Long-term care providers should take their staff turnover rate into account when looking for ways to increase employee flu vaccination rates, according to a new research review. Because there could be frequent newcomers, managers should make sure flu-prevention efforts are continual and not pinned to just one day or week.

Citing the increased care costs and complications that can accompany influenza in older adults, researchers with the Department of Veterans Affairs and the University of California-Los Angeles stressed that all staff members should be involved with flu season preparation. But getting employees on board with vaccinations “can often be a challenge,” the researchers wrote in their review, which was published Thursday in the Annals of Long-Term Care.

“LTCF staff may be unwilling to be vaccinated for a variety of reasons,” they said. “Furthermore, local policies or union agreements may limit implementation of mandatory preventive strategies to reduce the exposure and transmission of influenza in their settings.”

The problem is exacerbated by the fact that long-term care facilities consistently lag behind other healthcare sectors in employee vaccination rates. A recent release from the Centers for Disease Control and Prevention found long-term care had a vaccination rate of just 68%, compared to hospitals (92%) and ambulatory care settings (76%).

In addition to making vaccinations free and readily available, the review encourages providers to consider staff turnover when designing their flu season plans. One suggested way to account for new workers joining the facility during flu season is to establish a vaccination policy, and then track which employees get the shot or decline. The authors also recommend providers incorporate influenza education into new employee orientation, and offer the vaccine at multiple times during flu season — including orientation.

Other methods of flu season preparation suggested by the review include creating events or incentives around vaccination; an employee flu shot reminder phone tree; rolling vaccination efforts into culture change; offering education in different languages; and partnering with hospitals or pharmacies.

“The more informed staff are about the seriousness of a flu outbreak, the easier it will be to prevent and contain widespread infection in facilities,” the authors wrote. “Having consistent and accessible protocols will keep staff focused and organized around the task of reducing morbidity and mortality associated with flu infection in the LTC setting.”