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Mandatory Flu Shots Gain Traction as the Future of Influenza Prevention

Evan Sweeney, for HealthLeaders Media, June 2, 2010

Every year, medical facilities plead with employees to get their annual influenza vaccinations. Some initiate campaigns as early as August, explaining the value of receiving the flu shot as well as the patient safety implications and worker safety benefits.

But despite even the most rigorous efforts, medical facilities often struggle to get flu shot rates over 50%.

A CDC report published April 2 indicated that by mid-January, nearly 62% of healthcare workers had been vaccinated against seasonal influenza, although only 37% had been vaccinated against H1N1 influenza. In previous years, rates have never been above 49%.

However, the CDC reported a 97.6% vaccination rate among facilities requiring seasonal flu shots, compared to 64.5% in facilities that only recommended the vaccine. Only 11.1% of facilities had a required policy.

Two particularly large hospital systems have taken on the challenge of implementing a mandatory flu shot policy within the past two years and have seen their compliance rates improve to as high as 98%. Although a mandatory policy eliminates the constant struggle to convince employees to get the shot, it's not without its own barriers.

In 2008, St. Louis–based BJC HealthCare, one of the largest nonprofit healthcare organizations in the United States with nearly 26,000 employees, made influenza vaccines a condition of employment. After years of voluntary vaccination programs that included incentives, leadership champions, and declination statements, BJC still could not climb above a 71% vaccination rate, according to Hilary M. Babcock, MD, MPH, assistant professor of medicine and medical director of occupational health (infectious diseases) at Barnes-Jewish and St. Louis Children's Hospitals, both in St. Louis and members of BJC HealthCare.

"[We] really just thought that we had pretty much exhausted all of the voluntary efforts," Babcock says. "Despite all of these many years of trying, we really hadn't gotten to where we wanted to be. So that's really what drove the decision to decide on the mandatory policy. We really felt it was an important patient safety issue to get our staff vaccinated."

BJC allowed exemptions for medical reasons (e.g., egg allergies, prior allergic reactions, and history of Guillain-Barré syndrome) and religious reasons only. The system successfully vaccinated 25,561 of its workforce members, a 98.4% vaccination rate, with only 90 religious exemptions and 321 medical exemptions.

In November 2009, the Hospital Corporation of America (HCA) in Nashville implemented a mandatory policy that required employees who could infect or become infected by a patient to get the seasonal flu vaccine or wear a surgical mask in patient care areas. Prior to the 2009 flu season, vaccination rates had varied from 20% to 74%.

HCA is one of the largest systems in the country with 163 hospitals, 112 outpatient centers, and 368 physician practices in 20 states. Under the mandatory policy, seasonal flu shots were offered to 140,599 employees, and 96% complied.

Communicating your policy
Simply making influenza vaccines mandatory does not replace the need for continued communication of the policy.

At BJC, each facility within the system was responsible for communicating the policy, answering individual questions, and continuing education about the vaccine. Most of the larger facilities established town hall meetings that included an infectious disease specialist, an occupational health professional, an infection prevention nurse, an HR representative, and someone from the legal team to answer questions and talk about the policy, says Babcock.

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