu shot didn’t happen. A lot of people who weren’t receiving the shots found it wasn’t as bad as they thought it would be and now get the flu shots.”

'Get a vaccine or wear a mask'

Likewise, a Milford adult day health center with 24 health care professionals and a Framingham nursing home with a staff of 212 find the key to their high vaccination rates is a strict requirement that all unvaccinated employees wear masks.

“We are adamant about it, and our staff doesn’t want to wear masks,” says Sister Jacquelyn McCarthy, RN, CEO/administrator of Bethany Health Care Center, a 169-bed nursing home that is a sponsored ministry of the Sisters of St. Joseph of Boston. Its staff vaccination rate has ranged from 94 to 98 percent since the state began collecting and publishing nursing home data in 2012-13.

 At hiring, all new employees of Blair House of Milford Adult Day Health are told they must wear masks if they do not get flu shots. The center has a 100 percent staff vaccination rate. “I have people who wore the masks for a couple of weeks then took the shot,” says Maureen Gulino, program director.

Meanwhile, back at Pioneer Valley in Springfield, Snell, the infection control coordinator, has tried something new this year. The center is using small, pre-loaded intradermal syringes, similar to those used at pharmacy clinics, instead of intramuscular shots.  “It’s not even as bad as a bee sting,” Snell says. “I think I’ll have 100 percent compliance.”

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