2014-2015 Seasonal Influenza Summary Report

Summary Report of 2014-2015 Seasonal Influenza Survey of Long-Term Care and Assisted Living Facilities

2014-2015 Seasonal Influenza Summary Report

Introduction

The Flathead City-County Health Department (FCCHD) Board of Health (BOH) identified seasonal influenza vaccination inlong-term care and assisted living facility (LTCF-ALF) staff as a strategic target. The priorities are increasing vaccination rates in LTCF-ALF staff and helping facilities work towards mandatory seasonal influenza vaccination policies. The survey provideda baselinevaccination rateof Flathead County LTCF-ALF staff. The survey also providedthe FCCHD BOH with current staff seasonal influenza vaccination policy information.

Current Data and Research

Influenza remains a major issue in the United States with approximately 114,000 hospitalizations and more than 36,000 deaths each year (Nace et. al., 2007). Older adults are at risk given that 90% of influenza deaths occur in people aged 65 and older (Nace et. al., 2007). Long-term care facilities can experience case fatality rates as high as 55% (Nace et. al., 2007).

Healthy People 2020 has set a target of achieving 90% influenza vaccination coverage for all HCP, including LTCF-ALF HCP (US HHS, 2015). Centers for Disease Control and Prevention early season 2014-2015 influenza vaccination data indicate LTCF-ALF HCP vaccination coverage of 54% (final data not published yet) (CDC, 2014). The most recent Montana specific data from the Montana Immunization Program for the 2011-2012 influenza season indicated vaccination coverage of 62% in Montana LTCF-ALF staff.

Influenza vaccination is the most effective way to prevent influenza infection (ApentengOpoku, 2014). Studies have demonstrated an association between influenza vaccination and reduced workplace absenteeism (ApentengOpoku, 2014). For those facilities not able to implement a mandatory influenza vaccination policy, ApentengOpoku (2014) demonstrate that providing vaccines onsite and for free, incentivizing staff for vaccination, and having restriction policies in place for employees who develop flu-like symptoms can help increase vaccination rates. Refusal consent forms have been recommended by several organizations, including The Society for Healthcare Epidemiology of America, and the Occupational Safety and Health Administration’s Bloodborne Pathogens and Needlestick Prevention program (Nace et. al., 2007). A refusal consent form represents a targeted communication, and targeted communication has been shown to increase vaccine uptake 20-fold (Nace et. al., 2007).

Kimuraet. al. (2007) have shown that having a well-publicized “Vaccine Day” for free employee vaccinations, in combination with educational interventions, resulted in an increase in staff influenza vaccination rates. It is proposed that staff vaccination rates will continue to increase with each subsequent annual“Vaccine Day” as it becomes a cultural norm for that facility (Kimura et. al., 2007).

Facilities can help create a culture of influenza vaccination by incorporating vaccination into other workplace wellness initiatives so employees feel like the organization genuinely wants healthy employees (Manuel et. al., 2002). Many long-term care staff stated they believe common influenza vaccination educational efforts focus on health of the residents, without considering the health of the staff person receiving the vaccination (Manuel et. al., 2002). Facilities can incorporate broad educational interventions highlighting benefits of staff influenza vaccination for both the resident and staff member.

Results

Key Informant Survey

At the time of survey distribution there were 18 state-licensed Flathead County LTCF-ALF. Of those 18 facilities, 15 participated in the Key Informant Survey (response rate of 83%).

Many facilities are using at least one method to raise employee awareness about seasonal influenza vaccination or to provide vaccination access to staff (see Figure 1).

Figure 1: Percent of facilities using strategies to raise awareness or provide access to influenza vaccination for staff. Data from Key Informant Survey, 2014-2015 influenza season.

Seven of the 15 responding facilities use at least one strategy to ensure compliance with an influenza policy, or in absence of a policy, to limit the spread of influenza. These strategies include terminating employees for violating the policy requirements (N=2), requiring unvaccinated staff to wear face masks (N=4), or restricting unvaccinated staff to specific areas of the facility (N=2).

Of the 15 responding facilities, 10 facilities track employee vaccinations and declinations.

Staff Survey

Thirteen facilities participated in the staff survey and the FCCHDcollected surveys from 276 respondents (response rate of 28%). Of those who responded, 91% had direct patient contact and 68% (189 of 276) received an influenza vaccination. Of the 189 people that received the vaccination, 80% (N=152) received it at their workplace.

For Tables 1, 2, and 3, your Facility ID is highlighted for your convenience.

Your facility may not be listed if the FCCHD was not able to collect sufficient numbers of staff surveys to make a calculation of vaccination rate.

The FCCHD used self-reported vaccination rates from the staff survey because not all facilities record staff influenza vaccination status. The staff survey vaccination rate and the key informant survey vaccination rate paralleled each other for facilities that provided both data sets (data not shown).

Table 1 –Percentage of Staff Vaccinated, by Facility: 2014-2015 Influenza Season

Percent Vaccinated
Facility ID / Staff Survey
GFC / 98
BCF / 97
FIE / 93
BHI / 76
EIB / 71
BAD / 61
FGH / 50
AED* / 50
IGG / 42
DEC / 33
BGH / 21
JBB / 6
BEE / 0
* Staff survey response rate less than 15%

Tables 2 and 3 separate out staff survey vaccination rates by LTCF and ALF for comparison between facilities of the same classification.

Table 2 – Percentage of Staff Vaccinated Based on Staff Survey Results in

Long-Term Care Facilities, by Facility: 2014-2015 Influenza Season

LTCF ID / Percent Vaccinated
GFC / 98
BCF / 97
FIE / 93
BHI / 76
DEC / 33

Table 3 – Percentage of Staff Vaccinated Based on Staff Survey Results in

Assisted Living Facilities, by Facility: 2014-2015 Influenza Season

ALF ID / Percent Vaccinated
EIB / 71
BAD / 61
FGH / 50
AED* / 50
IGG / 42
BGH / 21
JBB / 6
BEE / 0
* Staff survey response rate less than 15%

Figures 2 and 3 demonstrate the responses given by all staff survey respondents regarding their reasons for receiving an influenza vaccination and their reasons for not receiving an influenza vaccination. Respondents could select more than one answer.

Figure 2: Reasons for receiving influenza vaccination.

Data from Staff Survey, 2014-2015 influenza season.

Figure 3: Reasons for not receiving influenza vaccination.Data from Staff Survey, 2014-2015 influenza season.* Other response themes included: shots are unnatural or contain toxins, don’t believe in flu shot or its efficacy, healthy so don’t need flu shot

Figures 4 and 5 demonstrate responses given by your facility staff survey respondents regarding their reasons for receiving and not receiving an influenza vaccination. Respondents could select more than one answer. (The following graphs depict facility-specific data for all facilities that participated in the staff survey. While each facility’s report contained only their specific data, this internal report compiles all of that information into one report)

Figure 4A: Staffsurvey respondents’ reasons for getting vaccinated.

Data from Staff Survey, 2014-2015 influenza season.

GFC had only one respondent not receive influenza vaccination due to medical exemption

Figure 5A: Staff survey respondents’ reasons for not getting vaccinated.

Data from Staff Survey, 2014-2015 influenza season.

Figure 4B: Staff survey respondents’ reasons for getting vaccinated.

Data from Staff Survey, 2014-2015 influenza season.

Figure 5B: Staff survey respondents’ reasons for not getting vaccinated.

Data from Staff Survey, 2014-2015 influenza season.

Figure 4C: Staff survey respondents’ reasons for getting vaccinated.

Data from Staff Survey, 2014-2015 influenza season.

Figure 5C: Staff survey respondents’ reasons for not getting vaccinated.

Data from Staff Survey, 2014-2015 influenza season.

Figure 4D: Staff survey respondents’ reasons for getting vaccinated.

Data from Staff Survey, 2014-2015 influenza season.

FIE had only two respondents who not receive influenza vaccination

Figure 5D: Staff survey respondents’ reasons for not getting vaccinated.

Data from Staff Survey, 2014-2015 influenza season.

Figure 4E: Staff survey respondents’ reasons for getting vaccinated.

Data from Staff Survey, 2014-2015 influenza season.

BCF had only one respondent who not receive influenza vaccination

Figure 5E: Staff survey respondents’ reasons for not getting vaccinated.

Data from Staff Survey, 2014-2015 influenza season.

Figure 4F: Staff survey respondents’ reasons for getting vaccinated.

Data from Staff Survey, 2014-2015 influenza season.

Figure 5F: Staff survey respondents’ reasons for not getting vaccinated.

Data from Staff Survey, 2014-2015 influenza season.

JBB only had one respondent receive influenza vaccination

Figure 4G: Staff survey respondents’ reasons for getting vaccinated.

Data from Staff Survey, 2014-2015 influenza season.

Figure 5G: Staff survey respondents’ reasons for not getting vaccinated.

Data from Staff Survey, 2014-2015 influenza season.

Figure 4H: Staff survey respondents’ reasons for getting vaccinated.

Data from Staff Survey, 2014-2015 influenza season.

Figure 5H: Staff survey respondents’ reasons for not getting vaccinated.

Data from Staff Survey, 2014-2015 influenza season.

Figure 4I: Staff survey respondents’ reasons for getting vaccinated.

Data from Staff Survey, 2014-2015 influenza season.

Figure 5I: Staff survey respondents’ reasons for not getting vaccinated.

Data from Staff Survey, 2014-2015 influenza season.

Figure 4J: Staff survey respondents’ reasons for getting vaccinated.

Data from Staff Survey, 2014-2015 influenza season.

Figure 5J: Staff survey respondents’ reasons for not getting vaccinated.

Data from Staff Survey, 2014-2015 influenza season.

Figure 4K: Staff survey respondents’ reasons for getting vaccinated.

Data from Staff Survey, 2014-2015 influenza season.

Figure 5K: Staff survey respondents’ reasons for not getting vaccinated.

Data from Staff Survey, 2014-2015 influenza season.

Conclusions

Self-reported vaccination rate in LTCF-ALF staff for 2014-2015 influenza season was 68%. This result is higher than preliminary CDCnationwide reports (54%) but does not yet achieve the Healthy People 2020 goal of 90%.

Workplace influenza vaccination accounted for the majorityof staff getting vaccinated (80%).

Facilities with mandatory vaccination policies have a 3-fold or higher vaccination rate compared to facilities with recommendation policies (see Figures 6 and 7).

Figure 6: Percent of staff vaccinated at facilities with mandatory influenza vaccination policies.

Data from Staff Survey, 2014-2015 influenza season.

Figure 7: Percent of staff vaccinated at facilities with recommendation policies.

Data from Staff Survey, 2014-2015 influenza season.

Limitations

Selection bias may exist in the staff survey. Some of the sample sizes from each facility were too small for any substantial conclusions. Furthermore, staff survey participation may have depended upon the methods used by the FCCHD’s contact responsible for distributing and collecting the surveys at each facility. Influenza vaccination status was self-reported, because not all facilities track staff vaccination status, so there was no way to verify the self-reported vaccination status of respondents.

Next steps

The FCCHD hopes this report provides insight into vaccination rates at Flathead County LTCF-ALF, how each facility’s vaccination rate compares to other facilities, and staff influenza vaccination attitudes and beliefs.

The FCCHD is prepared to offer assistance to interested facilities in a variety of ways including:

• Provide customizable toolkits to help facilities move towards a mandatory staff influenza vaccination policy (which can be shown to upper management to encourage mandatory policy implementation)
• Provide influenza vaccination clinics at your facility and provide educational information to advertise such events
• Provide targeted education to your facility to address the most common reasons that staff did not get vaccinated, based on Staff Survey results

If you are interested in partnering with the FCCHD to improve the influenza vaccination rates in your facility, please contact Theresa Majeski at or 260-4906.

In addition, Theresa will be reaching out to those facilities that expressed interest in the FCCHD’s assistance during the Key Informant Survey.

Thank you

The FCCHDBOH has a long-term strategic priority of increasing seasonal influenza vaccination rates in LTCF-ALF staff in Flathead County. Therefore, the FCCHD will continue to utilize surveys of facility administrators or directors of nursing, and staff to determine vaccination rates.

The FCCHD thanks all participating facilities for their assistance with this project and looks forward to working with all LTCF-ALF on future surveys and projects.

References

Apenteng B.A. & Opoku S.T. 2014.Employee Influenza Vaccination in Residential Care Facilities.American Journal of Infection Control, 42, 294-299.

Centers for Disease Control and Prevention. (2014, December 16). Influenza Vaccination Coverage in Long-Term Care Settings. Retrieve from

Kimura A.C., Nguyen C.N., Higa J.I., Hurwiz E.L., & Vugia D.J. (2007). The Effectiveness of Vaccine Day and Educational Interventions on Influenza Vaccine Coverage Among Health Care Workers at Long-Term Care Facilities. American Journal of Public Health, 97, 684-690.

Manuel D.G., Henry B., Hockin J., & Naus M. (2002). Health Behavior Associated With Influenza Vaccination Among Healthcare Workers in Long-Term Care Facilities. Infection Control and Hospital Epidemiology, 23, 609-614.

Nace D.A., Hoffman E.L., Resnick N.M., & Handler S.M. (2007). Achieving and Sustaining High Rates of Influenza Immunization Among Long-Term Care Staff. Journal of American Medical Directors Association, 8,128-133.

United States Department of Health and Human Services, Healthy People 2020. (2015, May 28). Immunizations and Infectious Diseases, Objectives, IID-12.13. Retrieved from

1