An effective strategy for influenza vaccination of healthcare workers in Australia: experience at a large health service without a mandatory policy

Heinrich-Morrison et al. BMC Infectious Diseases (2015) 15:42 DOI 10.1186/s12879-015-0765-7 RESEARCH ARTICLE Open Access An effective strategy for influenza vaccination of healthcare workers in Australia: experience at a large health service without a mandatory policy Kristina Heinrich-Morrison1*, Sue McLellan1, Ursula McGinnes2, Brendan Carroll2, Kerrie Watson1, Pauline Bass1, Leon J Worth1 and Allen C Cheng1,3 Abstract Background: Annual influenza vaccination of healthcare workers (HCWs) is recommended in Australia, but uptake in healthcare facilities has historically been low (approximately 50%). The objective of this study was to develop and implement a dedicated campaign to improve uptake of staff influenza annual vaccination at a large Australian health service. Methods: A quality improvement program was developed at Alfred Health, a tertiary metropolitan health service spanning 3 campuses. Pre-campaign evaluation was performed by questionnaire in 2013 to plan a multimodal vaccination strategy. Reasons for and against vaccination were captured. A campaign targeting clinical and non-clinical healthcare workers was then implemented between March 31 and July 31 2014. Proportional uptake of influenza vaccination was determined by campus and staff category. Results: Pre-campaign questionnaire responses were received from 1328/6879 HCWs (response rate 20.4%), of which 76% were vaccinated. Common beliefs held by unvaccinated staff included vaccine ineffectiveness (37.1%), that vaccination makes staff unwell (21.0%), or that vaccination is not required because staff are at low risk for acquiring influenza (20.2%). In 2014, 6009/7480 (80.3%) staff were vaccinated, with significant improvement in uptake across all campuses and amongst nursing, medical and allied health staff categories from 2013 to 2014 (p < 0.0001). Conclusions: A non-mandatory multimodal strategy utilising social marketing and a customised staff database was successful in increasing influenza vaccination uptake by all staff categories. The sustainability of dedicated campaigns must be evaluated. Keywords: Influenza, Vaccination, Healthcare worker Background Annual influenza vaccination is recommended due to antigenic change in circulating influenza virus stains and the relatively short-lived immunity achieved by immunisation. Influenza vaccination has been shown to be moderately protective against influenza [1]. Health care workers (HCWs) are a target group for influenza vaccination because of their contact with susceptible patients during the course of employment [2,3]. Due to poor reported vaccine coverage, there have been calls for * Correspondence: 1 Infection Prevention and Healthcare Epidemiology Unit, Department of Infectious Diseases, Alfred Health, P.O. Box 315, Prahran VIC 3181, Australia Full list of author information is available at the end of the article mandatory vaccination policies for staff, including influenza vaccination [4,5], although these have not yet been adopted in Australia. In 2013, only 56% of HCWs at our health service were knowingly vaccinated against influenza. Recent data from US centres suggests that promotion of vaccination in settings where vaccination is not required (i.e. nonmandatory) can significantly increase uptake [6], and others have demonstrated high vaccine uptake with non-mandatory programs, especially when these effectively engage medical staff [7]. We describe the development and implementation of a successful campaign to improve staff influenza vaccination at our health service in 2014. © 2015 Heinrich-Morrison et al.; licensee BioMed Central. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Heinrich-Morrison et al. BMC Infectious Diseases (2015) 15:42 Methods Alfred Health is a tertiary referral health service in Melbourne, Australia with approximately 7000 staff employed across three campuses. The service has a Staff Immunisation and Exposure Management Unit which provides government-funded influenza vaccination free of charge to staff. Annually, mass vaccination days are held at each campus and are supported by mobile immunisation services. In 2013, the additional resources available for the influenza immunisation program were 1.7 equivalent full-time (EFT) staff for 12 weeks. Page 2 of 8 vaccinated HCWs so that nurse immunisers could quickly identify those staff who had already received influenza vaccine. Posters and screensavers for network computers were locally developed and displayed across all three campuses. c) Marketing In preparation for the 2014 HCW influenza vaccination program, the Public Affairs Unit at Alfred Health was engaged to formulate a social marketing campaign to improve staff influenza vaccination uptake. Key elements of this campaign included: Formative research To plan and inform the 2014 staff influenza vaccination program, we surveyed staff towards the end of the 2013 program (July 2013) at all campuses regarding their influenza vaccination status and barriers and enablers to influenza vaccination. Electronic (email) invitations containing a link to a web-based survey tool were used to recruit employed staff. The survey contained 10 questions, allowing staff to nominate reasons for vaccination or nonvaccination (see Appendix). Approval to perform the survey was obtained from the Alfred Health Human Research Ethics Committee. Participation was voluntary and anonymity of respondents was preserved. Intervention The 2014 HCW influenza vaccination program was implemented between March 1 and July 31, 2014. The program consisted of the following components: a) Vaccine availability Immunisation nurses were available throughout the vaccination program on wards and during routine multidisciplinary meetings to offer the influenza vaccination to HCWs. The number of mass influenza vaccination days increased from 3 in 2013 (one each at each campus) to 5 in 2014 (two at The Alfred campus, two at the Caulfield campus and one at the Sandringham campus), with additional days allocated to the 2 larger campuses within our health service. Staff resources available for vaccination outside of the mass vaccination days were comparable to additional resources allocated for the 2013 program, but were focussed earlier in the campaign (2.9 EFT for 8 weeks). b) Communication Information regarding staff influenza vaccination sessions was provided in weekly electronic communiqués with the support of senior executive and short presentations with a strong public health message were delivered at various hospital-wide meetings. A small campai (...truncated)