1004
Results Survey Responses
In total, 140 facilities responded to the survey; 3 network respondents increased the total number of facilities to 146. Of the network responders, 2 hospitals and an urgent-care facility were excluded. An additional 15 sites that did not fully complete the survey were excluded, resulting in responses from 129 of the 461 licensed LTCFs in Michigan (28%). The median number of HCP per facility was 142 (IQR, 96–215), and the median number of LTCF residents per facility was 89 (IQR, 65–125). Annual influenza, HepB, and Tdap vaccines were most com-
monly required for employment (Table 1). Some respondents only required vaccinations for HCP with direct patient contact (Table 1). Overall, 80% of respondents strongly encouraged HepB, and 76% strongly encouraged annual influenza vaccination (Table 1). These vaccinations were also the most frequently offered on site for HCP, with 96% offering influenza vaccination and 64% offering HepB vaccination. Furthermore, 75% of the respondents reported using paper forms
to trackHCP immunity status, 32% used a computer application, 23% used Michigan’s immunization registry, the Michigan Care Improve- ment Registry (MCIR), and 3% did not track immunity status. The most frequently reported primary barrier for annual HCP
influenza vaccination was HCP misconceptions or lack of knowledge (37%). Many respondents did not report a primary barrier for HCP noninfluenza vaccinations (34%); however, the most frequently reported barriers were misconceptions or lack of knowledge (17%) and fear (13%) (Table 2). The unweighted kappa statistic for interrater reliability was 0.8, suggesting good agreement for barrier categorization. In total, 76 respondents reported HCP annual influenza
coverage, with a median of 86% (IQR, 51–98); 26 reported HCP HepB coverage, with a median of 76% (IQR, 25–100); and responses were low for the remaining HCP coverage estimates.
Discussion Limited Policies
Similar to national estimates,5 in our study, only 26% of respondents reported a policy requiring all HCP to receive an annual influenza vaccine; even fewer required HepB (12%), Tdap (12%), MMR (9%), and varicella (6%). Previous studies have demonstrated that HCP who are required by their employer to be vaccinated are more likely
Lynsey M. Kimmins et al
to be vaccinated than HCP without an employer requirement.6 The high frequency of annual influenza vaccination policies high- light the need for increased awareness of HCP vaccination recom- mendations for noninfluenza vaccines.8 Integrating influenza and noninfluenza HCP vaccinations into performance metrics would likely increase HCP vaccination polices, reporting, and coverage.7
Low Coverage
Overall, HCP in LTCF settings consistently have the lowest reported influenza vaccination rates among all HCP, with 68% coverage, nationally, during the 2016–2017 influenza season,5 and our survey estimated LTCF flu coverage at 86% (n=76). The 2015 national HCP coverage estimates were 64.7% for HepB8 compared to our survey estimate of 76% (n=26) for HepB. Coverage estimate responses were limited for the remaining HCP vaccinations, but a 2013 survey estimated all HCP Tdap coverage at 47.2% with LTCF HCP at 33.3%.8,9 Knowledge of HCP vac- cination rates is crucial in preventing transmission of VPDs.1
Table 2. Primary Healthcare Personnel (HCP) Vaccination Barriers as Reported by 129 Michigan Licensed Long-Term Care Facilities HCP Immunization Survey Respondents
Barrier
Misconceptions/lack of knowledgea
No response/unknown Fearb
Religious/personal beliefs/right No barriers/required Otherc
Vaccine specificd Not requirede
Influenza, No. (%)
48 (37.2) 24 (18.6) 21 (16.3) 16 (12.4) 11 (8.5) 9 (7.0) … …
Noninfluenza, No. (%)
22 (17.1) 44 (34.1) 17 (13.2) 7 (5.4) 3 (2.3)
13 (10.1) 16 (12.4) 7 (5.4)
aIncludes HCP thinking they would get influenza/preventable disease (VPD) from the vaccine, that influenza/VPD vaccine was not effective, that they are not at risk for influenza/VPD, or that
influenza/VPD is not serious. bIncludes fear of needles, vaccinations, and side effects. cExamples of “other” include cost, inconvenience, or allergies. dExamples of “vaccine specific” include multiple series vaccine (HepB), and specific vaccine is
too expensive. eRespondent reported “not required” as the primary barrier for noninfluenza vaccines.
Table 1. Healthcare Personnel (HCP) Vaccination Policies and Practices by Antigen, 129 Michigan Licensed Long-Term Care Facilities HCP Immunization Survey Responses
Survey Questiona
All HCP are REQUIRED to receive or have documentation of receipt of vaccine as a condition of employment
Only HCP with direct patient care are REQUIRED to receive or have documentation of receipt of vaccine as a condition of employment
Vaccination strongly encouraged, but not required Vaccine is offered on-site for HCP HCP vaccination rates are tracked
Annual Influenza, No. (%)
33 (25.6)
13 (10.1) 98 (76.0) 124 (96.1) 106 (82.2)
aSurvey responses are not mutually exclusive, respondents could select all that applied for multiple-choice questions.
Hepatitis B, No. (%)
MMR, No. (%)
Tdap, No. (%)
Varicella, No. (%)
15 (11.6) 12 (9.3) 15 (11.6) 8 (6.2) 11 (8.5) 5 (3.9) 7 (5.4) 2 (1.6)
104 (80.6) 24 (18.6) 28 (21.7) 25 (19.4) 82 (63.6) 9 (7.0) 16 (12.4) 7 (5.4) 55 (42.6) 6 (4.7) 11 (8.5) 7 (5.4)
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100 |
Page 101 |
Page 102 |
Page 103 |
Page 104 |
Page 105 |
Page 106 |
Page 107 |
Page 108 |
Page 109 |
Page 110 |
Page 111 |
Page 112 |
Page 113 |
Page 114 |
Page 115 |
Page 116 |
Page 117 |
Page 118 |
Page 119 |
Page 120 |
Page 121 |
Page 122 |
Page 123 |
Page 124 |
Page 125 |
Page 126 |
Page 127 |
Page 128 |
Page 129 |
Page 130 |
Page 131 |
Page 132 |
Page 133 |
Page 134 |
Page 135 |
Page 136 |
Page 137 |
Page 138 |
Page 139 |
Page 140
