Implementation of a Hospital-Wide Employee Influenza Vaccination Program

ISSUE: Influenza can be community or occupationally acquired by healthcare staff and transmitted to patients and coworkers. Immunization of US healthcare workers against influenza has usually been based on voluntary compliance and fewer than 40% are vaccinated each year. APIC is currently recommending mandatory vaccination of all direct patient care staff with deferral for some circumstances. The CDC estimates that hospitals should vaccinate at least 80% of direct patient care staff. PROJECT: In 2005/06, Bronson Methodist Hospital, a 308-bed community hospital, implemented a mandatory influenza vaccination program for direct patient care employees with allowable deferral for documented vaccine contraindications and warnings and for religious reasons. The program was implemented as a component of Bronsonʹs patient safety goals. Vaccination was made easy to obtain, a significant education program was done, and both intranasal and intramuscular vaccine were provided. It was not previously known how well employees would accept influenza vaccination as a minimum work requirement, and to what extent deferrals would reduce participation. RESULTS: A total of 4152 Bronson employees were considered for designation as direct patient care staff or non-patient care. A total of 3201 (77%) of these employees were designated as direct patient care. Hospital-employed physicians were included in this group; non-hospital employed physicians and all other staff were vaccinated voluntarily but vaccination was not required. Of this total, <1% of employees were on long-term leave and were excluded from the program, 3% of employees left the organization between the beginning (October 2005) and the end (January 2006) of the program, and 2.5% met some criteria for deferral. The majority of deferred staff documented anaphylactic allergy to eggs or egg protein, a severe allergic reaction to a previous influenza vaccination, a history of Guillain Barre Syndrome, or a severe latex allergy. Three individuals documented a religious objection. LESSONS LEARNED: For a hospital-wide influenza vaccination program to succeed, the program must have the strong and unwavering support of the medical staff and the hospital administration. The hospital must have a strong preexisting culture of patient and employee safety, and the program must be presented as an essential component of a culture of safety. The program must be easy for the staff to comply with. The program should be accompanied by staff education on influenza disease and epidemiology and the role of immunization in controlling the disease.