Taking the Final Step: Implementation of a Mandatory Flu Shot Program Within a Healthcare System

Background: Recognizing influenza immunization of healthcare workers as a critical patient safety issue, hospital leadership strongly supported a decision to require seasonal influenza immunization as a condition of employement, beginning with the 2009-2010 season. This followed multiple years of incentives to improve vaccine compliance (i.e., free vaccine, convenient administration at the worksite, and prizes) and education, which typically resulted in about 50% compliance. Compliance rose to 85% after implemetation of a mandatory, online documentation system. The system, initiated in 2006-2007, allowed exemption by declination and offered no penalty for non-compliance.

Objective: To immunize all employees, contracted clinical personnel, licensed independent providers, students and their instructors, vendors involved in patient care, and volunteers for seasonal influenza in order to protect patients, employees, employees' families and the community.

Methods: Consultation was sought from a large healthcare system that had experience with mandatory employee flu shots. Legal opinion and Human Resource's support of the program was obtained. Venues and opportunities for obtaining shots remained unchanged from recent years and a multi-modal approach was used to infrom and remind employees of the new requirement. A deadline was set for submission of written documentation. Exemption from vaccination was allowed for egg allergy, history of either Guillian-Barré or a post-flu shot anaphylaxis. A formal exemption process began as a written appeal to an internal review board which determined exemption. For the non-exempt, the choice to not be vaccinated resulted in termination. Rehire is conditional, based on the intent to comply with influenza vaccination in the future.  

Results: Over 99.99% of approximately 3800 employees received a seasonal flu shot. No serious side effects occurred among those receiving vaccine. Of those employees who applied for exemption but were denied, 4 chose to terminate employement; however, one of these, a physician, chose retirement rather than immunization. Consequences for unvaccinated, non-employees were not explored this initial year.

Conclusions: Healthcare organizations have a legal and ethical obligation to protect patients from healthcare-acquired infections, including influenza. Previous strategies (i.e. education plus incentives and a policy which allowed declination) yielded only 85% compliance. Taking the final step toward universal influenza immunization of healthcare workers required strong leadership at the highest level.