For more than three decades, the Centers for Disease Control and Prevention has recommended influenza vaccination for healthcare workers (HCWs), on the basis of HCWs’ duty to “do no harm,” frequency of exposure to influenza virus, close contact with vulnerable hospitalized patients, and possible absenteeism during influenza season, as well as presymptomatic infectivity and the respiratory infection route. Yet fewer than two-thirds (63.5%) of HCWs were vaccinated in 2010–2011. Traditional evidence-based interventions to increase influenza vaccination rates have achieved limited success, whereas vaccination mandates, either by hospital policy or state law, have shown the most promise for reaching HCW coverage goals of 90 percent or more. This study used hierarchical linear modeling (HLM) to determine the relative impact of these factors while accounting for the clustering of hospitals within states.
HCW influenza vaccination rates were significantly related to mandated vaccination with (1) termination for noncompliance and (2) declination or noncompliance that results in consequences other than termination (eg, masking, reassignment), as well as to state racial distribution. The estimated impact of a hospital mandate with termination for noncompliance was an increase in vaccination rates of 12.8 percentage points, while a mandate with consequences other than termination was 11.5 percentage points. In addition, HCW influenza vaccination rate increased 1 percent for each 0.31 percent increase in the number of white persons in the state.