Taking charge of the demand side when short-supplied: Prioritized distribution of the 2004-2005 influenza vaccine to members in common of a designated high-priority group of healthcare workers

Abstract

BACKGROUND: Critical early season shortages of influenza vaccine necessitated a sudden change in prior on-demand distribution practice in this 326-employee, 130-bed hospital providing combined behavioral and medical care services to a broad range of patient age and health status. Direct versus indirect care employee distinction obscured by complex multibuilding campus with wide range of patient flow. All employees classified as healthcare workers (HCWs). OBJECTIVE: Effective and equitable distribution of a limited supply of influenza vaccine to members in common of an identified high-priority group (healthcare workers) utilizing a respiratory assessment–based approach. METHODS: A hospital-specific HCW respiratory hygiene questionnaire (RHQ) was developed. Weighted questionnaire combines multiple Centers for Disease Control and Prevention (CDC) influenza risk factors, OSHA respirator medical screening, and facility-specific direct patient contact questions. Scoring of individual questionnaires produced a binomial HCW-specific respiratory hygiene index (RHI), creating a group matrix of members in common. Preestablished matrix thresholds were set based on initial vaccine supply. All hospital employees were asked to complete an RHQ in our medical clinic setting in order to prioritize vaccine distribution. RHQ was reviewed one-to-one with employee at time of visit. HCWs above RHI threshold were offered immediate vaccine. HCWs below threshold were advised to attend to subsequent hospital-wide advisories regarding supply/threshold changes. RESULTS: 294 employees (90%) visited the clinic and underwent RHQ assessment, scoring, and one-to-one RHI evaluation. Some received immediate vaccination based on pre-established scoring thresholds. Subsequent supply/threshold changes and revisitations to the clinic resulted in a vaccination rate of 80% of employees who completed evaluation. The overall vaccination rate for the 2004-2005 season was 72%, compared with the prior 5-year rate of 46–52%. CONCLUSIONS: Limited vaccine supply distribution to members in common of a designated high-priority group requires assessment of the individual HCWs' personal health risk as well as their level of patient contact in order to provide for optimal herd protection. When HCWs understand the dual nature of their priority status their compliance raises dramatically. Additionally, an individual HCW-focused approach simultaneously satisfied OSHA-mandated respirator medical screening requirements. BACKGROUND: Critical early season shortages of influenza vaccine necessitated a sudden change in prior on-demand distribution practice in this 326-employee, 130-bed hospital providing combined behavioral and medical care services to a broad range of patient age and health status. Direct versus indirect care employee distinction obscured by complex multibuilding campus with wide range of patient flow. All employees classified as healthcare workers (HCWs). OBJECTIVE: Effective and equitable distribution of a limited supply of influenza vaccine to members in common of an identified high-priority group (healthcare workers) utilizing a respiratory assessment–based approach. METHODS: A hospital-specific HCW respiratory hygiene questionnaire (RHQ) was developed. Weighted questionnaire combines multiple Centers for Disease Control and Prevention (CDC) influenza risk factors, OSHA respirator medical screening, and facility-specific direct patient contact questions. Scoring of individual questionnaires produced a binomial HCW-specific respiratory hygiene index (RHI), creating a group matrix of members in common. Preestablished matrix thresholds were set based on initial vaccine supply. All hospital employees were asked to complete an RHQ in our medical clinic setting in order to prioritize vaccine distribution. RHQ was reviewed one-to-one with employee at time of visit. HCWs above RHI threshold were offered immediate vaccine. HCWs below threshold were advised to attend to subsequent hospital-wide advisories regarding supply/threshold changes. RESULTS: 294 employees (90%) visited the clinic and underwent RHQ assessment, scoring, and one-to-one RHI evaluation. Some received immediate vaccination based on pre-established scoring thresholds. Subsequent supply/threshold changes and revisitations to the clinic resulted in a vaccination rate of 80% of employees who completed evaluation. The overall vaccination rate for the 2004-2005 season was 72%, compared with the prior 5-year rate of 46–52%. CONCLUSIONS: Limited vaccine supply distribution to members in common of a designated high-priority group requires assessment of the individual HCWs' personal health risk as well as their level of patient contact in order to provide for optimal herd protection. When HCWs understand the dual nature of their priority status their compliance raises dramatically. Additionally, an individual HCW-focused approach simultaneously satisfied OSHA-mandated respirator medical screening requirements.