Making a Dent in the Flu: Try In-Reach!


Employers have countless reasons for encouraging employees to be immunized against influenza.

Employers have countless reasons for encouraging employees to be immunized against influenza. With the annual economic burden in the United States estimated at $30.4 billion, money is one motivator. But other reasons abound to ensure that employees are immunized also. Retail employees are at increased risk of contractinginfluenzabecause they interact with many people every day, and the virus can be transmitted when money is exchanged. Influenza is associated with health risks in people with chronic illnesses, and decreasing spread of influenza among retail employees could also decrease spread among customers.

Study results published in the journalWorkplace Health & Safetyindicate that nurse practitioners can be part of a multicomponent approach that increases influenza immunization rates among employees. This study describes a nurse practitioner-lead, evidence-based intervention to do just that.

Participating immunizers hope to achieve an influenza immunization rate of at least 50% among employees, and determine if nurse practitioners could positively influence the immunization rate. The researchers compared immunization rates at retail locations that had a nurse practitioner-staffed clinic, and were open weekdays from 9:00 am to 8:00 pm with shortened hours on the weekend.

The site that employed the intervention had an average of 260 employees. The comparison site had an average of 305 employees. Both stores hired additional employees from October through December to accommodate increased traffic during the holidays.

The intervention offered free immunization (and the employee could choose the form of delivery) and a gift card and gift bag after immunization. Participating immunizers also distributed flyers and posted posters on-site.

At the intervention site, the immunization rate reached 45%; this was below the goal but significant regardless. This site’s immunization rate was only 35% the previous year. At the comparison site, the immunization rate languished at 32%.

This study demonstrates a principal that’s growing in popularity. After years of talking about “outreach,” some researchers are beginning to talk about “inreach.” Programs that use outreach seek populations who might not otherwise have access to services. Programs that use inreach look at their own populations and try to find people who have access to the service but simply don’t use it.

This study has implications for retail health practitioners. Mounting a campaign to immunize employees who are co-located with retail health clinics should be easier than trying to find new patients. Retail healthcare practitioners can also influence employees and encourage them to establish mandatory immunization programs.


Montejo L, Richesson R, Padilla BI, Zychowicz ME, Hambley C.Increasing influenza immunization rates among retail employees: an evidence-based approach.Workplace Health Saf.2017;65(9):424-429.

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