Dear Colleague Letter: Importance of Influenza Vaccination for All Health Care Personnel (HCP)

October 2012

Dear Colleague:

The 2012 influenza season is approaching and influenza vaccine distribution has already begun. I am writing to reiterate the critical importance of influenza vaccination for all health care personnel (HCP) as the single most important tool available to prevent transmission of influenza in health care settings. During the 2011-2012 influenza season, the average influenza vaccination rate for HCP in hospitals in New York state was only 48 percent, and the rate for long term care facilities was only 44 percent. We must do better. The successful implementation of strategies to increase vaccination among HCP is dependent on clear organizational leadership and administrative policies to promote and facilitate adherence to vaccination recommendations among patients, visitors, and HCP.

Vaccination not only helps to assure patient safety in health care settings, but also benefits HCP and their family members. The New York State Department of Health (Department) encourages you to review your facility's policies and procedures to ensure that influenza vaccination is promoted and made readily accessible free of charge for all HCP working in your facilities, according to the guidelines of the federal Advisory Committee on Immunization Practices1(ACIP). Please note that the ACIP defines HCP more broadly than just employees, but also includes attending physicians, contractors and others working in facilities.

I urge you to actively promote influenza vaccination in your facility to achieve the highest possible vaccination rates among HCP. Systematic strategies employed to improve HCP vaccination rates that you may wish to consider include providing incentives, improving access (e.g., offering vaccination at work and during work hours on all three shifts and utilizing a mobile cart to deliver vaccine to staff), and requiring personnel not wishing to be vaccinated to sign declination forms to acknowledge that they have been educated about the benefits and risks of vaccination or to wear face masks during work hours for the duration of the influenza season2. Several recent publications in the peer reviewed literature have shown that mandates for HCP achieve higher levels of influenza vaccination coverage in HCP than previously used strategies, and a number of health care facilities have made influenza vaccination mandatory for their staff 3,4,5,6. The National Vaccine Advisory Committee recommends that employers strongly consider a requirement for influenza immunization if they have not been able to achieve the Healthy People 2020 goal of 90 percent vaccination rates through vigorous and sustained efforts7.

To assist you in your efforts, a tool kit for influenza vaccination programs in health care facilities is available on the Department website at: www.health.ny.gov/prevention/immunization/toolkits/. The Department will again this year conduct a survey of selected health care facilities later in the influenza season to determine the extent to which your efforts have resulted in HCP immunization during the 2012-2013 influenza season.

Achieving high influenza vaccination rates among HCP is a critical step in preventing health care transmission of influenza and protecting patients. In addition to the immunization of HCP, the following actions to prevent transmission within health care facilities are recommended8:

  • reinforcement of respiratory hygiene and cough etiquette;
  • appropriate exclusion of ill HCP;
  • adherence to infection control precautions for all patient care activities and aerosol- generating procedures;
  • implementation of environmental and engineering infection control measures; and
  • restrictions on visitors during the peak of influenza illness in the community.

In closing, I want to reiterate the importance of annual vaccination as the single most important action to prevent seasonal influenza infection. The Department strongly urges all facilities to actively promote influenza immunization for all HCP to ensure patient health and safety and a healthy and robust health care workforce during the current influenza season. Please see the Department website at http://www.health.ny.gov/diseases/communicable/influenza/seasonal/ and the CDC website at http://www.cdc.gov/flu/ for additional information, brochures, and resources.

Thank you for working with us to promote the health and safety of all New Yorkers.

Sincerely,

Nirav R. Shah, M.D., M.P.H
Commissioner of Health

  1. Centers for Disease Control and Prevention: Recommendation of the Immunization Practices Advisory Committee (ACIP): Prevention and control of influenza. Morbidity and Mortality Weekly Report (MMWR) August 26, 2011 60(33); 1128–1132 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6033a3.htm?s_cid=mm6033a3_w
  2. The Joint Commission on Accreditation of Healthcare Organizations: Providing a Safer Environment for Health Care Personnel and Patients Through Influenza Vaccination http://www.jointcommission.org/assets/1/18/Flu_Monograph.pdf (accessed July 20, 2011).
  3. Mandatory Influenza Vaccination of Health Care Workers: Translating Policy to Practice by Hilary M. Babcock, et al; Clinical Infectious Diseases 2010;50:459–64; www.ncbi.nlm.nih.gov/pubmed/20064039
  4. Rakita RM, Hagar BA, Crome P, Lammert JK. Mandatory Influenza Vaccination of Healthcare Workers: A 5- Year Study. Infect Control Hosp Epidemiol. July 23, 2010.
  5. Morbidity and Mortality Weekly Report (MMWR) Interim Results: State-Specific Seasonal Influenza Vaccination Coverage --- United States, August 2009—January 2010. April 30, 2010/ 59(16); 477–484 www.cdc.gov/mmwr/preview/mmwrhtml/mm5916a1.htm
  6. Morbidity and Mortality Weekly Report (MMWR) Interim Results: State-Specific Seasonal Influenza Vaccination Coverage --- United States, August 2011—February 2011. June 10, 2011 / 60(22); 737-743 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6022a3.htm
  7. National Vaccine Advisory Committee. Recommendations on Strategies to Achieve the Healthy People 2020 Annual Influenza Vaccine Coverage Goal for Health Care Personnel February 2012. http://www.hhs.gov/nvpo/nvac/influenza_subgroup_final_report.pdf
  8. Centers for Disease Control and Prevention: Strategies for Seasonal Influenza in Healthcare Settings 2010. www.cdc.gov/flu/professionals/infectioncontrol/healthcaresettings.htm.