Challenges and Improvement Strategies to Increase Staff Vaccination Coverage in Long-Term Care

Objectives Keeping staff in post-acute and long-term care (PALTC) settings up to date on adult vaccinations is important to protect them and reduce the spread of vaccine-preventable illness to residents. This quality improvement (QI) project aimed to increase vaccination coverage among PALTC staff while exploring improvement strategies tailored to this setting. Design QI project conducted in 2, 12-month cohorts between 2022 and 2024. Setting and Participants QI teams from 15 skilled nursing facilities and 6 assisted living facilities across 9 states participated in the QI project. QI teams included staff and administrators working at the facility and corporate level in roles such as medical directors, directors/assistant directors of nursing, and infection preventionists. Methods QI teams implemented vaccination strategies, reported monthly staff vaccination coverage for 3 vaccines (COVID-19, influenza, and hepatitis B), received monthly technical assistance, and met quarterly with other facilities to share lessons learned. We report staff vaccination coverage at baseline and end point by vaccine, highlight common challenges across participating facilities, and provide examples of facilities' QI strategies. Results Most facilities did not improve staff vaccination coverage. Only 1 of 16 facilities with complete COVID-19 coverage data (6%) showed a modest improvement over time, 7 of 15 facilities with complete influenza coverage data (47%) maintained or improved coverage, and 4 of 6 facilities with complete hepatitis B coverage data (67%) showed improvement. Facilities focused their QI efforts on making vaccination convenient, respecting staff autonomy, and engaging staff in dialog but were challenged by staffing shortages, limited data infrastructure, and vaccine hesitancy. Facilities found it especially difficult to gather and report immunization data for staff; in some cases, low coverage reflected missing data. Conclusions and Implications Improving PALTC staff vaccination coverage nationally will require addressing data gaps, making vaccination convenient and affordable for staff, and addressing vaccine hesitancy through respectful dialog.