From 51 to 99.8% - Mandatory Seasonal Influenza Vaccination

Background:

Vaccination of healthcare workers (HCW) has been shown to reduce absenteeism, infection among staff, patients and visitors, and to result in financial savings for the hospital.¹ In the 2006-2008 fall vaccination seasons, University Hospital in Cincinnati achieved voluntary immunization rates ranging from 35- 51%. In late August 2009, the decision was made by administration and the hospital’s Medical Executive Committee to make seasonal flu vaccine mandatory for all employees and medical staff.

Objective:

Describe the process of mandating the seasonal flu vaccine for employees and physicians of a large, urban, unionized, teaching hospital, in the hope of assisting other hospitals that are considering this patient safety initiative.

Methods:

A dedicated flu shot clinic was opened daily, and a “shot brigade” took vaccine to locations around the hospital. A general publicity and educational campaign occurred by email and by posters. A program to review and approve exemptions for medical reasons was created. Negotiations with each of three unions were held according to terms of their respective contracts. A deadline of October 20^th was set after which time staff who had not received vaccine or an approved exemption would be declared unfit for duty and taken off work schedules.

Results:

Compliance reached 99.1% as of the October 20^th deadline, and as of November 13^th, it was 99.8 %. Most of the compliance was actual vaccinations. A total of 115 exemption requests were received and 74 approved out of a total work force of 4,500. The program came very close to running out of vaccine at the mid-point due to failures of suppliers to deliver promised shipments. We were able to find enough vaccine to immunize all workers, but were delayed somewhat in being able to offer vaccine to patients.

Conclusions:

This patient/staff safety initiative succeeded beyond our expectations and we believe it will have positive effects beyond its impact on infection control. Things we could have done better include: (1) Start earlier and plan better, (2) Construct a better tracking system,  (3) Set a deadline for exemption applications and arrange review committee meeting times well in advance.