25408 Implementation of An Influenza Vaccine Mandate for Employees at a Rural Tribal Health Care Facility

Tuesday, March 29, 2011
Columbia Hall
Jane Oski, MD, MPH , Epidemiological Response Team, Tuba City Rehional Health Care Corporation

Background: In the 2009 Influenza A (H1N1) Pandemic, the mortality rate for American Indians (AI) and Alaska Natives (AN) was 4 times higher compared to other racial/ethnic populations.  Indian Health Service data show that over 50% of the total AI/AN population falls into one of the categories of increased risk for medical complications from influenza.  Many of these high-risk individuals will have contact with the healthcare system during an average influenza season. Due to the risk of healthcare-associated influenza infection, the Advisory Committee on Immunization Practices (ACIP) recommends vaccination of Healthcare workers (HCW). Despite this and other recommendations, rates of voluntary influenza immunization among HCWs have remained low. The Tuba City Regional Health Care Corporation (TCRHCC) has encouraged voluntary HCW influenza vaccination and tracked coverage since 2008. In 2010, TCRHCC adopted a policy of mandatory influenza vaccination for all employees. 

Setting:  The TCRHCC is a 55-bed tribal facility serving AI/AN people located on the Navajo Nation in NE Arizona with 1076 employees and providing approximately 180,000 outpatient visits per year.

Population:  All employees of the TCRHCC

Project Description:  A mandatory influenza vaccination policy for all employees (not just HCW) was adopted beginning September 2010. Employees who decline vaccination for medical, religious or other reasons are required to wear a mask during duty hours from November 1, 2010 through March 31, 2011. 

Results/Lessons Learned:  In 2008 and 2009, influenza vaccination coverage rates among TCRHCC employees were 85% and 89%. Within 1 month of implementation of the mandatory policy, 97% of hospital employees were vaccinated, 2% were wearing masks, and 1% were unaccounted.  Mandatory vaccination was effective in increasing coverage. Successful implementation of a vaccine mandate requires interdepartmental collaboration, effective employee education, legal review of policy and a clear method for enforcement of mask wearing.