Seasonal Influenza and Tdap Vaccination Policies In Michigan Hospitals: Michigan Department of Community Health (MDCH) Hospital Survey, Fall 2011

Background: The Advisory Committee on Immunization Practices (ACIP) recommends vaccination of healthcare personnel (HCP) because of their risk for exposure to and transmission of vaccine-preventable diseases.  The recommendation for annual influenza vaccination has been in place since 1984 and Tdap vaccination since 2005.   While mandatory vaccination policies in hospitals demonstrably improve coverage rates, vaccination policies vary in Michigan.

Objectives: Determine the prevalence of mandatory influenza and Tdap vaccination policies for HCP in Michigan hospitals. Determine critical factors associated with implementing mandatory polices and barriers associated with not implementing mandatory policies. Provide information and business practices to assist hospitals leaders with implementing mandatory vaccination policies.

Methods: We surveyed all Michigan hospitals (n=177) to determine the prevalence of mandatory Tdap and influenza vaccination policies for HCP and to identify factors associated with implementation.

Results: Forty-one percent of hospitals had a mandatory flu vaccination policy for all staff; 96% implemented the policy in 2009 or later. Leadership support was the factor most commonly reported by hospitals with mandatory policies (56%).  Staff resistance (25%) and challenges from labor unions (20%) were the most commonly reported barriers to implementation of a mandatory policy. Eleven percent of hospitals had a mandatory Tdap policy for all staff. Patient safety (42%) and leadership support (32%) were associated with policy implementation; lack of Tdap policy discussion (29%) was the most frequently cited barrier.

Conclusions: The Healthy People 2020 target of 90% influenza vaccination coverage among HCP is achievable in Michigan.  Voluntary HCP influenza vaccination programs have resulted in low vaccination rates for nearly 3 decades.  To reach the 2020 target, hospital leaders’ support for mandatory vaccination policies will be critical.  The scientific and ethical framework, in addition to resources and support from professional organizations are available to overcome barriers and implement effective policies to increase influenza and Tdap vaccination coverage rates among HCP.