Influenza vaccination in health care: a four-year intervention story

Background: Although the Veterans Health Administration has had an employee influenza vaccination program since 1988, recent discussions about mandatory declination statements triggered a four-year goal of achieving an 80% vaccine acceptance prevalence by 2011.  It developed a systematic campaign with educational messages, information campaigns, and resourcing, relying on a local employee flu coordinator to manage the program.
Objective: 1) to present prevalence rates of vaccine acceptance in each year and 2) to present results of a survey exploring predictors of success and subsequent reasons for lack of progress
Methods: Data on administered vaccine doses and populations were acquired through usual management resources.  A mail survey was sent to all 144 employee flu coordinators
Results: Vaccination prevalence increased from 53% to 54% to 65% in 2006, 2007, and 2008.  95.8% of the coordinators responded to a mail survey in 2008.  Factors associated with increased vaccine acceptance included year-round educational campaigns, a "flu map" showing local risk, and pamphlets and newsletters.  40 faciliity required signature of decliniation forms ("mandatory declination forms").  No differences were seen as a funciton of that action (Student’s T = -0.72, P = 0.6).  No increase in average acceptance was seen between 2008 and 2009.  Facilites with major declines between 2008 and 2009 attributed those to staffing reassignments, lack of resources, and "lack of management commitment". 
Conclusions: appropriate assignation of resources can dramatically increase vaccine acceptance among health care workers without the use of mandatory decliniation statements.  In a large, relatively homogenous health care system, such statements added nothing to vaccine acceptance