A Successful Healthcare Personnel (HCP) Influenza Vaccination (IV) Program in a Children's Hospital without a Mandate (MAND)

Background: Rate of IV of U.S. HCP remained at 40% from 1997 to 2002 despite recommendations for annual IV of HCP. There is debate concerning the necessity of mandatory IV policies to achieve higher rates among HCP who have direct patient contact (DPC) for protection of patients and themselves.

Objective: To summarize strategies (STR) used to achieve an acceptance rate of influenza vaccine > 80% among HCP with DPC in the absence of a MAND.

Methods: We reviewed STR implemented from the 2002-2003 season to the 2008-2009 and the associated rates of influenza vaccine acceptance by HCP who have DPC. DPC was defined as having consistent exposure within 3 feet of patients. STR used were: 1) Provision of vaccine at no charge on site 2) Education 3) Advertising 4) Encouragement of competition among units 5) Flu deputies (FD) 6) Mobile carts (MC) 7) Dedicated single day for IV in 1 central location (“Flu Frenzy”); and 8) Signed declination (SD). Rates of IV by inpatient unit (INP) and ambulatory clinic (AMB) were calculated every 2-3 weeks and low uptake areas were reported to managers and targeted by occupational health (OH) staff, using MC. IV programs began in October and continued until 2-4 weeks into the local flu epidemic.

Results: The senior administration of Children’s Medical Center supported the HCP IV program by providing vaccine at no charge on site, engaging administrative nursing supervisors in vaccine administration, allocating resources to OH, communicating to all clinical leaders and staff, and encouraging competition among units. Since 2002, additional STR were added, annual goals set, resulting in a voluntary HCP vaccination rate of 88%. Use of FD was associated with difficulty accounting for all vaccine allocated to specific areas. Delayed receipt of vaccine in fall, 2006 was associated with rates below the target goal. The most common reasons for signed declination were “ it always makes me sick”,  “I don’t need it”, “I don’t want it”. Results are summarized in the Table:

YEAR	2002-03	2003-04	2004-05	2005-06	2006-07	2007-08	2008-09
STR added	FD on INP units, at night	Increased FD for INP and AMB	Continued FD, publicized flu deaths in patients	Increased advertising, took vaccine to offsite locations	Required education module, SD	“Flu frenzy”: 1748 vaccinations by 7 nurses in 12 hours; Flu vaccine clinics all shifts, on weekends; FD for selected areas, SD	“Flu frenzy”: 2404 vaccinations by 10 nurses  in 12 hrs.; Flu vaccine clinics for all shifts and week-ends and offsite, SD
% DPC HCP vaccinated	70% 922/1320	76% 1256/1650	78% 1404/1810	80% 1528/1910	77% 1624/2113	89% 1992/2248	88% 2643/2990

Conclusions: In the absence of a mandatory IV program, we were able to achieve IV rates of HCP with DPC approaching 90% at the same time that our patient population and HCP pool expanded. By encouraging, educating, using SD and real time response to deficient areas, we created a culture of trust and adherence to IV recommendations.