Letters
doi: 10.1111/1753-6405.12260
Influenza vaccination of Victorian healthcare workers: will a higher target increase vaccine uptake? David Wang,1,2 Leon Worth,1 Ann Bull,1 Noleen Bennett,1 Michael Richards1 1. Victorian Healthcare-Associated Infection Surveillance System 2. School of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria
Annual influenza vaccination of healthcare workers (HCW) is an important component of infection prevention in healthcare facilities and confers multiple benefits, including reduced incidence of influenza among HCWs,1 lower rates of staff absenteeism1 and reduced patient mortality.2 Although estimated vaccination rates of healthcare personnel in the United States have now exceeded 70%,3 the majority of published reports in Australia have indicated poorer uptake, with rates generally less than 50%.4,5 However, data captured more recently by the Victorian Healthcare-Associated Infection Surveillance System (VICNISS) Coordinating Centre suggest that aggregate vaccination rates in Victoria have increased from 38% to 64.7% during the period 2005 to 2013 (see Figure 1). In 2013, 94 Victorian public hospitals and health services reported rates spanning 35.2% to 95%. In 2014, the Victorian Department of Health increased the target from 60% to 75% for individual healthcare facilities, coinciding with HCW influenza vaccination being introduced as a key performance indicator
for Victorian hospitals.6 While this is a positive step forward, a number of questions remain. First, the ability of hospitals to feasibly reach the revised target using existing resources must be considered. Applied retrospectively to data captured in 2013, only 22% of participating hospitals would have attained a rate of 75%. To improve uptake, the Centers for Disease Control recommends distribution of educational material regarding influenza vaccination, increasing vaccine availability and regular measurement and feedback during the course of influenza campaigns.7 Formal evaluation of Victorian programs has not been performed, but it is likely that these measures are variably employed.8 Second, it is not clear if or how this indicator will be enforced within the state of Victoria. One way to achieve high coverage is mandatory vaccination. However, it is unlikely that this approach will be adopted in the near future in Victorian hospitals, given debate concerning HCW autonomy. High uptake may also be achieved through dedicated non-mandatory programs,9,10 but the required resources and sustainability of these programs have not been widely evaluated. Third, if influenza vaccination rates are to be used as a quality indicator for hospitals, data must be valid. For example, the method used to determine the denominator of total employed HCWs must be uniform so that hospital-level data are comparable. Heterogeneity in the approach to calculating denominators has previously been identified in the United States, driving the development of standardised methodology.11
Figure 1: Influenza vaccination uptake by Victorian health care workers, 2005–2013.
*Defined as National Health and Medical Research Council categories A, B and C staff employed by Victorian public hospitals participating in VICNISS program.
490
While HCW vaccination uptake is an important quality indicator in healthcare, we suggest that compliance with a vaccination program may be a more pragmatic metric in the current era of non-mandatory programs. If staff opt not to be vaccinated, declination should be documented,12 and ‘total staff assessed’, should be reported in tandem with ‘total staff vaccinated’. With a revised Victorian target, we also believe that evaluation of existing vaccination strategies would provide timely and valuable insights into data regarding vaccination uptake for individual healthcare facilities.
References 1. Wilde JA, McMillan JA, Serwint J, Butta J, O’Riordan MA, Steinhoff MC. Effectiveness of influenza vaccine in health care professionals: A randomized trial. JAMA. 1999;281(10):908-13. 2. Ahmed F, Lindley MC, Allred N, Weinbaum CM, Grohskopf L. Effect of influenza vaccination of healthcare personnel on morbidity and mortality among patients: Systematic review and grading of evidence. Clin Infect Dis. 2014;58(1):50-7. 3. Centers for Disease C and Prevention. Influenza vaccination coverage among health-care personnel-United States, 2012-13 influenza season. MMWR Morb Mortal Wkly Rep. 2013;62(38):781-6. 4. Seale H, Macintyre CR. Seasonal influenza vaccination in Australian hospital health care workers: A review. Med J Aust. 2011;195(6):336-8. 5. Bull AL, Bennett N, Pitcher HC, Russo PL, Richards MJ. Influenza vaccine coverage among health care workers in Victorian public hospitals. Med J Aust. 2007;186(4):185-6. 6. Department of Health. Victorian Health Service Performance Monitoring Framework 2013–14 Business Rules [Internet]. Melbourne (AUST): State Government of Victoria; 2014 [cited 2014 Mar]. Available from: www. health.vic.gov.au/hospital-performance 7. Fiore AE, Uyeki TM, Broder K, et al. Prevention and control of influenza with vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010. MMWR Recomm Rep. 2010;59(RR-8):1-62. 8. Seale H, Kaur R, MacIntyre CR. Understanding Australian healthcare workers’ uptake of influenza vaccination: examination of public hospital policies and procedures. BMC Health Serv Res. 2012;12:325. 9. Honda H, Sato Y, Yamazaki A, Padival S, Kumagai A, Babcock H. A successful strategy for increasing the influenza vaccination rate of healthcare workers without a mandatory policy outside of the United States: A multifaceted intervention in a Japanese tertiary care center. Infect Control Hosp Epidemiol. 2013;34(11):1194-200. 10. Leung VK, Harper SE, Slavin MA. Influenza vaccination uptake in an Australian hospital: Time to make it mandatory for health care workers? Med J Aust. 2012;197(10):552. 11. Libby TE, Lindley MC, Lorick SA, et al. Reliability and validity of a standardized measure of influenza vaccination coverage among healthcare personnel. Infect Control Hosp Epidemiol. 2013;34(4):335-45. 12. Fricke KL, Gastanaduy MM, Klos R, Begue RE. Correlates of improved influenza vaccination of healthcare personnel: a survey of hospitals in Louisiana. Infect Control Hosp Epidemiol. 2013;34(7):723-9.
Correspondence to: Associate Professor Leon Worth, Victorian Healthcare-Associated Infection Surveillance System Coordinating Centre, Peter Doherty Institute, 792 Elizabeth Street, Melbourne, VIC 3000; e-mail: [email protected]
Australian and New Zealand Journal of Public Health © 2014 Public Health Association of Australia
2014 vol. 38 no. 5
doi: 10.1111/1753-6405.12260
Influenza vaccination of Victorian healthcare workers: will a higher target increase vaccine uptake? David Wang,1,2 Leon Worth,1 Ann Bull,1 Noleen Bennett,1 Michael Richards1 1. Victorian Healthcare-Associated Infection Surveillance System 2. School of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria
Annual influenza vaccination of healthcare workers (HCW) is an important component of infection prevention in healthcare facilities and confers multiple benefits, including reduced incidence of influenza among HCWs,1 lower rates of staff absenteeism1 and reduced patient mortality.2 Although estimated vaccination rates of healthcare personnel in the United States have now exceeded 70%,3 the majority of published reports in Australia have indicated poorer uptake, with rates generally less than 50%.4,5 However, data captured more recently by the Victorian Healthcare-Associated Infection Surveillance System (VICNISS) Coordinating Centre suggest that aggregate vaccination rates in Victoria have increased from 38% to 64.7% during the period 2005 to 2013 (see Figure 1). In 2013, 94 Victorian public hospitals and health services reported rates spanning 35.2% to 95%. In 2014, the Victorian Department of Health increased the target from 60% to 75% for individual healthcare facilities, coinciding with HCW influenza vaccination being introduced as a key performance indicator
for Victorian hospitals.6 While this is a positive step forward, a number of questions remain. First, the ability of hospitals to feasibly reach the revised target using existing resources must be considered. Applied retrospectively to data captured in 2013, only 22% of participating hospitals would have attained a rate of 75%. To improve uptake, the Centers for Disease Control recommends distribution of educational material regarding influenza vaccination, increasing vaccine availability and regular measurement and feedback during the course of influenza campaigns.7 Formal evaluation of Victorian programs has not been performed, but it is likely that these measures are variably employed.8 Second, it is not clear if or how this indicator will be enforced within the state of Victoria. One way to achieve high coverage is mandatory vaccination. However, it is unlikely that this approach will be adopted in the near future in Victorian hospitals, given debate concerning HCW autonomy. High uptake may also be achieved through dedicated non-mandatory programs,9,10 but the required resources and sustainability of these programs have not been widely evaluated. Third, if influenza vaccination rates are to be used as a quality indicator for hospitals, data must be valid. For example, the method used to determine the denominator of total employed HCWs must be uniform so that hospital-level data are comparable. Heterogeneity in the approach to calculating denominators has previously been identified in the United States, driving the development of standardised methodology.11
Figure 1: Influenza vaccination uptake by Victorian health care workers, 2005–2013.
*Defined as National Health and Medical Research Council categories A, B and C staff employed by Victorian public hospitals participating in VICNISS program.
490
While HCW vaccination uptake is an important quality indicator in healthcare, we suggest that compliance with a vaccination program may be a more pragmatic metric in the current era of non-mandatory programs. If staff opt not to be vaccinated, declination should be documented,12 and ‘total staff assessed’, should be reported in tandem with ‘total staff vaccinated’. With a revised Victorian target, we also believe that evaluation of existing vaccination strategies would provide timely and valuable insights into data regarding vaccination uptake for individual healthcare facilities.
References 1. Wilde JA, McMillan JA, Serwint J, Butta J, O’Riordan MA, Steinhoff MC. Effectiveness of influenza vaccine in health care professionals: A randomized trial. JAMA. 1999;281(10):908-13. 2. Ahmed F, Lindley MC, Allred N, Weinbaum CM, Grohskopf L. Effect of influenza vaccination of healthcare personnel on morbidity and mortality among patients: Systematic review and grading of evidence. Clin Infect Dis. 2014;58(1):50-7. 3. Centers for Disease C and Prevention. Influenza vaccination coverage among health-care personnel-United States, 2012-13 influenza season. MMWR Morb Mortal Wkly Rep. 2013;62(38):781-6. 4. Seale H, Macintyre CR. Seasonal influenza vaccination in Australian hospital health care workers: A review. Med J Aust. 2011;195(6):336-8. 5. Bull AL, Bennett N, Pitcher HC, Russo PL, Richards MJ. Influenza vaccine coverage among health care workers in Victorian public hospitals. Med J Aust. 2007;186(4):185-6. 6. Department of Health. Victorian Health Service Performance Monitoring Framework 2013–14 Business Rules [Internet]. Melbourne (AUST): State Government of Victoria; 2014 [cited 2014 Mar]. Available from: www. health.vic.gov.au/hospital-performance 7. Fiore AE, Uyeki TM, Broder K, et al. Prevention and control of influenza with vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010. MMWR Recomm Rep. 2010;59(RR-8):1-62. 8. Seale H, Kaur R, MacIntyre CR. Understanding Australian healthcare workers’ uptake of influenza vaccination: examination of public hospital policies and procedures. BMC Health Serv Res. 2012;12:325. 9. Honda H, Sato Y, Yamazaki A, Padival S, Kumagai A, Babcock H. A successful strategy for increasing the influenza vaccination rate of healthcare workers without a mandatory policy outside of the United States: A multifaceted intervention in a Japanese tertiary care center. Infect Control Hosp Epidemiol. 2013;34(11):1194-200. 10. Leung VK, Harper SE, Slavin MA. Influenza vaccination uptake in an Australian hospital: Time to make it mandatory for health care workers? Med J Aust. 2012;197(10):552. 11. Libby TE, Lindley MC, Lorick SA, et al. Reliability and validity of a standardized measure of influenza vaccination coverage among healthcare personnel. Infect Control Hosp Epidemiol. 2013;34(4):335-45. 12. Fricke KL, Gastanaduy MM, Klos R, Begue RE. Correlates of improved influenza vaccination of healthcare personnel: a survey of hospitals in Louisiana. Infect Control Hosp Epidemiol. 2013;34(7):723-9.
Correspondence to: Associate Professor Leon Worth, Victorian Healthcare-Associated Infection Surveillance System Coordinating Centre, Peter Doherty Institute, 792 Elizabeth Street, Melbourne, VIC 3000; e-mail: [email protected]
Australian and New Zealand Journal of Public Health © 2014 Public Health Association of Australia
2014 vol. 38 no. 5
