Infection Preventionist Leads Flu Vaccination Effort

Making getting vaccinated against influenza has become a requirement for employees in many hospitals and other healthcare institutions. Christopher Blank, CIC, MPH, an infection preventionist with BJC Healthcare, a large healthcare system in the Midwest in which workers are required to get vaccinated, recently sat down with Infection Control Today® to discuss some of the hurdles involved in flu vaccination campaigns during the coronavirus disease 2019 (COVID-19) pandemic. “Rather than opening up a mass vaccination campaign in the cafeteria and having staff come when they’re able, we’ve tried to focus very heavily on using staff that are working on, for example, a nursing unit to vaccinate coworkers because they’re working together, they have PPE that they’re using,” Blank tells ICT®. He also says that leadership and various departments at BJC Healthcare have been meeting to discuss exactly how to deal with the COVID-19 vaccine when it arrives. Should it be mandatory for healthcare workers, too?

Infection Control Today®: The numbers in your study are really eye-popping. Before they had to get the flu shot, healthcare workers [at BJC Healthcare] had something like a 70% compliance rate for flu shot, and it after became mandatory it shot up to 98.4%. Were you surprised by the findings?

Christopher Blank, CIC, MPH: I don’t know if surprised would be the word I would use. I think when you look at the literature, we know that employer policies make a big difference in this area. The last year of our study, if you look at the overall flu vaccination rate in the United States among healthcare workers, it was around 75% or 80%. But when you break that down, based upon how that healthcare worker’s employer treated flu, you see big differences. It’s less than 50%, or was less than 50%, when employers didn’t require, promote, or offer flu vaccine in that workplace. And it exceeded 90%, nearly 95%, when employers required it and offered it. And so, we know that employer policies matter a great deal. I think this study really is another example and further evidence of just how important employer policies are when we start looking at flu vaccination for healthcare workers.

ICT®: And if memory serves, you also found that the number of people who asked for exemptions because of religious or health reasons also decreased after the flu shot became mandatory as well?

Blank: Yes. In the year before the mandatory policy, there were about 3400 people. In the 10th year—so after 10 years of a mandatory policy—there were about 400 people in the organization who received a medical exemption, or religious accommodation to flu vaccination. Obviously, a big shift there in terms of people not only getting vaccinated, but actually receiving the flu shot. Not just complying with the policy, but actually getting vaccinated, which is why the policy exists.

ICT®:I have to ask: Did you get your flu vaccination this year?

Blank: Not yet. You know, it just started. Spent a lot of work getting the campaign going. And that’s on my list for either tomorrow or later this week. I want to make sure that we are providing access to all of our staff before I jump in and get in line, but it will be essential, particularly this year. [Note: Blank has since gotten the flu vaccine.]

ICT®: I have to admit that I haven’t gotten my flu vaccination yet, but I usually do try to get it. I think it’s a good idea. Now, what’s also interesting is that even though you’re talking about the flu vaccine, we know everybody is talking about the coming COVID vaccine when that arrives. Do you think that some of what you found out will carry over to that COVID vaccine? In other words, will hospital leaders make it mandatory for healthcare workers to take the COVID vaccine, or will they wait a while to see how it works in the community and if there might be any side effects?

Blank: I think we have to be careful about drawing direct connections from what we know about flu vaccines and how we would approach COVID vaccines. The diseases are different. There are a lot of differences in the vaccine. I think there’s a lot more information that we need to gather and think through and understand before we can take the evidence base that has been developed for flu and how we encourage and promote flu vaccinations and try and directly apply that to a COVID vaccine going forward here. But, that said, just like everything else with COVID, there’s just a lot that we don’t know yet that we really need to understand so that we’re applying things in a way that’s going to work well in that scenario.

ICT®: You are a practicing infection preventionist. What is your role in the healthcare workers getting flu vaccine where you work?

Blank: I’m fortunate in that I am an IP, but I work directly with occupational health and emergency preparedness. We have been fortunate enough to be able to assign an IP to assist with those two departments. I’m heavily involved with flu vaccinations from a data management perspective, from a program management perspective. Although we heavily rely upon our occupational health nurses to actually administer the vaccine, I help support that effort in terms of how we structure our campaigns, as well as how we maintain the data and track compliance with the requirement. And also, this year with everything that’s been going on with COVID, I’ve been heavily involved in ensuring that the design of how we are approaching vaccinations this year is in a way that’s safe and in alignment with the precautions that we put in place to prevent COVID transmission within our workplaces and our facilities.

ICT®: How are you doing that?

Blank: I think it’s a lot of the strategies that we that we have tended to use, although to the degree that we can, we’ve tried to decentralize. Rather than opening up a mass vaccination campaign in the cafeteria and having staff come when they’re able, we’ve tried to focus very heavily on using staff that are working on, for example, a nursing unit to vaccinate coworkers because they’re working together, they have PPE that they’re using. But we’re not drawing from all of the departments and all of the areas of the hospital into one spot. So, we’ve tried to decentralize where we can. That obviously works in some areas, it doesn’t work in others. We have used and are using appointments. We’re vaccinating by appointment in 10-minute blocks. And then where we have staff from throughout our facility coming to one location to be vaccinated, we’re promoting very heavily some of the social distancing measures that are so important. And then also screening at that vaccination site, which is a requirement already to get to work each day, but just to validate that screening has been done and that the employee is not symptomatic, which is important, both from a safety perspective, but also from a vaccine effectiveness perspective.

ICT®: How effective is the flu vaccine? I know there might be a range of how effective it is through the years?

Blank: Yes, you know, so that varies every year and part of it is the match between the vaccine and what’s circulating. Part of that is what is the predominant subtype of flu that’s circulating. But we know that it is effective. And that even if it doesn’t prevent someone from getting the flu, it decreases the duration and the severity of symptoms. There’s a benefit from a direct prevention perspective, but also from an overall health perspective, even if there is a vaccine breakthrough.

ICT®: And keeping with social distancing, and masking and decentralizing how the flu vaccine is given out, does that make it harder to keep track of how many employees actually get the flu vaccine?

Blank: We’ve been very fortunate. We have a pretty strong data management system in place where we are able to track pretty effectively who is vaccinated, what they’re vaccinated with, the date that they were vaccinated. Information that’s essential from an employee health record perspective, and also essential from a policy compliance perspective. And so that hasn’t been as much of a challenge as some of the other pieces when you think about social distancing steps and other precautions that have the downside of decreasing your throughput a little bit. It requires a little more staff and a little more intensive of an effort in order to reach everyone that that we’ve been able to reach every year. But we’re well on track to be able to accomplish that.

ICT®: Is there usually a deadline for when staff needs to get the flu vaccination? And has that deadline been adjusted this year in light of everything else that’s happening?

Blank: For us, it has historically been before mid-December. And this year, we decided to push that up to before November 25. And the logic for that decision, which wasn’t made lightly, is that we want to encourage earlier season flu vaccination. We also wanted to increase the likelihood that our staff have had time to be vaccinated, develop immunity, before we get to what has historically been our peak flu season, so that it maximizes the effectiveness of vaccination. And from our research, we observed that the dates of vaccination were heavily correlated to when we made concerted efforts to promote vaccination and made it the vaccine most available. And so recognizing that we had a degree of influence at least over when staff got vaccinated, it made it a little easier to stomach trying to do everything that we do in a typical flu season with the precautions that we need to take for COVID. And also do that on a little bit tighter timeline.

ICT®: What about patients and visitors? Are they reminded about the flu vaccine when they come to your hospitals? Are they getting more encouragement this year?

Blank: In our region in St. Louis, we partnered with other healthcare providers in our area to promote flu vaccination broadly to the public. For patients there is a separate essentially protocol for vaccinating patients for flu, who may not be in the hospital for flu and often are not. But as long they’re our patients, we’re able to promote and encourage flu vaccinations.

ICT®: A lot of my readership, as you know, our comprises infection preventionists. Any words of advice for them about how to go about flu vaccination? Well, let’s back up a little bit. Any words of advice for those [working at hospitals] who have not made it mandatory yet?

Blank: So obviously, that’s an organization by organization decision. And there’s a lot that goes into it. I think the evidence base is pretty clear at this point, certainly from our study, and from other organizations that have published their experience with flu vaccination and flu vaccination requirements, that it is effective. And that we’ve been able to sustain that effectiveness over 10 years. One of the key steps as you’re approaching this is truly leadership support and buy in from some of your key groups in the organization. We’ve been very fortunate that we’ve had strong leadership support for when it was a promotion and an encouragement phase for doing that. And then when it became a requirement, that support which is so important, has been sustained. Because if not…. There are resources that are required in order to do this. We’re vaccinating around 30,000 employees every year. And BJC Healthcare leadership supports that effort and the resources that are required to reach all of those employees. They support the requirement to do it. And they’ve also supported us as we’ve administered this program and move forward. Building that leadership support has been really important for us.

ICT®: You used the phrase keep key groups in the organization. Now, aside from leadership—and I think by leadership, you mean hospital administrators or the hospital administration team—what are the key groups as far as the vaccination program in hospitals are concerned?

Blank: I think if you look at your big employee groups. So nursing, obviously in a hospital, that’s a major staff population and ensuring that nursing is aware of the discussion, participating in that discussion and ultimately, ideally supportive of the requirement is important. Obviously, there’s going to be a medical provider component to it as well. But also thinking through what will this mean for occupational health. And who is going to be—to the extent you need—the person who’s going to enforce the requirement. HR as a partner is particularly important. Human resources as a partner has been a key partner for us. In occupational health going forward from your other requirements, because there is being a condition of employment, we needed human resources to be supportive of that. And then also assisting in some of the religious accommodation components of the requirement. That’s really not an occupational health issue so much as a human resources issue. Human resources has been a key partner on that as well.

ICT®: Are you meeting now or making plans now with either hospital administrators or anybody else in hospital for when the COVID-19 vaccine does arrive and how you’re going to deal with that?

Blank: We have a planning team that is multidisciplinary that has been meeting. It includes infection prevention, it includes emergency preparedness, occupational health, human resources, pharmacy supply chain. I’m sure I’m missing a few others that are part of our group that’s actively trying to develop what our strategy is going to be. There are a number of things that we don’t know, that make developing that strategy a little more difficult. But we’ve been meeting now for probably about a month, just trying to understand what is the current landscape and trying to stay current on that, which is its own almost full-time job. And then trying to think through what that will look like for our organization, particularly where our organization is in two different states, which adds its own layer of complexity.

ICT®: Anything I neglected to ask you that you think might be pertinent?

Blank: I don’t think so. I think you covered … just looking at my notes to see if I didn’t cover anything. And I think the only point I would make that was another interesting finding that we had very specifically around the medical exemption is that with the advent of the egg-free flu vaccine, that really made a big difference on the number of employees that needed a medical exemption. And we didn’t necessarily see a mass migration from “I need a medical exemption because I have an egg allergy” to “I need a medical exemption for another reason.” And so, we were able to—and do—provide an egg-free flu vaccine that reached a notable number of our employees that were exempted from the from flu vaccination for that reason.

This interview has been editor for clarity and length.