Note: A version of this column originally appeared in the September 2004 issue of Home Healthcare Nurse, Volume 22, Number 9. The VNAA is reprinting it here because 3 years later, influenza immunization rates of healthcare workers have improved only by approximately 6% (Centers for Disease Control & Prevention, 2007), and 58% of healthcare workers are still not being immunized and are placing their patients at risk. A recent review concluded that vaccination of healthcare practitioners in settings in which patients were also vaccinated provided significant reductions in deaths among elderly patients from all causes and deaths from pneumonia (Thomas, R. E., Jefferson, T. O., Demicheli, V., & Rivetti, D., 2006). Voluntary programs that are built on educational/ awareness campaigns have not significantly impacted this dismal statistic. More effective programs include those that require the direct care staff to be immunized or sign a declination. This approach is recommended this year by the Advisory Committee on Immunization Practices. More radical (but effective) programs are making immunization mandatory. Nurses should be leaders in improving these rates.

You have heard the statistics: more than 36,000 persons die of influenza-related complications each year, and more than 200,000 persons are hospitalized (Centers for Disease Control & Prevention [CDC], 2003; CDC, 2007). Most of these numbers represent the elderly and the ill, precisely the persons to whom you are providing care. You may be one of the immunization champions who encourage your patients to receive flu vaccine. Maybe you even administer it during a visit. The question begging is, "Have you received your own influenza vaccine?"

If you answered negatively, you are unfortunately in excellent company. Recognizing this issue as a significant public health challenge, the National Foundation for Infectious Diseases (NFID) convened a roundtable in the fall of 2004 composed of leaders in healthcare, including representation from the Visiting Nurse Associations of America (VNAA). In a subsequent call-to-action statement, NFID referred to the need for "improving the dismal influenza vaccination rates among healthcare workers." And dismal they are.

Statistics from the CDC (2003) show that only 36% of healthcare workers actually are immunized against influenza each year. According to the NFID, the remaining 64% unvaccinated healthcare workers are thought to be a key cause of outbreaks in a variety of healthcare settings.

Why Aren't More of Our Colleagues Being Immunized Against Flu?

The reasons for not receiving influenza vaccine cited in several studies include (NFID, 2004)

* Concern about side effects or vaccine safety, including the misperception that the injectable vaccine could cause the flu

* Perception of a low personal risk for contracting influenza

* Inconvenience

* Ignorance of the CDC recommendations

* Dislike of needles

Clearly, these barriers are challenges, but they should be manageable once a healthcare facility has made a commitment to increasing education and access.

Not only are healthcare workers not quick to get immunized. They also often work while infected with the influenza virus, frequently becoming the source of influenza for their coworkers and patients. Why do they go to work sick? In one study (Watanakunakor, Ellis, & Gemel, 1993), some of the reasons cited for continuing to work included the need to perform important tasks, a sense of being irreplaceable, a desire not to impose one's work on colleagues, and not being sick enough to stay home. Preserving sick leave also was an issue, particularly among nurses.

The NFID publication raises an excellent discussion point. Until now, healthcare worker immunization for influenza has been treated as a public health initiative focused on the personal choice of employees. As the NFID suggests, a shift in the focus of immunization strategy is appropriate: to healthcare worker vaccination as an employee and patient health and safety initiative.

Home healthcare professionals owe it to themselves, their patients, their patients' families, and their own families to be protected against influenza. Every level of direct care staff needs encouragement to receive flu vaccine. The age range of most healthcare workers involves the group that responds best to flu vaccine. The vaccine is 70% to 90% effective in preventing influenza infection for healthcare workers younger than 65 years (CDC, 2003).

An added and equally compelling reason to be immunized is so you can answer your patients when they ask whether they should get a flu shot this year: "Absolutely, I just got mine!!"

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