title: Increases in vaccination coverage of healthcare personnel following institutional requirements for influenza vaccination: a national survey of U.S. hospitals.
abstract: BACKGROUND
  Institutional requirements for influenza vaccination, ranging from policies that mandate declinations to those terminating unvaccinated healthcare personnel (HCP), are increasingly common in the U.S. Our objective was to determine HCP vaccine uptake following requirements for influenza vaccination at U.S. hospitals.
  
  
  METHODS
  Survey mailed in 2011 to a nationally representative sample of 998 acute care hospitals. An institutional requirement was defined as an institutional policy that requires receipt or declination of influenza vaccination, with or without consequences for vaccine refusal. Respondents reported institutional-level, seasonal influenza vaccination coverage, if known, during two consecutive influenza seasons: the season prior to (i.e., pre-requirement), and the first season of requirement (i.e., post-requirement). Weighted univariate and multivariate analyses accounted for sampling design and non-response.
  
  
  RESULTS
  808 (81.0%) hospitals responded. Of hospitals with institutional requirements for influenza vaccination (n=440), 228 hospitals met analytic inclusion criteria. Overall, mean reported institutional-level influenza vaccination coverage among HCP rose from 62.0% in the pre-requirement season to 76.6% in the post-requirement season, representing a single-season increase of 14.7 (95% CI: 12.6-16.7) percentage points. After adjusting for potential confounders, single-season increases in influenza vaccination uptake remained greater among hospitals that imposed consequences for vaccine refusal, and among hospitals with lower pre-requirement vaccination coverage. Institutional characteristics were not associated with vaccination increases of differential magnitude.
  
  
  CONCLUSIONS
  Hospitals that are unable to improve suboptimal influenza vaccination coverage through multi-faceted, voluntary vaccination campaigns may consider institutional requirements for influenza vaccination. Rapid and measurable increases in vaccination coverage followed institutional requirements at hospitals of varying demographic characteristics.
authors.affiliation: Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. ion2@cdc.gov
authors.forename: Brady L
authors.initials: BL
authors.lastname: Miller
authors.forename: Faruque
authors.initials: F
authors.lastname: Ahmed
authors.forename: Megan C
authors.initials: MC
authors.lastname: Lindley
authors.forename: Pascale M
authors.initials: PM
authors.lastname: Wortley
mesh_terms: D003625:Data Collection; D006282:Health Personnel / Q000706:statistics & numerical data*; D006291:Health Policy; D006761:Hospitals; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000517:prevention & control*; D037141:Mandatory Programs; D014481:United States; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D007252:Influenza Vaccines