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Minnesota Healthcare Setting Employee Influenza Vaccination
Program Survey
Denise Dunn, RN, MPHAdult/Adolescent Immunization CoordinatorMinnesota Department of HealthAugust 2009
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Overview
Survey background Survey methods Initial findings Dissemination of results
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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
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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
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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.
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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)
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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
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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
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Survey findings
Overall employee influenza vaccination rate (all facilities combined) = 70.1%
VaccinatedUnvaccinated
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Survey findings
Influenza vaccination rates by facility type:– Hospital = 78%– LTC = 63%– Both = 73%– Other = 77%
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Survey findings
100% of healthcare facilities surveyed provided influenza vaccination to all employees during the 2008-09 season
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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%
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Survey findings
99% of facilities provided vaccination onsite 86% provided vaccination during all work
shifts 99% provided vaccination at no cost
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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%
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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%
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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
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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
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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%
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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
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Declination
For those who used declinations forms, was it mandatory for employees to return the form?
– Yes 72.7%– No 27.3%
YesNo
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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
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Declination
Will your organization use a declination process next influenza season?
– Yes 67%– No 5%– Unknown 28%
YesNoUnknown
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Findings
Vaccination rate comparison:
– Used declination form = 75%
– No declination form = 60%
0
10
20
30
40
50
60
70
80
% vaccinated
Useddeclination
Nodeclination
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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
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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
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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
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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
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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
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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
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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