The line for flu shots was already moving briskly, just an hour into the first day of the staff vaccination campaign at Seattle Cancer Care Alliance, which runs through Oct. 31.
Peggy Sherlin, 54, who works in the Patient Family Resource Center, said there was no question that she’d bare her arm and get the jab that not only keeps her from getting sick – but, even more important, protects vulnerable patients from seasonal influenza.
“With their immune deficiencies here, you don’t want to chance it,” said Sherlin, waiting for the poke from registered nurse Nancy Johnson. “They’re like babies – especially the transplant patients.”
It’s attitudes like that that have kept flu vaccination rates above 80 percent for years at SCCA, far higher than the 75.2 percent rate for health care workers across the nation, according to the latest figures from the Centers for Disease Control and Prevention.
But boosting the total even higher – to nearly 97 percent – required taking a tougher stance with staffers who wanted to skip the shots, according to new research by SCCA and Fred Hutchinson Cancer Research Center scientists.
Education alone wasn't enough, said Dr. Steve Pergam, SCCA’s director of infection control and an assistant member of the Fred Hutch Vaccine and Infectious Disease Division. Offering the “carrot” of individual incentives for center-wide compliance worked a little better, according to research presented at a recent meeting of the Infectious Diseases Society of America.
But what worked best was using a “stick” approach that requires employees who decline vaccination to complete an online training, take a test about common flu myths and, finally, confirm that they won’t get the shot in a face-to-face session with a counselor.
“We want people who are engaged in protecting patients,” Pergam said.
Unlike some medical centers, SCCA doesn’t mandate flu vaccination for its 1,600 workers. Nor do the employees have to wear masks or sport buttons that say they refused flu shots, tactics some hospitals have adopted.
Forcing health care workers to get the shots only creates resistance, said Pergam and Sara Podczervinski, SCCA’s infection prevention and control practitioner. Instead, they want to encourage staff members to choose vaccination on their own. Their non-mandatory strategy has been so successful they haven't needed to move to such tactics.
“Our job is to get people to change their minds,” Pergam said.
CDC infection experts have recommended flu vaccination for health care workers for 30 years, but as late as 2012, only two-thirds actually complied. The push to vaccinate workers at all levels, from doctors in hospitals to kitchen staff at long-term care centers, is aimed at preventing employees from spreading disease to vulnerable patients and from getting sick during the busy flu season.
It’s especially important in settings where patients have had their immune systems wiped out by therapy or disease. A flu infection can progress quickly to pneumonia – and worse, Pergam said.
“People survive and have been cured of their cancer and they die of a simple respiratory infection,” he said.
Employees who refuse flu shots do so for a number of reasons, Podczervinski said.
“A lot of them just don’t think they should put anything unnatural into their bodies,” she said.
Others say they don’t believe in flu shots or think they won’t work.
Requiring health workers to sign off on a form that details flu myths, such as the possibility of getting flu from the shot, and to talk to a counselor cut denials by nearly 10 percent from 2010 to 2012, the new paper reported. That’s in addition to previous efforts such as showing staff members videos of patients discussing how vulnerable they feel to the flu.
And it appears to pay off, according to a CDC analysis last year that found vaccinating health workers was associated with a 29 percent reduction in patient deaths from all causes.
Although SCCA’s uptake rates are nearly perfect, Pergam and Podczervinksi say they hope to reduce the number of refusals even further – and are part of a major push to get patients and their families vaccinated, too.
“If you walk into the SCCA for any reason, we want you to be vaccinated,” Pergam said.
SCCA employees can find flu shot information on the CenterNet site.
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JoNel Aleccia is a staff writer at Fred Hutchinson Cancer Research Center. From 2008 to 2014, she was a national health reporter for NBC News and msnbc.com. Prior to that she was a reporter, editor and columnist for more than two decades at newspapers in the Northwest. Reach her at firstname.lastname@example.org.