Hospital policies, state laws and health care worker influenza vaccination rates

For more than three decades, the Centers for Disease Control and Prevention (CDC) has recommended influenza vaccination for health care workers (HCWs). During that period, myriad interventions have been employed to increase HCW influenza vaccination rates have met limited success. Influenza immunization rates for this group remain far below the coverage goal of ≥90%. State legislatures have attempted to address this problem by enacting laws mandating a host of influenza vaccine activities across distinct categories of health care facilities and HCW disciplines. Concurrently, health care institutions, physician practices and health care systems nationwide have instituted policies to improve their HCW influenza vaccine rates. But the true impact of these state laws and institutional policies on HCW influenza immunization rates is unknown. This research set out to identify which, if any, components of state HCW influenza immunization law or institutional policy have the greatest impact on increasing HCW influenza immunization rates? To determine this, we used hierarchical linear modeling to analyze the relative impact of HCW demographic data (age, gender, race) and the precise components of state law and institutional policy (employee category, law/policy requirement, ease of law/policy opt out, and the penalties for non-compliance. Data analysis revealed that state laws and/or institutional policies that mandate offering immunizations to HCW staff or require education of HCW staff do not increase immunization rates among the intended population. However institutional policies which require influenza immunization and impose sanctions such as termination and/or reassignment yield the highest rates of HCW immunization rates.