Influenza vaccination: a multi-modal approach to increase compliance in an italian teaching hospital.

Issue Influenza vaccination of Healthcare workers (HCW) has a key role in avoiding flu transmission among patients and HCWs and is annually recommended by health authorities. Despite the 75% target identified by WHO, coverage is still inadequate in many European countries. Description of the problem The Infection Control Team and Public Health Residents of a University Hospital annually cooperate to actively offer flu shots directly in the Units, but in 2017-18 campaign only 12,1% of HCWs took advantage of the service. From July to December 2018 a composite intervention was performed to increase immunization rates. In each Unit a medical doctor and a nurse (midwife for the Obstetrics unit) were identified as Link Professionals (LPs).Two educational meetings with Infectious Diseases and Public Health experts were organized for LPs to deal with their hesitancies and to engage them for the vaccination promotion among colleagues.The calendar (2/week ambulatory + 16 in-ward appointments), tailored to maximise the HCW accessibility, was sent to medical consultants and head of departments, to all physicians, and to head nurses for dissemination. Promotional posters and videos were displayed across the hospital. Results Educational meetings were attended by 130 LPs. A total of 772/3420 HCW took advantage of the 2018-19 active campaign (22,6%), with a significant increase from the previous year (+10,4%; 95%CI 8,7-12,2; p < 0,001). The immunization rates raised in all HCWs categories: 279/660 doctors (it was 167/660 in 2017-18; +17.0%; 95%CI 11,9-21.9; p < 0,001); 303/1615 nurses (150/1615 in 2017-18; +9.5%; 95%CI 7.1-11-9; p < 0,001); 13/43 midwives (2/43 in 2017-18; +25,6%; 95%CI 9.7-40.8; p = 0,002). Lessons Despite the significant increase,further efforts are necessary to reach the WHO target rate. All HCWs categories were positively affected by the multi-modal intervention. LPs seem to play an important role in promoting vaccination among colleagues, in a peer-to-peer trust relationship. Key messages Influenza vaccination rates needs to be increased in healthcare workers for their protection and for patient safety. A well-structured multi-modal intervention programme involving prepared HCW promoters into wards is essential to increase compliance.