You're Gonna Make Me Do What??? Mandatory Seasonal Influenza Immunization for Staff, Students and Volunteers. Is it Time for Less Carrot and More Stick?

Background: Immunization for many vaccine preventable illnesses is mandated as a condition of employment, but typically influenza has not been included amongst these obligatory immunizations. Despite recommendations from the Center for Disease Control since 1984 that healthcare workers (HCWs) be vaccinated annually for influenza, the national average was only 48%. Although our compliance of 73% exceeded the national average, we sought to achieve universal influenza immunization for all staff, students and volunteers in our healthcare system.   

Objective: Because patient safety and preventing nosocomial infections is central to our organization's culture of safety, we implemented mandatory influenza vaccination.

Methods: The target for participation was 100% of all HCWs in our healthcare system - constituting a pool of 7,850 persons. After securing the firm commitment of leadership, a multidisciplinary task force was convened with representation of Ambulatory Services, Emergency Medicine Services (EMS), Human Resources (HR), Infection Control, Information Technology, Materials Management, Media Services, Nursing Administration, Occupational and Student Health, Pharmacy, Safety and Security, and the Schools of Medicine and Nursing. Multiple interventions and policy changes were instituted - HR policy to include seasonal flu immunization as condition of employment; widespread publicity in local media and throughout health system; 3 ply consent form & an electronic medical record-based tracking system was created to measure compliance; HR implemented exemption process; EMS coordinated mass vaccination drill Oct 15-16; Student Affairs coordinated medical school efforts; Nursing administration coordinates vaccination sites up to the December 1 deadline. Communication methods included multiple “town hall meetings”, creation of the “Flu Central” intranet website, computer pop-up messages, text messaging, email, flat screen television messages, and many large educational sessions, small group meetings and inservices.

Results: Figure 1

Conclusions: With the solid support of leadership, 100% participation in influenza immunization in the healthcare setting is possible and near universal influenza immunization is achievable. 99.3% of all persons received influenza vaccine, 0.7% were granted an exemption on a medical or religious basis. Only 9 employees (0.001%) refused vaccination and terminated employment. It is doubtful that these levels of immunization would be achievable if not as a condition of employment. The change in immunization policy resulted in a substantial increase in the vaccination rate for HCWs and is now standard policy at our institution.