Minnesota Healthcare Setting Employee Influenza Vaccination

Program Survey

Denise Dunn, RN, MPHAdult/Adolescent Immunization CoordinatorMinnesota Department of HealthAugust 2009

Overview

Survey background Survey methods Initial findings Dissemination of results

Survey background

National healthcare worker vaccination rate is about 45%*

Interest in what Minnesota’s rate might be Strong backing from MIPAC Influenza

Subgroup to survey MN MDH decides to survey 2008-09 season

*National Health Interview Survey (NHIS), 2006-07

Survey background

Decision to do more than just a declination survey

Interest in obtaining Minnesota-specific information about employee influenza vaccination programs and rates in health care settings

Purpose of survey

To collect:– Minnesota-specific employee influenza vaccination

rates in health care settings to give us a benchmark to mark progress;

– Information on various employee influenza vaccination program activities used by organizations;

– Data on the perceived barriers to vaccination; and – Baseline information on utilization/usefulness of the

Minnesota Immunization Information Connection (MIIC), our statewide immunization registry, for tracking employee influenza vaccinations.

Coverage & sampling

Survey population = all hospitals and long-term care facilities in Minnesota

Surveyed all hospitals (N=145) and a random sample of long-care facilities (N=135)

Total facilities surveyed = 280 Facility lists obtained from Compliance

Monitoring Division (MDH)

Survey methods

Online survey available mid-April through May 2009

Paper version was available, but no requests for it

Pre-letter to administrators, followed by instructional letter to infection control staff (if known) or again to administrators, by default

ICP email list used, as available

Survey methods

Reminders sent either via mail or email Response rate = 62%

– Excluded 6 incomplete surveys– Total responses; N = 173

Response deadlines were extended – Last 2 weeks of original timeframe were

extremely busy for hospitals with H1N1 Analysis is still underway

Survey findings

Overall employee influenza vaccination rate (all facilities combined) = 70.1%

VaccinatedUnvaccinated

Survey findings

Influenza vaccination rates by facility type:– Hospital = 78%– LTC = 63%– Both = 73%– Other = 77%

Survey findings

100% of healthcare facilities surveyed provided influenza vaccination to all employees during the 2008-09 season

Survey findings

In addition to employees, who was included in your vaccination program?– Volunteers 61%– Licensed independent contractors 42%– Students 31%– Community providers 11%– Vendors 6%

Survey findings

99% of facilities provided vaccination onsite 86% provided vaccination during all work

shifts 99% provided vaccination at no cost

Vaccination delivery methods

Vaccination clinics/fairs 73% Peer-vaccinators 60% Mobile carts 50% Coordination with other programs 39% Occupational health site 28% Using congregating areas 25% Flu captains/teams 12%

Promotional activities

Respondents used the following promotional activities to enhance vaccination programs:

– Reminders 91% – Promotional campaign 70%– Strong support by admin 49%– One on one counseling 42%– Incentives 38%– Rates reviewed by admin 35%– Rates shared within facility 32%– Kick off event 21%– Influenza champions 12%

Educational activities

92% of facilities provide education as part of their employee vaccination program

Of those facilities that provided education:– In 34%, education was required– In 66%, education was not required

Survey findings

Respondents track employee influenza vaccinations using:– Paper forms 88%– Other computer application 23%– MIIC 10%– Other, included consent forms, checklists, sign up

sheets, employee health records

Survey findings

Barriers cited to using MIIC to track employee vaccinations:– Lack of time for entering data 26%– Prefer own system 25%– Lack of awareness about MIIC benefits 21%– Lack of trained personnel 13%– General difficulty in use 4%– Privacy concerns 2%

Declination

Did your organization use a declination form as part of its employee influenza vaccination program during the 2008-09 season?

– Yes 70%– No 30%

YesNo

Declination

For those who used declinations forms, was it mandatory for employees to return the form?

– Yes 72.7%– No 27.3%

YesNo

Declination

Reasons given for not using declination forms:– Lack of time or personnel resources 25%– Not convinced of value 21%– Leadership does not endorse 17%– Union barriers 6% – Other included: never used before, unaware of

form, employee rights, tried with little effect

Declination

Will your organization use a declination process next influenza season?

– Yes 67%– No 5%– Unknown 28%

YesNoUnknown

Findings

Vaccination rate comparison:

– Used declination form = 75%

– No declination form = 60%

0

10

20

30

40

50

60

70

80

% vaccinated

Useddeclination

Nodeclination

Declination reasons

Fear of adverse events 9% Fear of getting sick from vaccine 6% Fear of injections 5% Medical contraindications 3%

*average % reported, of those facilities that use declination forms

Initial findings

Program characteristics of facilities with high vaccination rates (close to or >90%):– Provide flu vaccine at no cost to employee– Provide vaccination during all work shifts– Expand vaccine offerings to “other” workers– Use reminder methods

Initial findings

Program characteristics of facilities with high vaccination rates (close to or >90%):– Most had a strongly motivated administrator

leading the vaccination drive– Most held kick-off events and campaigns– Almost all provide education on influenza and flu

vaccine to staff– Most used declination forms and required their

return

Initial findings

Program characteristics of facilities with high vaccination rates (close to or >90%):– All evaluate influenza vaccination rates annually– All set influenza vaccination rate goals annually– Almost all track reasons why employees choose

not to participate– All track the previous season’s data

Data analysis continues

Still analyzing data Continue analyzing specific activities

associated with high-rate facilities Compare vaccination rates of facilities that

use declination forms to those that do not Look at nonresponders

Dissemination of results

Internal MDH stakeholders MIPAC Influenza Subgroup CDC site visit “Brown bag” for additional MDH employees Fact sheet with summary of results / web MN Influenza Vaccination Plan 2009-10 State, regional, and/or national conferences

What’s next

Amend sample declination form Finish analysis and disseminate results Plan to repeat survey next year

– Possibly add sampling of clinics

H1N1 vaccine campaign may complicate next year’s survey

Questions/Discussion

Denise Dunn: – Denise.Dunn@state.mn.us– 651-201-5560