title: Voluntary to mandatory: evolution of strategies and attitudes toward influenza vaccination of healthcare personnel.
abstract: BACKGROUND
  Assessing the relative success of serial strategies for increasing healthcare personnel (HCP) influenza vaccination rates is important to guide hospital policies to increase vaccine uptake.
  
  
  OBJECTIVE
  To evaluate serial campaigns that include a mandatory HCP vaccination policy and to describe HCP attitudes toward vaccination and reasons for declination.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  We assessed the impact of serial vaccination campaigns on the proportions of HCP who received influenza vaccination during the 2006-2011 influenza seasons. In addition, declination data over these 5 seasons and a 2007 survey of HCP attitudes toward vaccination were collected.
  
  
  RESULTS
  HCP influenza vaccination rates increased from 44.0% (2,863 of 6,510 HCP) to 62.9% (4,037 of 6,414 HCP) after institution of mobile carts, mandatory declination, and peer-to-peer vaccination efforts. Despite maximal attempts to improve accessibility and convenience, 27.2% (66 of 243) of the surveyed HCP were unwilling to wait more than 10 minutes for a free influenza vaccination, and 23.3% (55 of 236) would be indifferent if they were unable to be vaccinated. In this context, institution of a mandatory vaccination campaign requiring unvaccinated HCP to mask during the influenza season increased rates of compliance to over 90% and markedly reduced the proportion of HCP who declined vaccination as a result of preference.
  
  
  CONCLUSIONS
  A mandatory influenza vaccination program for HCP was essential to achieving high vaccination rates, despite years of intensive vaccination campaigns focused on increasing accessibility and convenience. Mandatory vaccination policies appear to successfully capture a large portion of HCP who are not opposed to receipt of the vaccine but who have not made vaccination a priority.
authors.affiliation: Department of Epidemiology and Infection Prevention, University of California Irvine Medical Center, Orange, California 92868, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Quan
authors.forename: David M
authors.initials: DM
authors.lastname: Tehrani
authors.forename: Linda
authors.initials: L
authors.lastname: Dickey
authors.forename: Eugene
authors.initials: E
authors.lastname: Spiritus
authors.forename: Denise
authors.initials: D
authors.lastname: Hizon
authors.forename: Kristie
authors.initials: K
authors.lastname: Heck
authors.forename: Pamela
authors.initials: P
authors.lastname: Samuelson
authors.forename: Elliott
authors.initials: E
authors.lastname: Kornhauser
authors.forename: Raja
authors.initials: R
authors.lastname: Zeitany
authors.forename: Susan
authors.initials: S
authors.lastname: Mancia
authors.forename: Lauri
authors.initials: L
authors.lastname: Thrupp
authors.forename: Susan M
authors.initials: SM
authors.lastname: Tiso
authors.forename: Susan S
authors.initials: SS
authors.lastname: Huang
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration; D001291:Attitude of Health Personnel; D002140:California; D006282:Health Personnel; D006801:Humans; D017589:Immunization Programs; D017053:Infection Control; D007252:Influenza Vaccines; D007251:Influenza, Human / Q000517:prevention & control*; D037141:Mandatory Programs; D057766:Policy; D012189:Retrospective Studies; D014611:Vaccination / Q000706:statistics & numerical data* / Q000639:trends*
chemical_list: D007252:Influenza Vaccines