Hostname: page-component-745bb68f8f-d8cs5 Total loading time: 0 Render date: 2025-02-04T01:05:22.106Z Has data issue: false hasContentIssue false
  • English
  • Français

Use of a Mandatory Declination Form in a Program for Influenza Vaccination of Healthcare Workers

Published online by Cambridge University Press:  02 January 2015

Bruce S. Ribner ,
Cynthia Hall ,
James P. Steinberg ,
William A. Bornstein ,
Rosette Chakkalakal ,
Amir Emamifar ,
Irving Eichel ,
Peter C. Lee ,
Penny Z. Castellano  and
Gilbert D. Grossman
Bruce S. Ribner*
Affiliation:
Emory University School of Medicine, Atlanta, Georgia Emory Healthcare, Atlanta, Georgia
Cynthia Hall
Affiliation:
Emory Healthcare, Atlanta, Georgia
James P. Steinberg
Affiliation:
Emory University School of Medicine, Atlanta, Georgia Emory Healthcare, Atlanta, Georgia
William A. Bornstein
Affiliation:
Emory University School of Medicine, Atlanta, Georgia Emory Healthcare, Atlanta, Georgia
Rosette Chakkalakal
Affiliation:
Emory University School of Medicine, Atlanta, Georgia
Amir Emamifar
Affiliation:
Emory Healthcare, Atlanta, Georgia
Irving Eichel
Affiliation:
Emory Healthcare, Atlanta, Georgia
Peter C. Lee
Affiliation:
Emory University School of Medicine, Atlanta, Georgia
Penny Z. Castellano
Affiliation:
Emory University School of Medicine, Atlanta, Georgia Emory Healthcare, Atlanta, Georgia
Gilbert D. Grossman
Affiliation:
Emory University School of Medicine, Atlanta, Georgia Emory Healthcare, Atlanta, Georgia
*
Emory University Hospital, 1364 Clifton Road NE, Suite B-705, Atlanta, GA 30322 (bribner@emory.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To evaluate the utility and impact of using a declination form in the context of an influenza immunization program for healthcare workers.

Methods.

A combined form for documentation of vaccination consent, medical contraindication(s) for vaccination, or vaccination declination was used during the 2006-2007 influenza season in a healthcare system employing approximately 9,200 nonphysician employees in 3 hospitals; a skilled nursing care facility; a large, multisite, faculty-practice plan; and an administrative building. Responses were entered into a database that contained files from human resources departments, which allowed correlation with job category and work location.

Results.

The overall levels of influenza vaccination coverage of employees increased from 43% (3,892 of 9,050) during the 2005-2006 season to 66.5% (6,123 of 9,214) during the 2006-2007 season. Of 9,214 employees, 1,898 (20.6%) signed the declination statement. Among the occupation groups, nurses had the lowest rate of declining vaccination (13.2% [393 of 2,970]; P < .0001), followed by pharmacy personnel (18.1% [40 of 221]), ancillary personnel with frequent patient contact (21.9% [169 of 771), and all others (24.7% [1,296 of 5,252]). Among the employees who declined vaccination, nurses were the least likely to select the reasons “afraid of needles” (3.8% [15 of 393], vs. 9.1% [137 of 1,505] for all other groups; P < .001) and “fear of getting influenza from the vaccine” (13.5% [53 of 393], vs. 20.5% [309 of 1,505]; P = .002). Seven pregnant nurses had been advised by their obstetricians to avoid vaccination. When declination of influenza vaccination was analyzed by age, 16% of personnel (797 of 4,980) 50 years of age and older declined to be vaccinated, compared with 26% of personnel (1,101 of 4,234) younger than 50 years of age {P < .0001).

Conclusions.

Implementing use of the declination form during the 2006-2007 influenza season was one of several measures that led to a 55% increase in the acceptance of influenza vaccination by healthcare workers in our healthcare system. Although we cannot determine to what degree use of the declination form contributed to the increased rate of vaccination, use of this form helped the vaccination program assess the reasons for declination and will help to focus future vaccination campaigns.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 4 , April 2008 , pp. 302 - 308
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Carman, WF, Elder, AG, Wallace, LA, et al.Effects of influenza vaccination of health-care workers on mortality of elderly people in long-term care: a randomised controlled trial. Lancet 2000;355:93–97.CrossRefGoogle ScholarPubMed
2.Potter, J, Stott, DJ, Roberts, MA, et al.Influenza vaccination of health care workers in long-term-care hospitals reduces the mortality of elderly patients. J Infect Dis 1997;175:1–6.Google Scholar
3.Saxen, H, Virtanen, M. Randomized, placebo-controlled double blind study on the efficacy of influenza immunization on absenteeism of health care workers. Pediatr Infect Dis J 1999;18:779–783.CrossRefGoogle ScholarPubMed
4.Wilde, JA, McMillan, JA, Serwint, J, Butta, J, O'Riordan, MA, Steinhoff, MC. Effectiveness of influenza vaccine in health care professionals: a randomized trial. JAMA 1999;281:908–913.CrossRefGoogle ScholarPubMed
5.Pearson, ML, Bridges, CB, Harper, SA. Influenza vaccination of healthcare personnel: recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2006;55(RR-2):1–16.Google Scholar
6.Joint Commission. 2007 comprehensive accreditation manual for hospitals: the official handbook. Oakbrook Terrace, IL: Joint Commission Resources, 2007.Google Scholar
7.Dash, GP, Fauerbach, L, Pfeiffer, J, et al.APIC position paper: improving health care worker influenza immunization rates. Am J Infect Control 2004;32:123–125.Google Scholar
8.Talbot, TR, Bradley, SF, Cosgrove, SE. SHEA position paper: influenza vaccination of healthcare workers and vaccine allocation for healthcare workers during vaccine shortages. Infect Control Hosp Epidemiol 2005;26:882–890.CrossRefGoogle Scholar
9.Walker, FJ, Singleton, JA, Lu, P, Wooten, KG, Strikas, RA. Influenza vaccination of healthcare workers in the United States, 1989-2002. Infect Control Hosp Epidemiol 2006;27:257–265.Google Scholar
10.King, WD, Woolhandler, SJ, Brown, AF, et al.Brief report: influenza vaccination and health care workers in the United States. J Gen Intern Med 2006;21:181–184.CrossRefGoogle ScholarPubMed
11.Bryant, KA, Stover, B, Cain, L, Levine, GL, Siegel, J, Jarvis, WR. Improving influenza immunization rates among healthcare workers caring for high-risk pediatric patients. Infect Control Hosp Epidemiol 2004;25:912–917.CrossRefGoogle ScholarPubMed
12.Centers for Disease Control and Prevention. Interventions to increase influenza vaccination of health-care workers—California and Minnesota. MMWR Morb Mortal Wkly Rep 2005;54:196–199.Google Scholar
13.Nichol, KL, Hauge, M. Influenza vaccination of healthcare workers. Infect Control Hosp Epidemiol 1997;18:189–194.CrossRefGoogle ScholarPubMed
14.Harbarth, S, Siegrist, CA, Schira, JC, Wunderli, W, Pittet, D. Influenza immunization: improving compliance of healthcare workers. Infect Control Hosp Epidemiol 1998;19:337–342.Google Scholar
15.Sartor, C, Tissot-Dupont, H, Zandotti, C, Martin, F, Roques, P, Drancourt, M. Use of a mobile cart influenza program for vaccination of hospital employees. Infect Control Hosp Epidemiol 2004;25:918–922.CrossRefGoogle ScholarPubMed
16.Occupational Safety and Health Administration. Occupational exposure to bloodborne pathogens: final rule. Fed Regist 1991;56:64004–182.Google Scholar
17.Louther, J, Feldman, J, Rivera, P, Villa, N, DeHovitz, J, Sepkowitz, KA. Hepatitis B vaccination program at a New York City hospital: seroprev-alence, seroconversion, and declination. Am J Infect Control 1998;26:423–427.Google Scholar
18.American College of Occupational and Environmental Medicine (ACOEM). Influenza control programs for healthcare workers. Elk Grove Village, IL: ACOEM, 2005. Available at: http://www.acoem.org/guide-lines.aspx?id = 730. Accessed February 18, 2008.Google Scholar
18.Bertin, M, Scarpelli, M, Proctor, AW, et al.Novel use of the intranet to document health care personnel participation in a mandatory influenza vaccination reporting program. Am J Infect Control 2007;35:33–37.Google Scholar
20.Gazmararian, JA, Coleman, MC, Prill, M, et al.Influenza vaccination of health care workers: policies and practices of hospitals in a community Setting. Am J Infect Control 2007;35:441–447.CrossRefGoogle Scholar
21.Agerton, TB, Mahoney, FJ, Polish, LB, Shapiro, CN. Impact of the blood-borne pathogens standard on vaccination of healthcare workers with hepatitis B vaccine. Infect Control Hosp Epidemiol 1995;16:287–291.CrossRefGoogle ScholarPubMed