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CE Article: Take practical steps to protect your staff members, patients from the flu*

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Learning objectives: After reading this article, you will be able to

  1. Recall specific Joint Commission standards that affect influenza planning
  2. Describe different strains of influenza and the threat each strain poses to the public
  3. Justify an employee vaccination program at your organization
  4. Identify strategies to implement a vaccination program at your organization

Each year between 250,000 and 500,000 people die worldwide from seasonal influenza. According to experts, the most efficient method of preventing outbreaks is through vaccinations, yet less than 40% of healthcare workers get influenza vaccines each year.

It's a trend that puts patients at risk - and regulators have taken notice. The Joint Commission enacted a new accreditation standard, IC.4.15, effective this year, which requires facilities to offer flu shots to employees and encourages them to make efforts to increase compliance. Click here to view the Joint Commission's new standard.

Other organizations, such as Hospital Infection Control Practices Advisory Committee (HICPAC) and the Advisory Committee on Immunization Practices, are also taking steps, such as recommending that healthcare workers who opt not to receive influenza vaccines sign declination forms.

With this in mind, the primary focus of your influenza preparedness efforts this year should be promoting employee vaccinations, say experts.

Although a solid vaccination program is crucial to the success of influenza preparedness and prevention, it's not the only measure your facility needs to take to get ready for the flu season. Hand hygiene, cough etiquette, respiratory hygiene, and influenza education programs are also critical. You should make sure that the nuts and bolts of your facility - the physical structure and your supply resources - are ready to take on the challenge.

Influenza: The basics

There are three categories of flu viruses: A, B, and C, according to Gloria Morrell, RN, BSN, MS, CIC, infection control specialist at Northside Hospital in Atlanta, who spoke at a recent HCPro audioconference, "Surge Strategies for Flu Outbreaks." Seasonal flu is typically caused by type A or B influenza. Type C viruses cause mild illness in humans, and don't cause pandemics or epidemics, said Morrell.

Type A is the most virulent. Most flu deaths are the result of type A viruses, and all three pandemics in the past century were related to type A influenza. Currently, healthcare organizations around the world are on alert due to influenza subtype A (H5N1)-avian flu. Click here to read more about the three types of influenza viruses.

How influenza is transmitted

The influenza virus is transmitted from person to person through droplets in the air, says Gay Howard, RN, CPHQ, CLNC, a senior consultant with The Greeley Company, a division of HCPro, Inc., in Marblehead, MA.

The droplets are released when the infected person sneezes or coughs. Influenza enters the body through the nose or throat, and symptoms emerge one to four days later, according to the World Health Organization. Someone suffering from influenza can be infectious from the day before he or she develops symptoms until seven days afterward, says Howard.

Vaccination is key

A strong employee influenza vaccination program should be a top priority for the 2007-2008 flu season. In fact, such programs are recommended or even required by the CDC, The Joint Commission, OSHA, and HICPAC. The reason healthcare agencies deem vaccination programs so critical is because healthcare worker vaccination has been shown to reduce not only absenteeism but also the number of patient deaths. Vaccination also reduces healthcare workers' medical costs by an average $47 per person, according to Morrell.

There are two types of vaccines, according to Sue Boeker, RN, BSN, CIC, an infection control practitioner at Greenville Hospital System in Greenville, SC, who also spoke at the HCPro audioconference in August:

  • Inactivated vaccine, which is given in an injection.
  • Live attenuated vaccine, which is a nasal mist formula. It is safe to use in the hospital environment except for healthcare workers, caregivers, and family members of patients who need a protective environment, such as transplant patients, says Boeker. The live attenuated vaccine is also not recommended for children under age five or adults over age 50.

To encourage vaccine compliance, your facility should make it as easy as possible for these individuals to obtain a flu shot - ideally at no cost. Click here to read more about the seasonal flu vaccine.

The whys of why nots

There are a number of reasons why healthcare workers don't get vaccinated, according to Morrell. They include the following:

  • Fear of vaccine side effects
  • Insufficient time or inconvenience
  • Perceived ineffectiveness of vaccine
  • Medical contradictions
  • Perceived low likelihood of contracting influenza
  • Reliance on treatment with homeopathic medications
  • Avoidance of medications
  • Fear of needles

Overcoming these barriers requires a combination of efforts, including education, to combat misconceptions about the vaccine. The following are some methods for promoting compliance:

  • Use reminder systems
  • Remove administrative and financial barriers
  • Use role models
  • Monitor and provide feedback on vaccination coverage
  • Offer incentives

Don't be afraid to dangle a carrot to encourage vaccination compliance, says Morrell. Some ideas for incentives might include rewarding the department with the highest percentage of immunized workers with:

  • Lunch for the department
  • Game night at a local center
  • Movie theater gift certificates
  • Starbucks cards

Flu season is here

Once flu season has arrived, it's important to stay on top of virus trends. The following are some steps that your facility can take, according to Howard:

  • Perform active surveillance and use rapid influenza testing to target your efforts. According to the CDC, rapid influenza testing can yield results in 30 minutes and should be used when the results will affect clinical decision-making.
  • Educate staff members about the signs and symptoms of influenza so that they can identify the flu when they see it.
  • Test for influenza when clusters of respiratory illnesses occur in patients or healthcare workers. This is where rapid influenza testing can be useful to prevent the spread of influenza in the facility.
  • Consider using antiviral medications, although influenza A viruses have already become resistant to some antivirals.
  • If influenza is widespread in the community, post notices that the hospital will not permit adults with respiratory illness and children with symptoms to visit the facility.
  • If you suspect a patient has influenza, you should separate him or her from asymptomatic patients until he or she tests negative for the influenza virus.

Source: Briefings on Infection Control, October 2007, HCPro, Inc.


  1. "New Standard IC.4.1.15" at
  2. "Influenza Viruses" at
  3. "Key Facts About Seasonal Flu Vaccine" at

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