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

Emory University School of Medicine, Atlanta, Georgia 30322, USA.
Infection Control and Hospital Epidemiology (Impact Factor: 4.18). 05/2008; 29(4):302-8. DOI: 10.1086/529586
Source: PubMed


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

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Available from: Rosette J Chakkalakal, Mar 03, 2014
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    • "Physician rates rose from 43% to 64%, with uptake among nurses remaining static (13% vs. 14%). A study in the USA found that the use of mandatory forms requiring HCWs to formally consent to or decline vaccination in writing (or record medical contraindications) played a role in increasing coverage (Ribner et al. 2008). Other factors included public support from management, regular feedback to supervisors on vaccine uptake and T-shirts for vaccinees. "
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    ABSTRACT: Many health authorities recommend routine influenza vaccination for healthcare workers (HCWs), and during the 2009 A (H1N1) pandemic, the World Health Organization (WHO) recommended immunization of all HCWs worldwide. As this remains an important area of policy debate, this paper examines the case for vaccination, the role of local guidelines, barriers to immunization and initiatives to increase uptake. Seasonal influenza is a major threat to public health, causing up to 1 million deaths annually. Extensive evidence supports the vaccination of priority groups, including HCWs. Immunization protects HCWs themselves, and their vulnerable patients from nosocomial influenza infections. In addition, influenza can disrupt health services and impact healthcare organizations financially. Immunization can reduce staff absences, offer cost savings and provide economic benefits. This paper reviews official immunization recommendations and HCW vaccination studies, including a recent International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) survey of 26 countries from each region of the world. HCW immunization is widely recommended and supported by the WHO. In the IFPMA study, 88% of countries recommended HCW vaccination, and 61% supported this financially (with no correlation to country development status). Overall, coverage can be improved, and research shows that uptake may be impacted by lack of conveniently available vaccines and misconceptions regarding vaccine safety/efficacy and influenza risk. Many countries recommend HCW vaccination against influenza. In recent years, there has been an increased uptake rate among HCWs in some countries, but not in others. Several initiatives can increase coverage, including education, easy access to free vaccines and the use of formal declination forms. The case for HCW vaccination is clear, and in an effort to further accelerate uptake as a patient safety measure, an increasing number of healthcare organizations, particularly in the USA, are implementing mandatory immunization policies, similar to other obligatory hygiene measures. However, it would be desirable if similar high vaccination uptake rates could be achieved through voluntary procedures.
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    • "Several studies have suggested other predictors associated with nurses' vaccination including age, previous vaccination history, professional ethos, group identification and health motivation (Campos & Jalaludin 2003, Ofstead et al. 2008, Falomir-Pichastor et al. 2009, Norton et al. 2008, Shahrabani et al. 2009). Vaccination campaigns have attempted to improve vaccination rates among HCWs in some local settings but these campaigns have not always obtained the expected outcomes among nurses (Harbarth et al. 1998, Sartor et al. 2004, Ofstead et al. 2008) although others have reported increased vaccination coverage of HCWs (Bryant et al. 2004, Kuntz et al. 2008, Ribner et al. 2008, Polgreen et al. 2009). We hypothesise that this may be due to variables influencing nurses' vaccination behaviours that have not been clearly identified because the instruments used in the above studies were not systematically developed and tested. "
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    • "What should we do now? The following options appear to be possible: • Further influenza education [5] [8]; • Informed declination forms [4] [9] [10]; • Mandatory influenza vaccination [1] [2]. "

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