title: Use of a mandatory declination form in a program for influenza vaccination of healthcare workers.
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.
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia 30322, USA. bribner@emory.edu
authors.forename: Bruce S
authors.initials: BS
authors.lastname: Ribner
authors.forename: Cynthia
authors.initials: C
authors.lastname: Hall
authors.forename: James P
authors.initials: JP
authors.lastname: Steinberg
authors.forename: William A
authors.initials: WA
authors.lastname: Bornstein
authors.forename: Rosette
authors.initials: R
authors.lastname: Chakkalakal
authors.forename: Amir
authors.initials: A
authors.lastname: Emamifar
authors.forename: Irving
authors.initials: I
authors.lastname: Eichel
authors.forename: Peter C
authors.initials: PC
authors.lastname: Lee
authors.forename: Penny Z
authors.initials: PZ
authors.lastname: Castellano
authors.forename: Gilbert D
authors.initials: GD
authors.lastname: Grossman
mesh_terms: D000046:Academic Medical Centers; D001291:Attitude of Health Personnel; D032962:Consent Forms / Q000706:statistics & numerical data*; D000075202:Contraindications; D005845:Georgia; D006282:Health Personnel / Q000523:psychology / Q000706:statistics & numerical data*; D006293:Health Promotion / Q000379:methods; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000517:prevention & control*; D037141:Mandatory Programs / Q000706:statistics & numerical data*; D009726:Nurses / Q000706:statistics & numerical data; D011996:Records; D016312:Treatment Refusal / Q000706:statistics & numerical data; D014611:Vaccination / Q000706:statistics & numerical data
chemical_list: D007252:Influenza Vaccines