You Want Me to Sign What?: Implementation of Influenza Immunization Declination Statements among San Diego Hospital-Based Healthcare Workers in 2007-2008

Background:
Healthcare worker (HCW) annual influenza immunization coverage rates are inadequate (<50%) in the US. To address the low immunization rate, California passed legislation that requires HCWs to sign a declination statement if they choose not to receive an influenza immunization. The San Diego Hospital Influenza Immunization Project, a collaborative effort of 15 hospitals, UCSD School of Medicine, and the County of San Diego HHSA Immunization Branch, was formed in 2005 to raise HCW influenza immunization rates across the entire community and worked together to implement declination statements in San Diego hospitals.

Objectives:
Evaluate the implementation of declination statements for influenza immunization among hospital-based HCW's.

Methods:
As part of a larger project to increase HCW influenza immunization coverage rates, the implementation of new legislation in California mandating that HCW's sign declination statements if they did not receive their annual influenza immunization was evaluated. A random digit dialing telephone survey was conducted to determine the influenza immunization coverage rates and the compliance with declination statements during the 2007-2008 influenza season.

Results:
All 15 hospitals implemented declination statement procedures. Despite legislation requiring declination statements, compliance with completing them was only 51% during the 2007-2008 influenza immunization season compared to 23% during the 2006-2007 season when declination statements were voluntary. Hospital-based HCW influenza immunization coverage rates in 2007-2008 for San Diego County increased to 76.7% from 70.7% the previous year.

Conclusions:
Declination statements may have contributed to the increased influenza vaccine coverage.