Child Health Evaluation and Research Unit Division of General Pediatrics, University of Michigan Nurses’ Knowledge, Attitudes and Practices Related to Influenza Vaccination                                                                                                                Sarah Clark, University of Michigan Anne Cowan, University of Michigan Pascale Wortley, CDC

Background Influenza vaccination of healthcare personnel recommended Vaccination rates are low                                                                                                               

Learning Objectives Identify reasons that nurses do not receive influenza vaccine Identify worksite policies related to influenza vaccination

Methods – Study Design Mailed survey of licensed 2000 RNs in four states (CO, FL, MO, PA) Random sample of 500 RNs from licensure file of each study state

Methods – Survey Instrument 17 questions on the following: Receipt of influenza vaccine/reasons why Worksite policies on influenza vaccine Relevant knowledge and attitudes Demographic characteristics

Methods – Survey Administration Data collected Jan-Feb 2006; questions referred to 2005-06 influenza season Two survey mailings Overall response rate 72% 72% CO, 65% FL, 76% MO, 76% PA

Results Practice Characteristics Total CO FL MO PA Provide Inpatient Care 73% 75% 78% 69% 70% Influenza Risk Level for Primary Patient Population High-risk patients 52% 49% 59% 50% 53% Medium-risk patients 33% 32% 28% 36% 34% Low risk patients 15% 19% 13% 14%

Results Influenza Vaccination Status State Variation 59% vaccinated 41% not vaccinated State Variation CO and MO: 64% vaccinated PA: 56% vaccinated FL: 48% vaccinated

Results % Vaccinated by Respondent Characteristics Age < 50 years 54% 0.0007 50-64 years 64%  65 years 78% Have Chronic Condition No 56% <0.0001 Yes 73% Patients’ Influenza Risk Level Low-risk 38% Medium-risk High-risk 67%

Results Primary reason(s) for vaccination 95% protect myself from illness 74% protect my patients from illness 19% member of target group for vaccination*

Results Primary reason(s) for vaccination 95% protect myself from illness 74% protect my patients from illness 19% member of target group for vaccination* 9% local epidemic/bad flu season 3% workplace mandate 15% other (e.g., protect family from illness)

Results Primary reason(s) against vaccination 39% concern about adverse reactions 19% small chance of contracting influenza 18% limited contact with high-risk patients 18% vaccine is not effective enough

Results Primary reason(s) against vaccination 39% concern about adverse reactions 19% small chance of contracting influenza 18% limited contact with high-risk patients 18% vaccine is not effective enough 17% too busy/forgot 6% contraindications 24% other (supply/access, “don’t want one”)

Proportion that “Strongly Agree” Among Those… Results Attitudes of Vaccinated vs Not Vaccinated RNs Proportion that “Strongly Agree” Among Those… Vaccinated Not Vaccinated Influenza and its complications can be serious 71% 50% Benefits of flu vaccine outweigh risk of side effects 51% 16% Flu vaccine is effective in preventing influenza-related hospitalizations in vaccinated persons 36% 15% Systemic side effects from flu vaccine are rare 27% 10%

Proportion that “Strongly Agree” Among Those… Results Attitudes of Vaccinated vs Not Vaccinated RNs Proportion that “Strongly Agree” Among Those… Vaccinated Not Vaccinated HCW vaccination can prevent the spread of influenza to patients 53% 23% HCWs have a professional responsibility to get an annual flu vaccine 39% 10% HCWs are at higher risk of getting influenza than the general public 46% 26% Hospitals / practices should track whether HCWs receive flu vaccine 41% 17%

Results Worksite recommendation on influenza vaccination 55% strongly recommended 19% recommended 25% somewhat or not recommended

Results Vaccination status and worksite recommendation 68% vaccinated when strongly recommended 37% vaccinated when not strongly recommended

Results Vaccination availability 95% vaccination available on-site 50% available during all work shifts 29% not available during all shifts 21% unsure

Results Vaccination status and availability 71% vaccinated when available during all shifts 47% vaccinated when not available during all shifts

Results Locations of on-site vaccination 55% employee/occupational health clinic 16% other fixed locations (ER) 38% congregate areas (cafeteria, conferences) 27% mobile carts, within units

Results Vaccination status by worksite options 72% vaccinated of those with multiple locations 56% vaccinated of those with single location 23% vaccinated of those with no worksite option

Conclusions Influenza vaccination rates higher among RNs who Are in target groups for vaccination Care for higher-risk patients Believe vaccination will protect them and their patients from disease

Conclusions Influenza vaccination rates lower among RNs who Are concerned about vaccine side effects Believe the vaccine is not effective Do not feel a professional responsibility to receive influenza vaccine

Conclusions Worksite policies to promote influenza vaccination among nurses should: Include a strong recommendation for vaccination Make vaccination available during all work shifts Provide multiple locations for vaccination