Worksite: Seasonal Influenza Vaccinations Using Interventions with On-Site, Free, Actively Promoted Vaccinations – Healthcare Workers

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Findings and Recommendations

The Community Preventive Services Task Force (CPSTF) recommends interventions with on-site, free, and actively promoted influenza vaccinations, when implemented alone or as part of a multicomponent intervention, based on strong evidence of their effectiveness in increasing influenza vaccination coverage among healthcare workers when implemented alone or as part of a multicomponent intervention.

The CPSTF recommends interventions with on-site, free, and actively promoted influenza vaccinations based on sufficient evidence of their effectiveness in decreasing cases of influenza among healthcare workers and patients when implemented alone or as part of a multicomponent intervention.

The CPSTF has related findings for the following:

The full CPSTF Finding and Rationale Statement and supporting documents for Worksite: Seasonal Influenza Vaccinations Using Interventions with On-Site, Free, Actively Promoted Vaccinations — Healthcare Workers are available in The Community Guide Collection on CDC Stacks.

Intervention

Interventions to increase uptake of flu vaccines in healthcare workers (HCW) involve making vaccines available to workers and announcing this availability using things such as newsletters, e-mails, or paycheck inserts.

Vaccines are offered on-site and may be provided:

  • At cost, reduced cost, or no cost
  • With health education and mobile units
  • In clinics
  • At multiple locations

On-site vaccination interventions principally attempt to enhance access to the vaccine for workers and address many identified barriers to vaccine uptake. By providing vaccination at the worksite, employers reduce temporal, geographic, and financial barriers that can prevent workers from getting vaccinated.

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 45 studies (search period through March 2008).

Study Characteristics

  • All 45 studies evaluated interventions with free, on-site, actively promoted influenza vaccinations alone and when combined with additional interventions including provision of information, efforts to enhance access, activities to change attitudes and norms, and policy changes
  • Conducted in medium and large hospitals, and in long-term care facilities
  • Conducted mostly in United States, Europe, and Canada; however, body of evidence included studies from Singapore, Brazil, South Korea, and Australia

Summary of Results

Forty-five studies qualified and examined changes in vaccination coverage, changes in influenza cases, or worker productivity.

  • Change in vaccination coverage: median increase of 21.0 percentage points (interquartile interval: 11 to 34 percentage points; 41 studies)
  • Change in influenza cases:
    • Among patients: median relative decrease of 11.3% (3 studies)
    • Nosocomial infections: median relative decrease of 78.0% (4 studies)
  • Change in worker productivity was not reported in qualifying studies

Summary of Economic Evidence

Three studies were included, one each from U.S., Canada, and U.K. Small body of evidence indicates cost-savings but firm conclusion cannot be reached. Monetary values in 2007 U.S dollars.

  • U.S study indicated substantial savings for a hospital where nosocomial influenza infections declined from six to one following campaign. Cost to treat one infection estimated at $7,000. Net benefit could not be calculated because cost of intervention was not reported
  • Canadian hospital study reported net benefit of $58 to $65 per vaccinated employee. Benefits based on productivity gains alone and did not consider nosocomial infections
  • U.K study reported cost of $692 per life year saved for program vaccinating staff responsible for care of high-risk patients. Program was cost-saving when estimate included averted work absences due to influenza

Applicability

Results applicable to workers in medium and large hospitals and long-term care facilities, including nurses and physicians.

Evidence Gaps

The following outlines evidence gaps for these interventions to promote seasonal influenza vaccinations among healthcare workers: on-site, free, actively promoted vaccinations; and actively promoted off-site vaccinations.

Although the body of evidence is strong, the field would benefit from research into the following questions:

  • How do the observed successes in large hospitals and long-term care facilities translate to coalitions of smaller healthcare facilities that may share health promotion resources or family practice clinics that operate on their own?
  • In what ways do current interventions with on-site, no-cost, actively promoted influenza vaccinations create, add to, reduce, or eliminate disparities among sub-groups of HCP?
  • What additional barriers should implementers address to achieve influenza vaccination coverage of greater than 90% among HCP?

Finally, as was shown in the review for general worksites, the overall body of knowledge for off-site, promoted interventions is weak. With only one study with small and non-significant effect measure, in spite of the study’s use of rigorous methods, in the body of literature that analyzed this approach, we were unable to conclude on its effectiveness.

Implementation Considerations and Resources

Barriers identified in broader literature include:

  • Tight schedules for healthcare workers
  • Distrust of the vaccine/medical industry
  • Weekend and night-shift workers may have reduced exposure to programs
  • Delay and uncertainty about vaccine delivery
  • Staff turnover, diversion of leadership attention, or lack of leadership involvement reduces financial and staff resources to implement new strategies
  • Fear of needles

Barriers suggested by review team include:

  • Language barriers
  • Mandatory programs can result in law suits
  • Less flexible schedules for lower-income workers
  • Prioritizing some groups over others can deter the non-prioritized groups

Crosswalks

Healthy People 2030 icon Healthy People 2030 includes the following objectives related to this CPSTF recommendation.