Mandatory employee vaccination as a strategy for early and comprehensive health care personnel immunization coverage: Experience from 10 influenza seasons.

BACKGROUND: Influenza is responsible for thousands of deaths in the United States and presents particular challenges in health care facilities with a greater prevalence of people at increased risk for adverse outcomes. Annual influenza vaccination has long been recommended, and employer policies influence the likelihood health care personnel are immunized. METHODS: This is a review of vaccination data maintained by a large health care organization to assess the effects of a mandatory health care personnel vaccination policy implemented during 2008-2009. Vaccination rates, timing of immunizations, and requests for medical or religious exemptions were assessed from 2006-2007 to 2017-2018. RESULTS: The health care personnel vaccination rate was 70% during the influenza season before the mandatory policy was implemented and increased to 98.4% immediately afterward. Vaccination rates exceeded 97% during the subsequent 9 years. Religious and medical exemptions decreased at academic medical centers and remained consistent at community hospitals. Among immunized employees, the peak date for vaccination shifted to late September or early October compared to late October or early November before the mandatory policy. CONCLUSIONS: Requiring vaccination led to sustained increases in staff vaccination coverage at academic medical centers and community hospitals. The mandatory policy also appeared to encourage earlier vaccination.

Mandatory influenza vaccination of health care workers: translating policy to practice.

BACKGROUND: Influenza vaccination of health care workers has been recommended since 1984. Multiple strategies to enhance vaccination rates have been suggested, but national rates have remained low. METHODS: BJC HealthCare is a large Midwestern health care organization with approximately 26,000 employees. Because organizational vaccination rates remained below target levels, influenza vaccination was made a condition of employment for all employees in 2008. Medical or religious exemptions could be requested. Predetermined medical contraindications include hypersensitivity to eggs, prior hypersensitivity reaction to influenza vaccine, and history of Guillan-Barré syndrome. Medical exemption requests were reviewed by occupational health nurses and their medical directors. Employees who were neither vaccinated nor exempted by 15 December 2008 were not scheduled for work. Employees still not vaccinated or exempt by 15 January 2009 were terminated. RESULTS: Overall, 25,561 (98.4%) of 25,980 active employees were vaccinated. Ninety employees (0.3%) received religious exemptions, and 321 (1.2%) received medical exemptions. Eight employees (0.03%) were not vaccinated or exempted. Reasons for medical exemption included allergy to eggs (107 [33%]), prior allergic reaction or allergy to other vaccine component (83 [26%]), history of Guillan-Barré syndrome (15 [5%]), and other (116 [36%]), including 14 because of pregnancy. Many requests reflected misinformation about the vaccine. CONCLUSIONS: A mandatory influenza vaccination campaign successfully increased vaccination rates. Fewer employees sought medical or religious exemptions than had signed declination statements during the previous year. A standardized medical exemption request form would simplify the request and review process for employees, their physicians, and occupational health and will be used next year.

Influenza vaccination among healthcare workers: ten-year experience of a large healthcare organization.

OBJECTIVE: To describe the results of different measures implemented to improve adherence to the healthcare worker (HCW) influenza immunization program at BJC HealthCare during the period from 1997 through 2007. DESIGN: Descriptive retrospective study. SETTING: BJC HealthCare, a 13-hospital nonprofit healthcare organization in the Midwest. METHODS: We reviewed and analyzed HCW influenza vaccination data from all BJC HealthCare Occupational Health Services and hospitals during the period from 1997 through 2007. Occupational health staff, infection prevention personnel, and key influenza vaccination campaign leaders were also interviewed regarding implementation measures during the study years. RESULTS: At the end of 2007, BJC HealthCare had approximately 26,000 employees. With the use of multiple progressive interventions, influenza vaccination rates among BJC employees increased from 45% in 1997 to 72% in 2007 (P < .001). The influenza vaccination rate in 2007 was significantly higher than in 2006: 72%, compared with 54% (P < .001). Five hospitals had influenza vaccination rates that exceeded the target goal of 80% in 2007. The most successful interventions were adding influenza vaccination rates to the quality scorecard incentive program and the use of declination statements, both of which were implemented in 2007. The most important barriers to success identified by interview respondents were HCWs' misconceptions about influenza vaccination and a perceived lack of leadership support. CONCLUSIONS: Influenza vaccination rates among HCWs significantly improved with multiple interventions over the years. However, the BJC HealthCare influenza vaccination target of 80% was not attained at all hospitals with these measures. More aggressive interventions, such as implementing mandatory influenza vaccination policies, are needed to achieve higher vaccination rates.