Enhancing capacity for influenza vaccination among skilled nursing facility staff through partnership with the health department in Marin County, California

Background: Residents of skilled nursing facilities (SNF's) are at increased risk for both influenza infection and influenza mortality. Influenza vaccination of healthcare workers reduces transmission risk to residents. SNF's nationally have among the lowest staff vaccination rates among healthcare facilities. The Marin County Division of Public Health assessed local SNF staff influenza vaccination status and performed on-site interventions to improve staff vaccination rates. Methods: In December 2012, surveys were administered to all registered SNF's in Marin County, soliciting the total number of employees and the number of employees with documented influenza vaccine since August, 2012 (vaccination rate). Barriers to increased vaccination rates were also assessed. Based on responses, visits were conducted to facilities requiring additional assistance in reaching staff vaccination goals. Results: 9 of 13 SNF's responded to the survey. Of 1,086 SNF employees, 620 (57 percent) had received the influenza vaccine during the current flu season. Staff vaccination rates among facility respondents ranged from 18 to 86 percent. 4 facilities with low vaccination rates were visited by public health nurses, who administered a total of 52 vaccines on-site to unvaccinated employees and offered technical assistance to enhance internal capacity for employee vaccination services. Conclusion: A small scale public health intervention can assess and increase employee vaccination rates in SNF's, where staff are historically under-vaccinated. A targeted approach toward facilities with low vaccination rates can provide a model for partnership between health departments and SNF's to protect those most vulnerable to influenza related mortality.