Impact of Hospital Mandates On Heath Care Personnel Influenza Vaccination Rates

Background: Vaccination of heath care personnel (HCP) has been shown to decrease deaths among nursing home patients. Despite this, HCP vaccination rates remains modest and are a quality measure for patient safety.

Objectives: We examined the association of hospital requirements for HCP influenza vaccination with vaccination rates and the factors associated with the implementation of these institutional requirements.

Methods: A survey was mailed to a random sample of infection control professionals in US hospitals in 2011. The institutional requirement was defined as 1) vaccination mandate with termination or other consequence for noncompliance; 2) vaccination mandate without consequences for noncompliance; and 3) no mandate for HCP influenza vaccination.

Results: 45% (N=433) responded. Compared to 229 hospitals without HCP influenza vaccination mandates, hospitals with HCP influenza vaccination mandates (83 with consequences for noncompliance and 121 with no consequences for noncompliance) were more likely to: provide vaccination at any meetings (p=0.019), provide visible vaccination of any key personnel (p=0.001), plan to provide feedback of vaccination rates to administration (p=0.019), track unit-based vaccination rates for some units (p<0.001), track vaccination rates regularly for targeting purposes (p=0.026), and use more than 8 strategies (p<0.001). Hospitals reporting mandates with consequences for noncompliance were more likely to attribute their policy implementation to state law or statute (p<0.001), experience of similar policies at other facilities (p=0.001), the Joint Commission’s recommendation (p<0.001), and corporate policy (p=0.005), than those hospitals reporting mandates without consequences for noncompliance. HCP influenza vaccination rates were reported by 150 hospitals pre- and post- implementation of the vaccination mandates, 69 with noncompliance consequences and 81 without. Those with noncompliance consequences increased vaccination rates 21.9% while those without increased 10.6% (p<0.01). 

Conclusions: Stricter hospital vaccination mandates are associated with a larger increase in HCP influenza vaccination rates than vaccination mandates without personal consequences.