Using NHSN Data to Identify Changes in Facility-Level Policies and Practices Associated with Increases in Healthcare Personnel Influenza Vaccination Rates

BACKGROUND: Tennessee acute care hospitals have been required to report healthcare personnel (HCP) seasonal influenza vaccination data to the state health department via the National Healthcare Safety Network (NHSN) since the 2012/2013 influenza season. Facilities voluntarily share their responses to the NHSN “Seasonal Survey on Influenza Vaccination Programs for Healthcare Personnel.” The survey includes questions about vaccination delivery methods, promotion strategies, vaccination documentation, and facility vaccination refusal policies. We sought to identify changes in facility-level policies from this survey associated with changes in facility HCP influenza vaccination rates.

METHODS: Responses to NHSN’s HCP influenza survey were compared between the 2012/2013 and 2013/2014 influenza seasons for each facility to identify policy changes. T-tests were used to compare the percent change in the overall HCP influenza vaccination rate between the 2012/2013 and 2013/2014 influenza seasons for facilities which added a policy or practice to the change for those which did not.

RESULTS: One hundred and five (95%) facilities had complete HCP influenza vaccination summary data and surveys for both influenza seasons. The average increase in HCP vaccination rate was 7.6% (median 4.8%) between seasons. The mean increase in vaccination for facilities with new vaccination requirements (as a condition of credentialing and/or employment) was 17.4% compared to 5.5% among facilities which did not add this requirement (p=0.002). Facilities indicating ‘other’ requirements of HCP who refused influenza vaccination in 2013/2014 but not in 2012/2013 experienced greater increases in vaccination rates than other facilities (23.2% vs. 4.0%, p<0.001). The requirements described by these facilities were generally stricter than the other options provided, examples include: requiring exemption forms, documentation of medical/religious exceptions, and wearing a mask in patient care areas.

CONCLUSIONS: The largest increases in HCP influenza vaccination rate were associated with facilities implementing new mandatory vaccination policies or stricter requirements of HCP who do not receive vaccine; however we were not able to evaluate the impact of specific policies. As more facilities report their HCP influenza vaccination data to NHSN, the responses to this survey are a valuable source of data to identify policies and practices to successfully increase HCP influenza vaccination, particularly as facilities approach the Healthy People 2020 target of 90% vaccination.