Successful Healthcare Worker Influenza Vaccination Program Without Declination Forms or Mandates

Background:   Due to a nosocomial outbreak of influenza in 2003, we initiated a more aggressive program to encourage healthcare worker (HCW) influenza vaccination acceptance and to track compliance.

Objective: Assess barriers to HCW influenza vaccination, optimize vaccine availability and acceptance, and track vaccination compliance.

Methods: A housewide HCW influenza survey was conducted and a comprehensive staff education campaign was performed. Unit-based influenza vaccination champions were identified and unit-based vaccination programs were initiated.  Rapid cycle audit and feedback was instituted to inform unit managers and directors of unit performance.  Convenient vaccination clinics and an incentive program were established.

Results:   In 2003, 1939 of 4510 (43%) hospital employees completed a flu vaccination opinion survey.  542 employees (28%) indicated they did not regularly receive yearly flu vaccine.  The most frequent reasons for not receiving vaccine were as follows: 1) flu shots don't work (28%), 2) flu shots make you sick (27%), 3) I never get the flu (23%), and 4) it wasn't offered (17%).  Other responses indicated problems with convenience, venue, potential side effects/contraindications, and perceived cost.   Initially, vaccination programs were optimized in critical care areas and inpatient wards.  As the program progressed, outpatient units, ancillary care personnel, medical staff, housestaff, students, and other groups were added.  Figure 1 documents the levels of influenza vaccine acceptance for various HCW classifications. During the 2008-09 influenza season, without use of declination forms or mandates, 88.6% of all hospital personnel with direct patient contact received seasonal influenza vaccine (94.6% critical care, 84.4% in-patient units, 86.7% hospital-based outpatient units).  No cases of nosocomial influenza were detected during this period.

 

Conclusions: At our institution, a voluntary influenza vaccination program has been highly successful. Key components required for the success of the program included broad education, unit-based leadership and role models, effective communication and rapid cycle feedback, and convenient availability of vaccine.