Flu season is officially here, and once again I find myself surprised by the tenacity of the old (and new) myths about the flu shot. (For instance, one that recently moved into the “myth” column is that people with egg allergies shouldn’t get the flu shot.) However, unless we’re prepared to have a repeat of last year’s flu season, which was particularly brutal for the frail older adults living in nursing homes and other post-acute and long-term care settings, we need to take steps now to get ready. Improving the rates of vaccination for PA/LTC health care personnel (HCP) would be a terrific first step.
Here at AMDA – The Society for Post-Acute and Long-Term Care Medicine, we recently updated our guidance on flu vaccination for HCP to make it stronger and more specific:
We support mandatory annual flu vaccination for all PA/LTC HCP — meaning anyone who is in direct or indirect contact with residents such as employees, contract staff, family caregivers, and volunteers — unless there’s a medical contraindication.
We encourage care communities to provide education for their workforce on the efficacy and safety of the flu vaccine, specifically as an important measure to enhance resident safety. Nursing home medical directors can be very effective here by actively promoting the flu vaccination program in their care communities and meeting with workers who may be reluctant to get a flu shot.
We recommend that employees who don’t receive a flu shot wear a mask when in direct contact with residents during flu season, as well as receive targeted education to encourage vaccination.
- • and at no cost to employees and volunteers. This has been shown to improve vaccination rates in our setting.
And, finally, we encourage care communities and corporations to make the flu vaccine available on-site and at no cost to employees and volunteers. This has been shown to improve vaccination rates in our setting.
The Society is working closely with the Centers for Disease Control and Prevention (CDC), the Immunization Action Coalition (IAC), and the National Adult and Influenza Immunization Summit (NAIIS), which are also renewing their efforts to improve PA/LTC HCP immunization rates. Why focus on HCP? You may not be aware of this, but while the vaccination rate for HCP in other care settings is over 90%, in PA/LTC it hovers around 68%. And this is in a setting that is particularly vulnerable to flu outbreaks, with the highest incidence and prevalence of mortality from the flu. We need to do better!
Fortunately, we have some inspiring models of success. A number of our Society members are leading the charge when it comes to HCP flu vaccinations. One of these pioneers is Sabine von Preyss-Friedman, MD, FACP, CMD, chief medical officer of Avalon Health Care Group. Headquartered in Utah, Avalon has over 50 care communities in California, Hawaii, Idaho, Oregon, Utah, and Washington, caring for between 3,500 and 4,000 patients at any given time.
When Dr. von Preyss-Friedman came on board in 2011, there was no organized employee vaccination program at Avalon. That first year, their employee immunization rate was between 20% and 30% company-wide — leading to hospital readmissions and restrictions for admissions to their facilities. “We actually had significant financial losses,” she said. “At that point the chairman of the company said he didn’t want influenza in our facilities. So I said, ‘Leave it to me.’”
The original plan was to make immunization mandatory for all HCP. For a variety of reasons, that turned out to be not possible for the organization. So, she explained, “We decided on a compromise where people would have to mask up during influenza season unless they were vaccinated. We started out by setting a goal and gave our facilities tools to achieve that goal.” Those tools include explanatory letters, posters, checklists, and monthly webinars.
After the first year, vaccination rates increased dramatically — and they’ve continued to climb since. Most Avalon care communities now have an employee immunization rate of between 85% and 90%. And “we’re always trying to see what we can improve,” Dr. von Preyss-Friedman said.
Another HCP flu vaccination pioneer is Gregory Gahm, MD, MS, FACP, who serves as chief medical officer for 30 primarily Colorado-based facilities. He helped write the state regulations that now require vaccinations of 90% of employees by December 31 of each year. “Employees” are defined as anyone with a financial tie to the facility, including staff, providers, vendors, and laboratory and hospice personnel, among others. The regulations also note that anyone who’s not vaccinated must wear a mask during flu season, which in Colorado is November 1 through April 1.
Although Dr. Gahm initially wasn’t a fan of the masks, he now sees them as a “scarlet letter that says, ‘I’m wearing a mask because I’m not vaccinated.’” He’s even written orders stating that no staff person wearing a mask during flu season can take care of his patients, and he has found that to be an effective tool for encouraging HCP vaccinations.
However, he said, his edict that “any employee who refuses to get vaccinated has to meet with me one on one has probably been more effective than anything else. They said, ‘I’d rather take the shot than talk to Dr. Gahm.’”
Earlier I mentioned our work with the CDC, IAC, and NAIIS. Thanks to that important work, the IAC has set up a specific honor roll to recognize the leadership of all PA/LTC facilities that pledge to adopt a mandatory flu vaccination program for their workforce. So far only seven facilities are listed, but I know that if we work together we can get those numbers up. Improving HCP vaccination rates will reduce flu deaths for our residents and patients. And the pioneering work of Drs. von Preyss-Friedman and Gahm shows us how!
Christopher E. Laxton, CAE is executive director of AMDA – The Society for Post-Acute and Long-Term Care Medicine.