Learning Objectives for this Presentation:
By the end of the presentation participants will be able to describe improvements in healthcare worker (HCW) influenza vaccination program due to a declination process.

Background:
In 2006, Children's Hospitals and Clinics of Minnesota (CHC) implemented an influenza vaccination declination process to: increase rates among staff, include vaccination of HCW at their private provider and identify reasons for declination.

Objectives:
Determine and improve HCW vaccination rates using a declination process.

Methods:
CHC held on-site vaccination clinics and provided a traveling nurse in November and December, 2006. Non-vaccinated employees were sent a letter and survey, encouraging staff to receive vaccine and reply if they were vaccinated elsewhere, planning on being vaccinated through occupational health services, or declined vaccination. Staff who replied they declined vaccination were asked why. Vaccination rates were provided to department managers and medical directors prior to and following sending the declination forms.

Results:
Of 4248 employees, 2385 (56%) received were vaccinated at on-site clinics, 330 (8%) were vaccinated elsewhere, 441 (10%) declined vaccination, and 1092 (26%) were non-responders. Vaccination rates increased by 10% following the declination process (range within specific departments 0 to 35%). Departments with strong medical and nurse manager support for vaccinations had the greatest improvements. 378 employees provided reasons declining vaccine: 79 (21%) afraid of side effects, 54 (14%) believe they are not at risk, 49 (13%) contraindicated, 26 (7%) personal reasons, 25 (7%) don't want to, 19 (5%) don't believe vaccine(s) are effective, 16 (4%) afraid of needles/injections, 9 (2%) believe they don't put patients at risk, 6 (2%) pregnant/breastfeeding, and 4 (1%) against vaccinations.

Conclusions:
Influenza declination processes at healthcare facilities are a valuable tool in improving and better assessing vaccination rates. Timely data to departments and department champions can improve rates. Information on reasons for declination assists to provide targeted messages to staff in the future.