A quality improvement initiative to increase Tdap (tetanus, diphtheria, acellular pertussis) vaccination coverage among direct health care providers at a children’s hospital

Abstract

ObjectivesHealth care providers (HCP) are at high risk of acquiring and transmitting pertussis to susceptible family members, co-workers, and patients. Public health authorities recommend administering a single dose of Tdap (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis) vaccine to all adults, including HCP, to increase adult immunity to pertussis. We set a quality improvement goal to increase Tdap vaccination coverage among HCP who provided direct patient care at a children’s hospital from 58% to 90% over 18 months. DesignA multidisciplinary working group comprised of Occupational Health Program (OHP) staff and representatives of various medical services drew from a variety of qualitative methods and previous studies of vaccination programs in the healthcare system to understand barriers to Tdap vaccination within the institution and to develop interventions to increase vaccination rates. InterventionsInterventions included changes to OHP processes, a general education campaign, improved access to vaccine, and personal engagement of HCP by task force members. ResultsOverall vaccination rates increased to 90% over 15 months, a rate that has been sustained by systematically assessing new employees’ vaccination status and vaccinating those without documentation of previous Tdap vaccination. ConclusionsTdap vaccination coverage in our institution was significantly increased by an intensive, multipronged educational campaign, and by improving processes of screening and vaccination of HCP. The use of direct engagement of vaccine hesitant populations to increase vaccination rates warrants further study.