Clinical Experience| Volume 11, ISSUE 7, P523-527, September 2010

Flu in 15: A Novel 15-Minute Education Program to Promote Acceptance of the Influenza Vaccine Among Health Care Workers

      Introduction and Rationale

      A performance improvement project was undertaken to increase health care worker (HCW) influenza vaccination acceptance rates in the long-term care setting by using a novel 15-minute education intervention called the “Flu in 15.” As a core principle, we taught that more Americans die from complications of influenza than hepatitis B, yet there remains individual reluctance and barriers to achieve high acceptance rates of influenza vaccination among HCWs.


      During chance encounters we offered the Flu in 15 in-service to all HCWs at the Johns Hopkins Bayview Care Center including certified nursing assistants (also called geriatric nursing assistants), registered nurses, registered dieticians, environment staff, physical therapists, occupational therapists, speech therapists, respiratory therapists, social workers, and administrators. Of the 106 of 347 HCWs who participated in the Flu in 15 in-service, 58 were by chance encounters selected to be surveyed based on convenience. We surveyed 68 of 241 HCWs who did not attend the Flu in 15 in-service as a comparison.


      Of the 58 participants who were asked if the in-service helped them understand why a flu vaccine is needed yearly, we found that 15% responded “tremendously,” 48% “a lot,” 26% “some,” 7% “a little,” and 2% “no.” We had 24% report that the program was effective in changing their behavior to accept the flu vaccination for the first time. We found that 49% responded that the in-service was effective in either changing their behavior to accept the flu vaccination for the first time or reaccept it if recently declined in previous years. With respect to motivation, 42% of the certified nursing assistants stated that the in-service made them think more about returning to school to get a license in some area of health care. Although not cause and effect, we observed an increase in the HCW acceptance rate of the influenza vaccine from 65% in 2006–2007 to 73% in 2007–2008. We noticed a decreased trend in patient deaths attributed to complications of influenza with 4 deaths in 2006–2007 and no deaths in 2007–2008.


      The Flu in 15 in-service promoted a better understanding of the importance of the influenza vaccine and demonstrated an associated increase in HCW acceptance of the flu vaccine. Although we cannot claim cause and effect, we noted a decrease in resident mortality in the intervention year compared with the prior year. Now that some medical centers require yearly influenza vaccines among HCWs, the education component remains relevant to provide reason behind the mandate.


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        • Harper S.A.
        • Fukuda K.
        • Uyeki T.M.
        • et al.
        Prevention and control of influenza: Recommendations of the Advisory Committee on Influenza Practices (ACIP).
        MMWR Recomm Rep. 2005; 54: 1-40
        • Centers for Disease Control and Prevention
        Prevention and control of influenza. Recommendations of the Advisory Committee on Immunization Practices (ACIP).
        MMWR Morb Mortal Wkly Rep. 2003; 52: 1-34
      1. The World Health Report 2004. Available at: Accessed August 17, 2010.

      2. National Foundation for Infectious Disease. Immunizing Healthcare Personnel Against Influenza: A Report on Best Practices. Bethesda, MD, 2008. Available at: Accessed August 17, 2010.

        • Van Delden J.
        • Ashcroft R.
        • Dawson A.
        • et al.
        The ethics of mandatory vaccination against influenza for healthcare workers.
        Vaccine. 2008; 26: 5562-5566
        • Potter J.
        • Stott D.J.
        • Roberts M.A.
        • et al.
        Influenza vaccination of healthcare workers in long-term-care hospitals reduces the mortality of elderly patients.
        J Infect Dis. 1997; 175: 1-6
        • Carman W.
        • Elder A.G.
        • Wallace L.A.
        • et al.
        Effects of influenza vaccination of healthcare workers on mortality of elderly people in long-term care.
        Lancet. 2000; 9198: 93-97
        • Hayward A.C.
        • Harling R.
        • Wetten S.
        • et al.
        Effectiveness of an influenza vaccine programme for care home staff to prevent death, morbidity, and health service use among residents: cluster randomized controlled trial.
        BMJ. 2006; 333: 1241
        • Salgado C.D.
        • Giannetta E.T.
        • Hayden F.G.
        • Farr B.M.
        Preventing nosocomial influenza by improving the vaccine acceptance rate of clinicians.
        Infect Control Hosp Epidemiol. 2004; 25: 923-928
        • Shugarman L.R.
        • Hales C.
        • Setodji C.M.
        • et al.
        The influence of staff and resident immunization rates on influenza-like illness outbreaks in nursing homes.
        J Am Med Dir Assoc. 2006; 7: 562-567
        • Burns E.A.
        • Lum L.G.
        • L'Hommedieu G.
        • Goodwin J.S.
        Specific humoral immunity in the elderly: in vivo and in vitro response to vaccination.
        J Gerontol. 1993; 48: B231-B236
        • Lewis L.
        Studies: LTC Staff still resist flu shots.
        Caring for the Ages. 2001; 2: 16-18
        • Elder A.G.
        • O'Donnell B.
        • McCRuden E.A.
        • et al.
        Incidence and recall of influenza in a cohort of Glasgow healthcare workers during the 1993–4 epidemic: Results of serum testing and a questionnaire.
        BMJ. 1996; 313: 1241-1242
        • Lemaitre M.
        • Meret T.
        • Rothan-Tondeur M.
        • et al.
        Effect of influenza vaccination of nursing home staff on mortality of residents.
        J Am Geriatr Soc. 2009; 57: 1580-1586