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Médecine du travail du personnel hospitalier

Carrots and sticks: achieving high healthcare personnel influenza vaccination rates without a mandate

Auteur       Marci Drees
Auteur       Kathleen Wroten
Auteur       Mary Smedley
Auteur       Tabe Mase
Auteur       J. Sanford Schwartz
Volume       36
Numéro       6
Pages       717-724
Publication       Infection Control and Hospital Epidemiology
ISSN       1559-6834
Date       Jun 2015
Résumé       OBJECTIVE: Achieving high healthcare personnel (HCP) influenza vaccination rates has typically required mandating vaccination, which is often challenging to implement. Our objective was to achieve >90% employee influenza vaccination without a mandate. DESIGN: Prospective quality improvement initiative SETTING AND PARTICIPANTS: All employees of a 2-hospital, 1,100-bed, community-based academic healthcare system. METHODS: The multimodal HCP vaccination campaign consisted of a mandatory declination policy, mask-wearing for non-vaccinated HCP, highly visible « I’m vaccinated » hanging badges, improved vaccination tracking, weekly compliance reports to managers and vice presidents, disciplinary measures for noncompliant HCP, vaccination stations at facility entrances, and inclusion of a target employee vaccination rate (>75%) metric in the annual employee bonus program. The campaign was implemented in the 2011-2012 influenza season and continued throughout the 2012-2013 through 2014-2015 influenza seasons. Employee compliance, vaccination, exemption and declination rates were calculated and compared with those of the seasons prior to the intervention. RESULTS: Compared with vaccination rates of 57%-72% in the 3 years preceding the intervention, employee influenza vaccination increased to 92% in year 1 and 93% in years 2-4 (P<.001). The proportion of employees declaring medical/religious exemptions or declining vaccination decreased during the 4 years of the program (respectively, 1.2% to 0.5%, P<.001; 4.4% to 3.8%, P=.001). CONCLUSIONS: An integrated multimodal approach incorporating peer pressure, accountability, and financial incentives was associated with increased employee vaccination rate from ≤72% to ≥92%, which has been sustained for 4 influenza seasons. Such programs may provide a model for behavioral change within healthcare organizations.

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doi:10.1017/ice.2015.47

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