Major Finding: An influenza immunization mandate increased vaccination rates among hospital employees from a high of 74% to 96% at one institution and from 63% to 91% at another.
Data Source: Databases of HCA and Children's Mercy Hospital and Clinics.
Disclosures: Dr. Livingston reported having no conflicts of interest. Dr. Perlin did not disclose whether he had conflicts of interest and could not be reached at press time.
Strategies that compel health care personnel to receive an influenza immunization were shown to successfully increase vaccination rates to nearly 100% in two U.S. studies.
Results from these studies—one involving a large health care system, the other a single hospital—were summarized in a telebriefing, a week prior to their full presentations at the 2010 Decennial International Conference on Healthcare-Associated Infections in Atlanta.
Dr. Jonathan Perlin, who is chief medical officer of the Nashville, Tennessee–based Hospital Corporation of America (HCA), presented the results of a “somewhat controversial” mandatory vaccination policy adopted during the 2009–2010 influenza season across the system's 163 hospitals, 112 outpatient clinics, and 368 medical practices in 20 states.
Two recent lawsuits pertaining to the program were successfully defended, he noted.
The policy required that any employee who would not be vaccinated because of an egg allergy, a history of Guillain-Barré syndrome, or a religious/philosophical objection must be either reassigned to nonpatient contact roles or required to wear surgical masks. Webcasts were shown at all facilities explaining the rationale for the program and also introduced nonvaccine strategies such as cough/sneeze etiquette, hand hygiene, proper cleaning techniques, and the importance of staying home when ill (the so-called presenteeism policy).
Prior to the program, seasonal influenza vaccination rates for 2008–2009 influenza season varied across the various HCA facilities from a low of 20% to a high of 74% (mean, 58%).
As of Nov. 1, 2009, 96% of the 140,599 total employees and of the 98,067 clinical employees who were offered the seasonal influenza vaccine accepted it.
A total of 5,015 employees declined the vaccine, of whom three-fourths gave no reason.
Among those who did give a reason, allergy was the most common (12%).
The vast majority of those who declined wore masks.
“The employee response has been overwhelmingly positive. … We believe that programs such as ours will become the standard of care,” Dr. Perlin said during the telebriefing.
Similar success was seen at Children's Mercy Hospital and Clinics, Kansas City, Mo., a freestanding children's hospital with approximately 5,600 employees. In 2004, the hospital began offering the vaccine free to all employees, along with education about influenza and the importance of vaccination.
Other strategies were introduced subsequently, including mass vaccination days, mobile vaccination carts, flu vaccine “champions” in hospital wards and critical care units, as well as rewards such as paid days off.
In 2008, the facility introduced a mandatory policy that required employees to either receive the vaccine or formally decline it in writing with an established deadline for compliance, said Dr. Robyn Livingston, director of infection control and prevention at the hospital.
Compared with a vaccination rate of 63% in 2004, introduction of the policy in 2008 resulted in a rate of 85% in the 2008–2009 season, with about 96% overall compliance with the policy.
In the 2009–2010 season, when vaccination with both the seasonal and H1N1 vaccine was started earlier, the vaccination rate increased to 91%, and 99% were compliant with the policy by either receiving the vaccine or formally declining it.
The institution is now considering a fully mandatory influenza vaccination policy—that is, with no allowance for declination—for the next influenza season.
“Though our rates are well above the national average, there is still room for improvement,” Dr. Livingston said.