Changes in Healthcare Personnel Influenza Vaccination Rates Associated with Changes in Facility-Level Policies and Practices

Objective.To describe practices for influenza vaccination of healthcare personnel (HCP) with emphasis on correlates of increased vaccination rates.Design.Survey.Participants.Volunteer sample of hospitals in Louisiana.Methods.All hospitals in Louisiana were invited to participate. A 17-item questionnaire inquired about the hospital type, patients served, characteristics of the vaccination campaign, and the resulting vaccination rate.Results.Of 254 hospitals, 153 (60%) participated and were included in the 124 responses that were received. Most programs (64%) required that HCP either receive the vaccine or sign a declination form, and the rest were exclusively voluntary (36%); no program made vaccination a condition of employment. The median vaccination rate was 67%, and the vaccination rate was higher among hospitals that were accredited by the Joint Commission; provided acute care; served children, pregnant women, oncology patients, or intensive care unit patients; required a signed declination form; or imposed consequences for unvaccinated HCP (the most common of which was to require that a mask be worn on patient contact). Hospitals that provided free vaccine, made vaccine widely available, advertised the program extensively, required a declination form, and imposed consequences had the highest vaccination rates (median, 86%; range, 81%–91%).Conclusions.The rate of influenza vaccination of HCP remains low among the hospitals surveyed. Recommended practices may not be enough to reach 90% vaccination rates unless a signed declination requirement and consequences are implemented. Wearing a mask is a strong consequence. Demanding influenza vaccination as a condition of employment was not reported as a practice by the participating hospitals.

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Impact of an influenza vaccine educational programme on healthcare personnel

Epidemiology and Infection ◽

10.1017/s0950268816000716 ◽

2016 ◽

Vol 144 (11) ◽

pp. 2290-2294 ◽

Cited By ~ 3

Author(s):

R. RODRÍGUEZ-FERNÁNDEZ ◽

A. B. MARTÍNEZ-LÓPEZ ◽

J. PÉREZ-MORENO ◽

M. I. GONZÁLEZ-SÁNCHEZ ◽

F. GONZÁLEZ-MARTÍNEZ ◽

...

Keyword(s):

High Risk ◽

Influenza Vaccination ◽

Risk Groups ◽

Educational Programme ◽

Healthcare Personnel ◽

Preventive Strategy ◽

Paediatric Hospital ◽

Vaccination Rates ◽

Question Survey ◽

Effective Preventive Strategy

SUMMARYInfluenza vaccination has been shown to be the most effective preventive strategy to reduce influenza-related morbidity and mortality in high-risk groups. Despite healthcare personnel (HCP) being considered part of such high-risk groups, their vaccination coverage is low in Europe. In January 2012, we distributed an 18-question survey regarding influenza vaccination to HCP at Gregorio Marañon Paediatric Hospital, in Madrid, Spain. After we documented that only ~30% of HCP were vaccinated an educational programme was implemented in October 2012 before the next influenza season. In January 2013, the same survey delivered again to all HCP documented a significant increase in vaccination rates (from 30% to 40%, P = 0·007) mainly among physicians and for patients' protection. In summary we found that a simple and inexpensive educational programme significantly improved the uptake of influenza vaccination in HCP in our centre. Nevertheless, vaccination rates remained low, and broader and updated campaigns are needed to overcome perception barriers.

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Revised SHEA Position Paper: Influenza Vaccination of Healthcare Personnel

Infection Control and Hospital Epidemiology ◽

10.1086/656558 ◽

2010 ◽

Vol 31 (10) ◽

pp. 987-995 ◽

Cited By ~ 138

Author(s):

Thomas R. Talbot ◽

Hilary Babcock ◽

Arthur L. Caplan ◽

Deborah Cotton ◽

Lisa L. Maragakis ◽

...

Keyword(s):

Influenza Vaccination ◽

Healthcare Workers ◽

Position Paper ◽

Healthcare Personnel ◽

Executive Summary ◽

Vaccination Rates ◽

Official Statement ◽

Healthcare Epidemiology ◽

Vaccine Shortages ◽

New Evidence

Executive SummaryThis document serves as an update and companion piece to the 2005 Society for Healthcare Epidemiology of America (SHEA) Position Paper entitled “Influenza Vaccination of Healthcare Workers and Vaccine Allocation for Healthcare Workers During Vaccine Shortages.” In large part, the discussion about the rationale for influenza vaccination of healthcare personnel (HCP), the strategies designed to improve influenza vaccination rates in this population, and the recommendations made in the 2005 paper still stand. This position paper notes new evidence released since publication of the 2005 paper and strengthens SHEA's position on the importance of influenza vaccination of HCP. This document does not discuss vaccine allocation during times of vaccine shortage, because the 2005 SHEA Position Paper still serves as the Society's official statement on that issue.

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Voluntary to Mandatory: Evolution of Strategies and Attitudes toward Influenza Vaccination of Healthcare Personnel

Infection Control and Hospital Epidemiology ◽

10.1086/663210 ◽

2012 ◽

Vol 33 (1) ◽

pp. 63-70 ◽

Cited By ~ 46

Author(s):

Kathleen Quan ◽

David M. Tehrani ◽

Linda Dickey ◽

Eugene Spiritus ◽

Denise Hizon ◽

...

Keyword(s):

Influenza Vaccination ◽

Vaccination Campaign ◽

Vaccine Uptake ◽

Healthcare Personnel ◽

Vaccination Policy ◽

Vaccination Rates ◽

Hospital Policies ◽

Mandatory Vaccination ◽

Vaccination Campaigns ◽

The Impact

Background.Assessing the relative success of serial strategies for increasing healthcare personnel (HCP) influenza vaccination rates is important to guide hospital policies to increase vaccine uptake.Objective.To evaluate serial campaigns that include a mandatory HCP vaccination policy and to describe HCP attitudes toward vaccination and reasons for declination.Design.Retrospective cohort study.Methods.We assessed the impact of serial vaccination campaigns on the proportions of HCP who received influenza vaccination during die 2006–2011 influenza seasons. In addition, declination data over these 5 seasons and a 2007 survey of HCP attitudes toward vaccination were collected.Results.HCP influenza vaccination rates increased from 44.0% (2,863 of 6,510 HCP) to 62.9% (4,037 of 6,414 HCP) after institution of mobile carts, mandatory declination, and peer-to-peer vaccination efforts. Despite maximal attempts to improve accessibility and convenience, 27.2% (66 of 243) of die surveyed HCP were unwilling to wait more than 10 minutes for a free influenza vaccination, and 23.3% (55 of 236) would be indifferent if they were unable to be vaccinated. In this context, institution of a mandatory vaccination campaign requiring unvaccinated HCP to mask during the influenza season increased rates of compliance to over 90% and markedly reduced the proportion of HCP who declined vaccination as a result of preference.Conclusions.A mandatory influenza vaccination program for HCP was essential to achieving high vaccination rates, despite years of intensive vaccination campaigns focused on increasing accessibility and convenience. Mandatory vaccination policies appear to successfully capture a large portion of HCP who are not opposed to receipt of die vaccine but who have not made vaccination a priority.Infect Control Hosp Epidemiol 2012;33(1):63-70

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Factorial Design for Improving Influenza Vaccination Among Employees of a Large Health System

Infection Control and Hospital Epidemiology ◽

10.1086/598343 ◽

2009 ◽

Vol 30 (7) ◽

pp. 691-697 ◽

Cited By ~ 27

Author(s):

Richard Kent Zimmerman ◽

Mary Patricia Nowalk ◽

Chyongchiou J. Lin ◽

Mahlon Raymund ◽

Dwight E. Fox ◽

...

Keyword(s):

Influenza Vaccination ◽

Health System ◽

Factorial Design ◽

Healthcare Personnel ◽

Patient Contact ◽

Administrative Positions ◽

Healthcare Facilities ◽

Vaccination Rates ◽

Contact Rates ◽

Acute Care Facilities

Objective.As healthcare personnel (HCP) influenza vaccination becomes a quality indicator for healthcare facilities, effective inter¬ventions are needed. This study was designed to test a factorial design to improve HCP vaccination rates.Design.A before-after trial with education, publicity, and free and easily accessible influenza vaccines used a factorial design to determine the effect of mobile vaccination carts and incentives on vaccination rates of HCP, who were divided into groups on the basis of their level of patient contact (ie, business and/or administrative role, indirect patient contact, and direct patient contact).Setting.Eleven acute care facilities in a large health system.Participants.More than 26,000 nonphysician employees.Results.Influenza vaccination rates increased significantly in most facilities and increased system-wide from 32.4% to 39.6% (P < .001). In the baseline year, business unit employee vaccination rates were significantly higher than among HCP with patient contact; rates did not differ significantly across groups in the intervention year. In logistic regression that accounted for demographic characteristics, intervention year, and other factors, the use of incentives and/or mobile carts that provided access to vaccine at the work unit significantly increased the likelihood of vaccination among HCP with direct and indirect patient contact, compared with control sites.Conclusions.Interventions to improve vaccination rates are differentially effective among HCP with varying levels of patient contact. Mobile carts appear to remove access barriers, whereas incentives may motivate HCP to be vaccinated. Education and publicity may be sufficient for workers in business or administrative positions. Interventions tailored by worker type are likely to be most successful for improving HCP vaccination rates.

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A Qualitative Assessment of a Performance Measure for Reporting Influenza Vaccination Rates among Healthcare Personnel

Infection Control and Hospital Epidemiology ◽

10.1086/667375 ◽

2012 ◽

Vol 33 (9) ◽

pp. 945-948 ◽

Cited By ~ 5

Author(s):

Taranisia MacCannell ◽

Alicia Shugart ◽

Amy K. Schneider ◽

Megan C. Lindley ◽

Suchita A. Lorick ◽

...

Keyword(s):

Influenza Vaccination ◽

Performance Measure ◽

Qualitative Assessment ◽

Healthcare Personnel ◽

Healthcare Facilities ◽

Key Informants ◽

Vaccination Rates ◽

Semistructured Interviews ◽

A Performance

To understand the feasibility of implementing a standardized performance measure for collecting and reporting influenza vaccination rates among healthcare personnel, qualitative, semistructured interviews were conducted with key informants in 32 healthcare facilities. Despite practical and logistical challenges to implementing the measure, respondents perceived clear benefits to its use.

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Impact of mandatory vaccination of healthcare personnel on rates of influenza and other viral respiratory pathogens

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.324 ◽

2021 ◽

pp. 1-5

Author(s):

Michael S. Simberkoff ◽

Susan M. Rattigan ◽

Charlotte A. Gaydos ◽

Cynthia L. Gibert ◽

Geoffrey J. Gorse ◽

...

Keyword(s):

Influenza Vaccination ◽

Health Systems ◽

Viral Infections ◽

Respiratory Infections ◽

Healthcare Personnel ◽

Respiratory Pathogens ◽

Respiratory Illnesses ◽

Vaccination Rates ◽

Increased Risk ◽

Viral Respiratory

Abstract Objective: The implementation of mandatory influenza vaccination policies among healthcare personnel (HCP) is controversial. Thus, we examined the affect of mandatory influenza vaccination policies among HCP working in outpatient settings. Setting: Four Veterans’ Affairs (VA) health systems and three non-VA medical centers. Methods: We analyzed rates of influenza and other viral causes of respiratory infections among HCP working in outpatient sites at 4 VA health systems without mandatory influenza vaccination policies and 3 non-VA health systems with mandatory influenza vaccination policies. Results: Influenza vaccination was associated with a decreased risk of influenza (odds ratio, 0.17; 95% confidence interval [CI], 0.13–0.22) but an increased risk of other respiratory viral infections (incidence rate ratio, 1.26; 95% CI, 1.02–1.57). Conclusions: Our fitted regression models suggest that if influenza vaccination rates in clinics where vaccination was not mandated had equalled those where vaccine was mandated, HCP influenza infections would have been reduced by 52.1% (95% CI, 51.3%–53.0%). These observations, their possible causes, and additional strategies to reduce influenza and other viral respiratory illnesses among HCP working in ambulatory clinics warrant further investigation.

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Championing Patient Safety through Mandatory Influenza Vaccination for All Healthcare Personnel and Affiliated Physicians

Infection Control and Hospital Epidemiology ◽

10.1086/659155 ◽

2011 ◽

Vol 32 (4) ◽

pp. 375-379 ◽

Cited By ~ 30

Author(s):

Lynne V. Karanfil ◽

Jan Bahner ◽

Joan Hovatter ◽

William L. Thomas

Keyword(s):

Influenza Vaccination ◽

Seasonal Influenza ◽

Influenza Season ◽

Vaccination Rate ◽

Vaccination Program ◽

Healthcare Personnel ◽

Full Time ◽

Seasonal Influenza Vaccination ◽

Vaccination Rates ◽

For Profit

Objective.To determine whether a mandatory seasonal influenza vaccination program will increase vaccination rates among healthcare personnel (HCP) and affiliated physicians.Setting.MedStar Health is a not-for-profit regional healthcare organization that includes 9 hospitals with approximately 25,000 HCP and approximately 4,000 affiliated physicians. HCP describes any person employed by MedStar Health.Methods.With previous vaccination rates parallel to reported national rates of 54% among HCP, MedStar Health introduced a mandatory seasonal influenza vaccination program promulgated during the 2009–2010 influenza season. HCP and affiliated physicians were given an opportunity to apply for medical or religious exemptions. Noncompliant HCP were terminated. Noncompliant physicians had their privileges administratively suspended for the influenza season.Results.HCP compliance (vaccinated and exempt) was 99.9%. The influenza vaccination rate among HCP was 98.5%. There were 338 approved medical exemptions and 18 approved religious exemptions. Only 0.01% of HCP (9 full-time, 2 part-time, and 17 per diem employees) were terminated. Overall, 93% of the affiliated physicians were vaccinated; 7 religious and 99 medical exemptions were granted. In total, 149 physicians (4%) had their admitting privileges suspended during the influenza season.Conclusion.A mandatory influenza vaccination program achieves high rates of vaccination among HCP and affiliated physicians.

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Measurement of Influenza Vaccination Coverage among Healthcare Personnel in US Hospitals

Infection Control and Hospital Epidemiology ◽

10.1086/648086 ◽

2009 ◽

Vol 30 (12) ◽

pp. 1150-1157 ◽

Cited By ~ 21

Author(s):

Megan C. Lindley ◽

Juliet Yonek ◽

Faruque Ahmed ◽

Joseph F. Perz ◽

Gretchen Williams Torres

Keyword(s):

Confidence Interval ◽

Influenza Vaccine ◽

Influenza Vaccination ◽

Vaccination Coverage ◽

Medical Staff ◽

Odds Ratio ◽

Healthcare Personnel ◽

American Hospital ◽

American Hospital Association ◽

Vaccination Rates

Objective.To characterize practices related to measuring influenza vaccination rates among healthcare personnel in US hospitals.Design.Descriptive survey.Setting.Nonfederal, short-stay hospitals that provide general medical and surgical services, identified by use of the 2004 American Hospital Association Annual Survey Database.Participants.Healthcare personnel from 996 randomly sampled US hospitals stratified by region and bed size.Methods.A self-administered questionnaire was distributed in 2006 to infection control coordinators to gather data on policies and practices related to the provision of the influenza vaccine and on the measurement and reporting of influenza vaccination rates. Descriptive statistics and associations were calculated, and logistic regression was conducted.Results.The response rate was 56% (ie, 555 of 996 US hospitals responded to the questionnaire). Weighting accounted for sampling design and nonresponse. Most hospitals provided the influenza vaccine to employees (100%), credentialed medical staff (ie, independent practitioners; 94%), volunteers (86%), and contract staff (83%); provision for students and residents was less frequent (58%). Only 69% of hospitals measured vaccination rates (mean coverage rate, 55%). Most hospitals that measured coverage included employees (98%) in the vaccination rates, whereas contract staff (53%), credentialed medical staff (56%), volunteers (56%), and students and residents (30%) were less commonly included. Among hospitals measuring coverage, 44% included persons for which vaccine was contraindicated, and 51% included persons who refused vaccination. After adjustment for region and size, hospitals with vaccination plans written into policy (odds ratio, 2.0 [95% confidence interval, 1.22–7.67]) or that addressed internally reporting coverage (odds ratio, 4.8 [95% confidence interval, 2.97–7.66]) were more likely to measure coverage than were hospitals without such plans.Conclusions.Hospitals vary in terms of the groups of individuals included in influenza vaccination coverage measurements. Standardized measures may improve comparability of hospital-reported vaccination rates. Measuring coverage in a manner that facilitates identification of occupational groups with low vaccination rates may inform development of targeted interventions.

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Protecting Healthcare Personnel in Outpatient Settings: The Influence of Mandatory Versus Nonmandatory Influenza Vaccination Policies on Workplace Absenteeism During Multiple Respiratory Virus Seasons

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2018.9 ◽

2018 ◽

Vol 39 (4) ◽

pp. 452-461 ◽

Cited By ~ 16

Author(s):

John Frederick ◽

Alexandria C. Brown ◽

Derek A. Cummings ◽

Charlotte A. Gaydos ◽

Cynthia L. Gibert ◽

...

Keyword(s):

Influenza Vaccination ◽

Respiratory Illness ◽

Healthcare Personnel ◽

Respiratory Protection ◽

Vaccination Rates ◽

Medical Centers ◽

Observational Cohort ◽

Mandatory Vaccination ◽

Outpatient Settings ◽

Multivariable Regression Models

OBJECTIVETo determine the effect of mandatory and nonmandatory influenza vaccination policies on vaccination rates and symptomatic absenteeism among healthcare personnel (HCP).DESIGNRetrospective observational cohort study.SETTINGThis study took place at 3 university medical centers with mandatory influenza vaccination policies and 4 Veterans Affairs (VA) healthcare systems with nonmandatory influenza vaccination policies.PARTICIPANTSThe study included 2,304 outpatient HCP at mandatory vaccination sites and 1,759 outpatient HCP at nonmandatory vaccination sites.METHODSTo determine the incidence and duration of absenteeism in outpatient settings, HCP participating in the Respiratory Protection Effectiveness Clinical Trial at both mandatory and nonmandatory vaccination sites over 3 viral respiratory illness (VRI) seasons (2012–2015) reported their influenza vaccination status and symptomatic days absent from work weekly throughout a 12-week period during the peak VRI season each year. The adjusted effects of vaccination and other modulating factors on absenteeism rates were estimated using multivariable regression models.RESULTSThe proportion of participants who received influenza vaccination was lower each year at nonmandatory than at mandatory vaccination sites (odds ratio [OR], 0.09; 95% confidence interval [CI], 0.07–0.11). Among HCP who reported at least 1 sick day, vaccinated HCP had lower symptomatic days absent compared to unvaccinated HCP (OR for 2012–2013 and 2013–2014, 0.82; 95% CI, 0.72–0.93; OR for 2014–2015, 0.81; 95% CI, 0.69–0.95).CONCLUSIONSThese data suggest that mandatory HCP influenza vaccination policies increase influenza vaccination rates and that HCP symptomatic absenteeism diminishes as rates of influenza vaccination increase. These findings should be considered in formulating HCP influenza vaccination policies.Infect Control Hosp Epidemiol 2018;39:452–461

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