HEALTH-SYSTEM EDITION
PROFESSIONAL PRACTICE

New report urges hospitals to immunize workers for safety

This year, health institutions have received renewed admonitions to immunize their employees. The Centers for Disease Control & Prevention (CDC) has long recommended annual influenza vaccination for all healthcare workers. But data from the National Health Interview Survey indicate that only 36% of healthcare professionals are immunized each year.

In response to such unacceptable immunization rates, the National Foundation for Infectious Diseases (NFID) recently issued a comprehensive report emphasizing the importance of the annual immunization of healthcare workers against influenza and urging healthcare institutions to support employee vaccination programs.

According to William Schaffner, M.D., an NFID board member and professor and chair of the department of preventive medicine at Vanderbilt University School of Medicine in Nashville, in November 2003 the NFID convened an expert roundtable in Washington, D.C. Representatives from about 25 organizations met to agree upon a series of consensus statements, which formed the basis of the group's report. Called "A Call to Action," the report was issued in February 2004. It is available on the NFID Web site at: http://www.nfid.org. The initiative was made possible by an unrestricted educational grant to the NFID from Aventis Pasteur.

According to the panel, four keys to increasing influenza vaccination rates among healthcare workers are: making the vaccination convenient; removing cost barriers; educating healthcare professionals; and encouraging advocacy for this issue by top management at healthcare institutions. Pharmacists can significantly reduce barriers to immunization by promoting vaccination to other healthcare providers and executives, said Cynthia LaCivita, Pharm.D., director of clinical standards and quality for ASHP. She also pointed out that as of April 2004, pharmacists can administer the vaccine in 37 states.

Schaffner said that pharmacists could ensure that an ample supply of vaccine is available in the right place at the right time. To make immunization convenient for healthcare workers, the influenza vaccine must be brought directly to the workplace, LaCivita said.

Offering the influenza vaccine to healthcare professionals at modified or no cost can increase participation in immunization programs, said LaCivita. Vaccination of healthcare workers protects patients from infection, so the authors of the report urged healthcare facilities to view influenza vaccination as "an infection control and patient safety measure that is the ultimate fiscal responsibility of the institution."

LaCivita emphasized that pharmacists are in a position to educate fellow health professionals about the importance of immunization against influenza. Workers may believe that because they are young, and do not have many of the comorbidities that older people do, they need not be vaccinated, she explained. The immunization of healthcare professionals is a different concept, however, observed Schaffner. It is a concept of patient safety.

In addition, LaCivita pointed out, many healthcare workers come to work even when they are ill, because they are so dedicated to their profession. Infected persons can shed the virus for 24 to 48 hours prior to becoming ill—and for several days thereafter, she cautioned.

Schaffner said that many healthcare professionals believe in myths about the influenza vaccine held by the general public, the most prominent being, "You will get the flu from the flu vaccine." Unfortunately, not enough health professionals have overcome these myths to get vaccinated themselves, he said.

Many persons, healthcare workers included, believe that they do not need to be vaccinated because the flu vaccine is imperfect, Schaffner said. He emphasized that the flu vaccine is always at least partially effective, and an ample supply is expected to be available this year.

Meanwhile, the CDC has announced that, for the first time, it plans to stockpile four million doses of vaccine for children. In addition, the agency recently began to promote its new recommendations that all children between the ages of six and 23 months receive the influenza vaccine.

Chiron and Aventis plan to make available a combined 100 million doses of influenza vaccine, approximately 17 million doses more than were distributed last year. MedImmune has announced that it will market its FluMist inhaled influenza vaccine to physicians and pharmacists (not the general public), and will slash the vaccine's price in half. It will produce only about one million doses this year.

"We cannot wait for a 'perfect' vaccine. As healthcare professionals, we have an obligation to do our best by our patients today," Schaffner concluded. "And we cannot do it without the pharmacist."

Charlotte LoBuono

Charlotte LoBuono. New report urges hospitals to immunize workers for safety.

Drug Topics

Aug. 23, 2004;148:HSE15.