Healthcare Personnel Influenza Immunization, a Condition of Employment

Background: The U.S. Advisory Committee on Immunization Practices has recommended immunization of healthcare personnel (HCP) against influenza since 1981 to prevent transmission within health care facilities.  Benefits of annual immunization of HCP include: improved patient safety, decreased healthcare-associated infections, decreased patient morbidity and mortality, and reduced HCP absenteeism.  Nationally HCP immunization rates remain low, averaging 40%.  Achieving adequate vaccination rates among HCP is challenging.  Education, best-practice campaigns, incentives, declination statements and inclusion on incented scorecards leads to incremental increases in vaccination rates.  Transformational change is required to significantly influence rates.

Setting: A large Midwestern not-for-profit health care organization, with over 27,000 employees, consisting of acute care, long-term, care, home care, physician practices, and community health services.

Population: All employees, clinical contracted personnel, volunteers, and students, regardless of job function.

Project Description: In 2008 a human resources policy was implemented making influenza immunization a condition of employment as a patient and HCP safety initiative.  HCP are required to be vaccinated against influenza or be granted a medical exemption or religious accommodation prior to December 15^th each year.  Non-compliance results in suspension without pay.  After the 30 day suspension, non-compliant HCP are terminated.  Strategies to develop and implement the policy included change management, key partnerships (legal, human resources, infection prevention, occupational health, etc.), consistent timely communication, practice standardization, extensive vaccination opportunities, standard educational materials, and consistent policy enforcement.  Various vaccine brands were available to meet the HCP needs (pregnancy, allergies, or fear of needles).

Results/Lessons Learned: Policy compliance rates have averaged 99.9% with HCP immunization rates averaging 98% over two years.  Successful implementation of a program making influenza immunization a condition of employment increases HCP immunization rates.  Key partnerships, administrative support, consistent timely communication, standardization, consistent policy enforcement and use of change management principles are critical to successful policy implementation.