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Primary study

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An effective strategy for influenza vaccination of healthcare workers in Australia: experience at a large health service without a mandatory policy.

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Journal BMC infectious diseases
Year 2015
Links Pubmed DOI PubMed Central

This article is included in 1 Systematic review Systematic reviews (1 reference)

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BACKGROUND: Annual influenza vaccination of healthcare workers (HCWs) is recommended in Australia, but uptake in healthcare facilities has historically been low (approximately 50%). The objective of this study was to develop and implement a dedicated campaign to improve uptake of staff influenza annual vaccination at a large Australian health service. METHODS: A quality improvement program was developed at Alfred Health, a tertiary metropolitan health service spanning 3 campuses. Pre-campaign evaluation was performed by questionnaire in 2013 to plan a multimodal vaccination strategy. Reasons for and against vaccination were captured. A campaign targeting clinical and non-clinical healthcare workers was then implemented between March 31 and July 31 2014. Proportional uptake of influenza vaccination was determined by campus and staff category. RESULTS: Pre-campaign questionnaire responses were received from 1328/6879 HCWs (response rate 20.4%), of which 76% were vaccinated. Common beliefs held by unvaccinated staff included vaccine ineffectiveness (37.1%), that vaccination makes staff unwell (21.0%), or that vaccination is not required because staff are at low risk for acquiring influenza (20.2%). In 2014, 6009/7480 (80.3%) staff were vaccinated, with significant improvement in uptake across all campuses and amongst nursing, medical and allied health staff categories from 2013 to 2014 (p < 0.0001). CONCLUSIONS: A non-mandatory multimodal strategy utilising social marketing and a customised staff database was successful in increasing influenza vaccination uptake by all staff categories. The sustainability of dedicated campaigns must be evaluated.

Primary study

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Healthcare worker influenza declination form program.

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Journal American journal of infection control
Year 2015
Links Pubmed DOI

This article is included in 1 Systematic review Systematic reviews (1 reference)

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BACKGROUND: Health care worker (HCW) vaccination rates have been low for many years (approximately 50%). Our goal was to implement an influenza declination form program (DFP) to assess feasibility, participation, HCW vaccination, and costs. METHODS: This was a prospective interventional pilot study using mixed methods to evaluate the DFP implementation processes and outcomes. We conducted a formative evaluation and interviews; data were transcribed and coded into themes. Secondary outcomes included self-reported HCW influenza vaccine uptake (pre-/postsurvey) and program costs; data were evaluated using descriptive and bivariate analyses. RESULTS: The DFP was compatible with ongoing strategies and unit culture. Barriers included multiple hospital shifts and competing demands. Facilitators included complementary ongoing strategies and leadership engagement. HCW vaccination rates were higher post- versus preimplementation (77.4% vs 53.5%, P =.01). To implement the DFP at site 1, using a mobile flu cart, 100% of declination forms were completed in 42.5 staff hours over <2 months. At site 2, using a vaccination table on all staff meeting days, 49% of forms were completed in 26.5 staff hours over 4.5 months. Average cost of staff time was $2,093 per site. CONCLUSION: DFP implementation required limited resources and resulted in increased HCW influenza vaccine rates; this may have positive clinical implications for influenza infection control/prevention.

Primary study

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Employee influenza vaccination in a large cancer center with high baseline compliance rates: comparison of carrot versus stick approaches.

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Journal American journal of infection control
Year 2015
Links Pubmed DOI PubMed Central

This article is included in 1 Systematic review Systematic reviews (1 reference)

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BACKGROUND: Influenza is a major complication in patients with cancer and hematopoietic cell transplant recipients. We set out to maximize influenza vaccination rates in health care personnel at our large ambulatory cancer center with high baseline compliance and to assess alternatives to mandatory policies. METHODS: Baseline influenza vaccine compliance rates at our center were >85%. During 2011 an incentive-based "carrot" campaign was implemented, and in 2012 a penalty-based "stick" approach to declining staff was required. Yearly approaches were compared using Kaplan-Meier survival estimates. RESULTS: Both the incentive and penalty approaches significantly improved the baseline rates of vaccination (2010 vs 2011 P = .0001 and 2010 vs 2012 P < .0001), and 2012 significantly improved over 2011 (P < .0001). Staff with direct patient contact had significantly higher rates of vaccination compared with those with indirect and minimal contact in every campaign year, except in the penalty-driven campaign from 2012 (P < .001, P < .001, and P = .24 and P < .001, P < .001, and P = .17, respectively). CONCLUSIONS: A multifaceted staff vaccination program that included education, training, and active declination was more effective than a program offering incentives. Improvements in vaccination rates in the penalty-driven campaign were driven by staff without direct care responsibilities. High compliance with systemwide influenza vaccination was achieved without requiring mandatory vaccination.

Primary study

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Understanding health care personnel's attitudes toward mandatory influenza vaccination.

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Journal American journal of infection control
Year 2014
Links Pubmed DOI

This article is included in 1 Systematic review Systematic reviews (1 reference)

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BACKGROUND: This study investigated the factors influencing influenza vaccination rates among health care personnel (HCP) and explored HCP's attitudes toward a policy of mandatory vaccination. METHODS: In September 2012, a 33-item Web-based questionnaire was administered to 3,054 HCP employed at a tertiary care hospital in metropolitan Detroit. RESULTS: There was a significant increase in the rate of influenza vaccination, from 80% in the 2010-2011 influenza season (before the mandated influenza vaccine) to 93% in 2011-2012 (after the mandate) (P < .0001). Logistic regression showed that HCP with a history of previous influenza vaccination were 7 times more likely than their peers without this history to receive the vaccine in 2011-2012. A pro-mandate attitude toward influenza vaccination was a significant predictor of receiving the vaccine after adjusting for demographics, history of previous vaccination, awareness of the hospital's mandatory vaccination policy, and patient contact while providing care (P = .01). CONCLUSIONS: The increased rate of influenza vaccination among HCP was driven by both an awareness of the mandatory policy and a pro-mandate attitude toward vaccination. The findings of this study call for better education of HCP on the influenza vaccine along with enforcement of a mandatory vaccination policy.

Primary study

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Mandatory seasonal influenza vaccination or masking of British Columbia health care workers: Year 1.

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Authors Ksienski DS
Journal Canadian journal of public health = Revue canadienne de sante publique
Year 2014
Links Pubmed DOI PubMed Central

This article is included in 1 Systematic review Systematic reviews (1 reference)

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OBJECTIVE: The Influenza Prevention Policy ("the Policy") aims to increase seasonal influenza vaccination coverage among British Columbia (BC) health care workers (HCWs). PARTICIPANTS: HCWs who work in publicly funded facilities and attend patient care areas. SETTING: The Policy was announced in August 2012 and took effect province-wide during the 2012/13 flu season. INTERVENTION: BC HCWs are required to receive seasonal influenza vaccination by the start of the flu season (December 1) or wear a mask while at work until the flu season ends (March 30). Vaccinated HCWs need to wear a green dot on their identification tag. HCWs are expected to report noncompliant coworkers. As initially proposed, continued noncompliance with the Policy could result in termination of employment (ultimately this component was put in abeyance). OUTCOME: For the 2012/13 flu season, 74% of HCWs (35,889/48,818) at acute care facilities received influenza vaccination compared with 40% (23,375/58,212) in 2011/12 (difference in proportion=0.33, 95% confidence interval [CI]: 0.33-0.34, p<0.001). Similarly, staff vaccination rates at residential care facilities increased from 57% (21,535/37,700) for the 2011/12 flu season to 75% (27,617/36,620) in 2012/13 (difference in proportion=0.18, 95% CI: 0.18-0.19, p<0.001). Health care unions claimed that the Policy was coercive, and they launched an unsuccessful grievance with the BC Labour Relations Board. CONCLUSION: Implementation of the Policy was associated with increased HCW vaccination; the Policy was upheld by an independent arbitrator. Further research is required to correlate HCW vaccination coverage rates with changes in influenza incidence and its complications. Continued stakeholder engagement is vital to achieve a collaborative decision-making process.

Primary study

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[Evaluation of a novel flu vaccination campaign among health personnel for the 2011-2012 season].

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Journal Archivos de prevencion de riesgos laborales
Year 2014
Links Pubmed DOI

This article is included in 1 Systematic review Systematic reviews (1 reference)

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The objective was to evaluate the healthcare personnel seasonal influenza immunization program in the 2011-2012 flu season. The campaign included several innovative actions (informational brochure, recommendations for unvaccinated staff to wear a mask, acknowledgement letters, etc). Coverage and characteristics of the health personnel were compared with the previous season using the chi-square test. Vaccination coverage for the 2011-12 flu season was 26.5%, compared to 24.5% achieved in 2010-2011 (p=0.052). The improvement in vaccination coverage approached statistical significance but remains very low. To improve these low vaccination levels, we recommend developing other strategies, such as incentive policies or making vaccination mandatory.

Primary study

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A pilot study of an influenza vaccination or mask mandate in an Australian tertiary health service.

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Authors Stuart RL , Gillespie EE , Kerr PG
Journal The Medical journal of Australia
Year 2014
Links Pubmed

This article is included in 1 Systematic review Systematic reviews (1 reference)

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Primary study

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A successful strategy for increasing the influenza vaccination rate of healthcare workers without a mandatory policy outside of the United States: a multifaceted intervention in a Japanese tertiary care center.

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Journal Infection control and hospital epidemiology
Year 2013
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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OBJECTIVE: Although mandatory vaccination programs have been effective in improving the vaccination rate among healthcare workers, implementing this type of program can be challenging because of varied reasons for vaccine refusal. The purpose of our study is to measure improvement in the influenza vaccination rate from a multifaceted intervention at a Japanese tertiary care center where implementing a mandatory vaccination program is difficult. DESIGN: Before-and-after trial. PARTICIPANTS AND SETTING: Healthcare workers at a 550-bed, tertiary care, academic medical center in Sapporo, Japan. INTERVENTIONS: We performed a multifaceted intervention including (1) use of a declination form, (2) free vaccination, (3) hospital-wide announcements during the vaccination period, (4) prospective audit and real-time telephone interview for healthcare workers who did not receive the vaccine, (5) medical interview with the hospital executive for noncompliant (no vaccine, no declination form) healthcare workers during the vaccination period, and (6) mandatory submission of a vaccination document if vaccinated outside of the study institution. RESULTS: With the new multifaceted intervention, the vaccination rate in the 2012-2013 season increased substantially, up to 97%. This rate is similar to that reported in studies with a mandatory vaccination program. Improved vaccination acceptance, particularly among physicians, likely contributed to the overall increase in the vaccination rate reported in the study. CONCLUSIONS: Implementation of comprehensive strategies with strong leadership can lead to substantial improvements in vaccine uptake among healthcare workers even without a mandatory vaccination policy. The concept is especially important for institutions where implementing mandatory vaccination programs is challenging.

Primary study

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Influenza vaccination as a condition of employment for a large regional health care system.

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Authors Smith DR , Van Cleave B
Journal WMJ : official publication of the State Medical Society of Wisconsin
Year 2012
Links Pubmed

This article is included in 1 Systematic review Systematic reviews (1 reference)

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Aurora Health Care (Aurora) is a large integrated delivery system in eastern Wisconsin/northern Illinois that serves over 1.2 million patients per year and has over 30,000 employees. Aurora adopted a policy of annual influenza vaccination as a condition of employment for all employees during May 2011, to commence with the 2011-2012 influenza season. The percentage of employees vaccinated against influenza had been below 100%-the rate recommended by the Centers for Disease Control and Prevention. The intervention increased the percentage of employees vaccinated to 97.7% in the first year of implementation, compared to 71% in 2010 (P < 0.00001). No medical or economic reactions to this intervention were determined to be unmanageable. Aurora recommends that health systems that currently fail to achieve 90% employee influenza vaccination rates adopt a similar process.

Primary study

Unclassified

Voluntary to mandatory: evolution of strategies and attitudes toward influenza vaccination of healthcare personnel.

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Journal Infection control and hospital epidemiology
Year 2012
Links Pubmed DOI

This article is included in 2 Systematic reviews Systematic reviews (2 references)

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BACKGROUND: Assessing the relative success of serial strategies for increasing healthcare personnel (HCP) influenza vaccination rates is important to guide hospital policies to increase vaccine uptake. OBJECTIVE: To evaluate serial campaigns that include a mandatory HCP vaccination policy and to describe HCP attitudes toward vaccination and reasons for declination. DESIGN: Retrospective cohort study. METHODS: We assessed the impact of serial vaccination campaigns on the proportions of HCP who received influenza vaccination during the 2006-2011 influenza seasons. In addition, declination data over these 5 seasons and a 2007 survey of HCP attitudes toward vaccination were collected. RESULTS: HCP influenza vaccination rates increased from 44.0% (2,863 of 6,510 HCP) to 62.9% (4,037 of 6,414 HCP) after institution of mobile carts, mandatory declination, and peer-to-peer vaccination efforts. Despite maximal attempts to improve accessibility and convenience, 27.2% (66 of 243) of the surveyed HCP were unwilling to wait more than 10 minutes for a free influenza vaccination, and 23.3% (55 of 236) would be indifferent if they were unable to be vaccinated. In this context, institution of a mandatory vaccination campaign requiring unvaccinated HCP to mask during the influenza season increased rates of compliance to over 90% and markedly reduced the proportion of HCP who declined vaccination as a result of preference. CONCLUSIONS: A mandatory influenza vaccination program for HCP was essential to achieving high vaccination rates, despite years of intensive vaccination campaigns focused on increasing accessibility and convenience. Mandatory vaccination policies appear to successfully capture a large portion of HCP who are not opposed to receipt of the vaccine but who have not made vaccination a priority.