Health-Care Personnel Influenza Vaccination Policies at New Hampshire Hospitals

BACKGROUND: Health-care personnel (HCP) are at risk for influenza virus infection with possible transmission to patients. Despite documented benefits of HCP vaccination on patient outcomes and HCP absenteeism, national vaccination rates are well below the Healthy People 2020 target of 90% (67% in 2012). In NH, HCP vaccination rates in hospitals have increased significantly each year since these data were first monitored (60% during 2008-2009 influenza season vs. 89% in 2011-2012). In 2012, the New Hampshire Department of Health and Human Services (NHDHHS) administered a survey to better understand the role of hospital vaccination policies on HCP vaccination rates.

METHODS: Since 2008, all NH hospitals (acute care, psychiatric, and rehabilitation) are required to report HCP influenza vaccination rates to NHDHHS through an online survey. As part of the 2011-2012 survey, questions were added regarding HCP vaccination policies at each facility. Questions included whether a policy was in place, whether employees were required to receive vaccine and what exemptions were allowed, and any consequences for unvaccinated employees, such as termination or mask use. Influenza vaccination rates were analyzed and stratified by policy type for assessment of potential policy impacts on vaccination rates. 

RESULTS: During the 2011-2012 influenza season, 17 (55%) of 31 hospitals had a HCP vaccination policy in place, 8 (26%) did not have one, and 6 (19%) were considering one. Among 17 hospitals with a policy, all 17 (100%) allowed for medical and religious exemptions and 12 (71%) also accepted philosophical exemptions. All 17 (100%) hospitals required unvaccinated HCP with an approved exemption to wear a mask and 3 (4%) terminated unvaccinated HCP without an approved medical or religious exemption. Hospitals with vaccination policies had significantly higher rates of influenza vaccination as a whole (93%) than hospitals without mandatory policies (78%). Hospitals that terminated unvaccinated employees without an exemption had a significantly higher vaccination rate (98%) than hospitals that required unvaccinated employees to wear a mask (90%).

CONCLUSIONS: Increases in HCP influenza vaccination rates in NH hospitals have been driven in part by vaccination policies implemented recently at these facilities. Allowable exemptions and consequences for unvaccinated HCP varied across hospitals. Hospitals with the highest vaccination rates were those that allowed only medical and religious exemptions and terminated those HCP without one. HCP influenza vaccination rates at hospitals without policies can be further increased through implementation of vaccination policies that educate HCP, promote vaccination, and ensure accessibility of vaccine.