Influenza Vaccination Campaign Strategies to Improve Healthcare Personnel Vaccination Coverage

BACKGROUND:  In 2013, the Los Angeles County (LAC) Department of Public Health issued a Health Officer Order mandating healthcare personnel (HCP) receive annual influenza vaccination or wear a mask.  Despite the mandate, influenza vaccination coverage among HCP at most facilities has not achieved the >90% national target. Our objective was to identify components of LAC acute care facilities’ annual influenza vaccination campaigns that were associated with employee vaccination coverage, in order to inform facilities’ development of campaigns and maximize employee vaccination.

METHODS:  We reviewed data from the Healthcare Personnel Safety Component of the National Healthcare Safety Network, which included the Seasonal Survey on Influenza Vaccination Programs for Healthcare Personnel and the Healthcare Personnel Influenza Vaccination Summary. Data from the 2013-14 and 2014-15 influenza seasons were analyzed.  Bivariate analyses were performed to assess employee vaccination coverage for each of the 18 annual influenza vaccination campaign components, adjusting for repeated measures and facility characteristics.  Multivariable linear regression with generalized estimating equations was used to identify campaign components independently associated with employee vaccination coverage. 

RESULTS:  Ninety of 100 LAC acute care hospitals had complete data.  Mean employee influenza vaccination coverage increased slightly from the 2013-14 season (79.7%, range: 31.0-97.0%) to the 2014-15 season (82.3%, range: 34.5-97.9%). Facilities applied an average of 11 strategies in their campaigns.  No facilities charged employees out-of-pocket for vaccination. Bivariate analyses demonstrated that inclusion of the following strategies was associated with increased employee vaccination coverage: providing vaccines during nights and weekends (7.3% increase, 95% CI: 0.4-14.1%), visible vaccination of key leadership (6.2% increase, 95% CI: 3.2-9.3%), advertising campaign with printed materials (5.3% increase, 95% CI: 0.5-10.2%), and tracking unit-based vaccination rates (3.8% increase , 95% CI: 1.0-6.5%). Sending vaccination reminders to staff was associated with a 3.6% decrease in employee vaccination coverage (95% CI: -7.1-0.0%).  Inclusion of regulatory components, such as requiring vaccination for credentialing, was not significantly associated with changes in coverage.  Visible vaccination of leadership and tracking unit-based rates remained significantly positively associated with employee vaccination coverage in multiple regression; sending vaccination reminders to employees remained significantly negatively associated.

CONCLUSIONS:  Several vaccination campaign strategies are employed by LAC facilities; however, not all are significantly associated with employee vaccination coverage. Outreach to LAC facilities promoting the identified effective strategies is underway to improve employee vaccination rates. Campaign strategies found to be associated with increased vaccination coverage should be considered by facilities when planning employee influenza vaccination programs.