Overcoming Barriers to Institutional Mandates for Healthcare Personnel Influenza Vaccination, Lessons From Pennsylvania

Background:  Mandating that all HCWs receive seasonal flu vaccine is the single most effective means of achieving universal vaccination (>90% coverage), but the number of institutions implementing mandatory policies is still very low. During the 2010/11 flu season, only 8 of 260 licensed hospitals and 5 of 830 licensed long term care facilities in Pennsylvania had achieved near universal vaccination (>90%). During the summer of 2011, the Pennsylvania Department of Health, in collaboration with the Center for Vaccine Ethics and Policy (University of Pennsylvania), the Hospital and Health System Association of Pennsylvania and the Pennsylvania Immunization Coalition, conducted 13 seminars across Pennsylvania to promote institutional mandates for influenza vaccination. We report on barriers noted by institutions considering mandating influenza vaccination.

Setting: The seminars targeted hospital executives, infection control practitioners, and human resources and employee health personnel at all PA-licensed hospitals and long term care facilities (LTCF).

Population:  580 individuals attended the seminars representing 168 hospitals, 128 LTCFs, and 82 other facilities (physician offices, public health facilities, etc.). Over 90% were employee health and infection control practitioners.

Project Description:  Each seminar showcased ethical and patient safety policies used by institutions which have mandates in place. Participants were asked to note barriers for mandating influenza vaccination. Commonly noted barriers were lack of executive level leadership; opposition from unions; consideration of religious, philosophical and constitutional exemptions; fear of lawsuits and losing staff to competing institutions; managing vaccine critics and measuring vaccine coverage

Results/Lessons Learned:  A growing number of institutions are open to implementing institutional mandates, but are hesitant largely due to the barriers noted above. Training programs which employ case studies and access to key staff from institutions which have successfully implemented mandates, and deployment of a training website with resources and follow-up strategies, proved to bridge these barriers.