1. Minnesota Healthcare Setting Employee Influenza Vaccination Program Survey Denise Dunn, RN, MPH Adult/Adolescent Immunization Coordinator Minnesota Department of Health August 2009

2. Overview Survey background Survey methods Initial findings Dissemination of results

3. Survey background National healthcare worker vaccination rate is about 45%* Interest in what Minnesota’s rate might be Strong backing from MIPAC Influenza Subgroup to survey MN MDH decides to survey 2008-09 season *National Health Interview Survey (NHIS), 2006-07

4. Survey background Decision to do more than just a declination survey Interest in obtaining Minnesota-specific information about employee influenza vaccination programs and rates in health care settings

5. Purpose of survey To collect: – Minnesota-specific employee influenza vaccination rates in health care settings to give us a benchmark to mark progress; – Information on various employee influenza vaccination program activities used by organizations; – Data on the perceived barriers to vaccination; and – Baseline information on utilization/usefulness of the Minnesota Immunization Information Connection (MIIC), our statewide immunization registry, for tracking employee influenza vaccinations.

6. Coverage & sampling Survey population = all hospitals and long- term care facilities in Minnesota Surveyed all hospitals (N=145) and a random sample of long-care facilities (N=135) Total facilities surveyed = 280 Facility lists obtained from Compliance Monitoring Division (MDH)

7. Survey methods Online survey available mid-April through May 2009 Paper version was available, but no requests for it Pre-letter to administrators, followed by instructional letter to infection control staff (if known) or again to administrators, by default ICP email list used, as available

8. Survey methods Reminders sent either via mail or email Response rate = 62% – Excluded 6 incomplete surveys – Total responses; N = 173 Response deadlines were extended – Last 2 weeks of original timeframe were extremely busy for hospitals with H1N1 Analysis is still underway

9. Survey findings Overall employee influenza vaccination rate (all facilities combined) = 70.1%

10. Survey findings Influenza vaccination rates by facility type: – Hospital = 78% – LTC = 63% – Both = 73% – Other = 77%

11. Survey findings 100% of healthcare facilities surveyed provided influenza vaccination to all employees during the 2008-09 season

12. Survey findings In addition to employees, who was included in your vaccination program? – Volunteers61% – Licensed independent contractors42% – Students31% – Community providers11% – Vendors 6%

13. Survey findings 99% of facilities provided vaccination onsite 86% provided vaccination during all work shifts 99% provided vaccination at no cost

14. Vaccination delivery methods Vaccination clinics/fairs73% Peer-vaccinators60% Mobile carts50% Coordination with other programs39% Occupational health site28% Using congregating areas25% Flu captains/teams12%

15. Promotional activities Respondents used the following promotional activities to enhance vaccination programs: – Reminders91% – Promotional campaign70% – Strong support by admin49% – One on one counseling42% – Incentives38% – Rates reviewed by admin35% – Rates shared within facility32% – Kick off event 21% – Influenza champions12%

16. Educational activities 92% of facilities provide education as part of their employee vaccination program Of those facilities that provided education: – In 34%, education was required – In 66%, education was not required

17. Survey findings Respondents track employee influenza vaccinations using: – Paper forms88% – Other computer application23% – MIIC10% – Other, included consent forms, checklists, sign up sheets, employee health records

18. Survey findings Barriers cited to using MIIC to track employee vaccinations: – Lack of time for entering data26% – Prefer own system25% – Lack of awareness about MIIC benefits21% – Lack of trained personnel13% – General difficulty in use 4% – Privacy concerns 2%

19. Declination Did your organization use a declination form as part of its employee influenza vaccination program during the 2008-09 season? – Yes 70% – No 30%

20. Declination For those who used declinations forms, was it mandatory for employees to return the form? – Yes 72.7% – No 27.3%

21. Declination Reasons given for not using declination forms: – Lack of time or personnel resources 25% – Not convinced of value 21% – Leadership does not endorse 17% – Union barriers 6% – Other included: never used before, unaware of form, employee rights, tried with little effect

22. Declination Will your organization use a declination process next influenza season? – Yes 67% – No 5% – Unknown 28%

23. Findings Vaccination rate comparison: – Used declination form = 75% – No declination form = 60%

24. Declination reasons Fear of adverse events9% Fear of getting sick from vaccine6% Fear of injections5% Medical contraindications3% *average % reported, of those facilities that use declination forms

25. Initial findings Program characteristics of facilities with high vaccination rates (close to or >90%): – Provide flu vaccine at no cost to employee – Provide vaccination during all work shifts – Expand vaccine offerings to “other” workers – Use reminder methods

26. Initial findings Program characteristics of facilities with high vaccination rates (close to or >90%): – Most had a strongly motivated administrator leading the vaccination drive – Most held kick-off events and campaigns – Almost all provide education on influenza and flu vaccine to staff – Most used declination forms and required their return

27. Initial findings Program characteristics of facilities with high vaccination rates (close to or >90%): – All evaluate influenza vaccination rates annually – All set influenza vaccination rate goals annually – Almost all track reasons why employees choose not to participate – All track the previous season’s data

28. Data analysis continues Still analyzing data Continue analyzing specific activities associated with high-rate facilities Compare vaccination rates of facilities that use declination forms to those that do not Look at nonresponders

29. Dissemination of results Internal MDH stakeholders MIPAC Influenza Subgroup CDC site visit “Brown bag” for additional MDH employees Fact sheet with summary of results / web MN Influenza Vaccination Plan 2009-10 State, regional, and/or national conferences

30. What’s next Amend sample declination form Finish analysis and disseminate results Plan to repeat survey next year – Possibly add sampling of clinics H1N1 vaccine campaign may complicate next year’s survey

31. Questions/Discussion Denise Dunn: – Denise.Dunn@state.mn.us – 651-201-5560