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Barriers and Strategies to Improving Influenza Vaccination among Health Care Personnel

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Photo of a female health care professional assisting a senior man in a wheelchair.

There are several reasons why health care personnel (HCP) get vaccinated against influenza. During the 2013-2014 influenza season, HCP reported the most common reason was to protect themselves from getting the flu. Other commonly reported reasons included an employer requirement for flu vaccination*and protecting their patients from flu.

There are also a number of reasons why HCP in long-term care (LTC) may not get vaccinated against influenza. The composition of the LTC workforce and the diversity of LTC settings may present unique challenges to employers and administrators in these settings.

Several individual strategies of successful programs have been identified. However, a comprehensive approach that uses several strategies together may be most effective at increasing influenza vaccination coverage among HCP in LTC. For example, the Task Force on Community Preventive Services recommends – as an evidence-based strategy to increase HCP influenza vaccination coverage in the workplace. A number of identified strategies to overcome these barriers are described below.


Recommended Strategies to Overcome Barriers

Lack of access to influenza vaccine

  • Provide free vaccine at the workplace
  • Offer vaccine at multiple times and locations convenient to all workers on all shifts during the flu season
  • Use a mobile vaccination cart to take influenza vaccinations to staff
  • Provide staff with a voucher for vaccination at a drugstore or clinic
  • Partner with a larger health care organization (e.g., hospital) to provide vaccinations
  • Work with pharmacy consultants to offer influenza vaccinations for facility staff
  • Work with visiting nurses associations or other community immunizers to provide vaccination on-site
  • Offer influenza vaccine at mandatory trainings, departmental conferences, and other meetings


  • Belief that influenza is not a serious illness/not a risk for young or healthy people
  • Belief that influenza vaccine is not effective
  • Belief that influenza vaccine causes illness/side effects
  • Fear of injections

Lack of enthusiasm about influenza vaccination

  • Establish a culture of prevention in your organization with the following ideas
    • Publicize a “vaccine day” in combination with education to offer influenza vaccinations
    • Emphasize that flu vaccination protects the employees, their loved ones and those they work with
    • Encourage employees to set an example; remind them that their action and recommendation carries a lot of weight in others’ decisions to get vaccinated
    • Encourage employees via e-mail, posters, an employee newsletter, and any other communication tools used in your workplace to get the vaccine
    • Track and report vaccination rates to staff and supervisors
    • Remind unvaccinated employees with e-mail, letters, encouragement from supervisors, and telephone calls
    • Provide contests or incentives to get vaccinated (small gift cards, raffles, pizza party, etc.)
    • Vaccinate the medical director and all managers in front of the staff
    • Foster team building to increase trust and cooperation
      • Team building may lead to increased compliance with organizational goals including immunization

High staff turnover

  • Offer influenza vaccination education multiple times during the flu season
  • Offer opportunities to be vaccinated at multiple times and locations convenient to all workers on all shifts during the flu season
  • Educate and vaccinate staff as part of new employee orientations
  • Establish a process to determine and track proof of influenza vaccination each year for each employee
  • Establish a written influenza vaccination policy for employees
  • Work with pharmacy consultants to offer influenza vaccination for facility staff, as a standard procedure

HCP represent diverse cultures

Lack of centralized workplace

  • Educate and vaccinate staff as part of new employee orientation, training, and meetings
  • Establish a process to determine and track proof of influenza vaccination each year for each employee

Lack of incentive for employer to cover cost of influenza vaccination

  • LTC organizations could advertise high HCP influenza vaccination rates to consumers to indicate patient safety
  • Share CDC’s Business Toolkit [1.8 MB, 15 pages] to demonstrate that employers across sectors think it makes good sense to promote influenza vaccination of employees
  • Educate staff about expanded health insurance coverage for influenza vaccinations under the Affordable Care Act
    • Employee health insurance plans may now cover influenza vaccination for your employees
    • Other health insurance plans that staff may participate in (such as a spouse’s insurance plan) may now cover influenza vaccinations
    • Staff who do not qualify for employer-provided insurance may be able to get insurance through state Health Insurance Marketplaces

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Some suggested academic resources reviewing evidence based practices for long-term care facilities:

* Coverage is highest among health care workers working in occupational settings with employer-mandated vaccination requirements. HHS does not issue any requirements or mandates for state agencies, health systems, or health care workers regarding infection control practices, including influenza vaccination. However, some employers require certain immunizations for those employees who work with people who are sick or vulnerable to disease, or employees who handle or are exposed to dangerous substances, such as certain bacteria or viruses. Employer-mandated influenza vaccination policies may impact labor-management relations and could have legal and ethical considerations. To find out more about the laws in your state, contact your state health department through Public Health Resources: State Health Departments.