Employee influenza vaccination in a large cancer center with high baseline compliance rates: Comparison of carrot versus stick approaches

Abstract

Background Influenza is a major complication in cancer and hematopoietic cell transplant (HCT) recipients. We set out to maximize influenza vaccination rates in healthcare personnel at our large ambulatory cancer center with high baseline compliance and to assess alternatives to mandatory policies. Methods Baseline influenza vaccine compliance rates at our center were over 85%. In 2011 an incentive-based “carrot” campaign was implemented, and in 2012 a penalty-based “stick” approach to declining staff was required. Yearly approaches were compared using Kaplan-Meier survival estimates. Results Both the incentive and penalty approaches significantly improved upon the baseline rates of vaccination (2010 vs. 2011 [p=0.0001]; 2010 vs. 2012 [p<0.0001), but 2012 significantly improved over 2011 (p<0.0001). Staff with direct patient contact had significantly higher rates of vaccination when compared to those with indirect and minimal contact in every campaign year, except in the penalty-driven campaign from 2012 (p<0.001, <0.001, 0.24, and p<0.001, <0.001, 0.17, respectively). Conclusion A multifaceted staff vaccination program that included education, training and active declination was more effective than one offering incentives. Improvements in vaccination rates in the penalty-driven campaign were driven by staff without direct care responsibilities. High compliance with system-wide influenza vaccination was achieved without requiring mandatory vaccination.

Interventions to increase seasonal influenza vaccine coverage in healthcare workers: A systematic review and meta-regression analysis

“…Regarding post-vs pre-pandemic studies, we did not observe statistically significant interaction for any intervention component but the term for "hard" mandates came very close to significance (p D 0.0506); indeed, among the studies assessing "hard" mandates, the 2 that had been conducted before the 2009 H1N1 pandemic 28,56 showed greater effectiveness than those conducted afterwards. 29,42,54,66,67 Finally, in the model that included an intercept and the intervention year, no temporal trend for the effectiveness of the reviewed interventions was identified (yearly change ratio of RR unvacc D 1.00, 95% CI: 0.98-1.03, p D 0.62).…”

“…Publication years ranged from 1992 to 2015. Most studies were BnA without a control group, [27][28][29][30][31][32][33][38][39][40][42][43][44][45][46]48 43,56 Five studies 35,41,54,58,71 evaluated separately more than one intervention on the same population or using the same controls, and 2 studies 27,28 were also performed on the same population. In two studies, 34,42 the same intervention was evaluated in independent populations or settings.…”

“…Seven studies were limited to particular types of HCWs (Table 1). The majority of comparisons examined an intervention with multiple simultaneous components; the exception was "hard" mandates, which were assessed in 8 comparisons (7 studies, all uncontrolled BnA 28,29,42,54,56,66,67 ) with no other simultaneous component. In one study the mandatory policy included termination of employment for unvaccinated workers, but due to reactions this was ultimately put in abeyance 42 ; we considered this intervention as a "hard" mandate nonetheless, in an "intention-totreat" manner.…”

Australasian Society for Infectious Diseases 2015 Conference Report: One Health, One World

“…HCW vaccination is not universal despite moral and ethical obligations. In a study examining incentive versus penalty-based approaches to improving vaccination compliance, a $25 gift card improved vaccination rates by 4% above baseline, compared with 9% when unvaccinated staff were obliged to undergo an online education module, a counseling session and sign a noncompliance declaration [12]. In a separate study, the compulsory use of face masks for unvaccinated staff increased vaccination compliance from 52 to 93%.…”

Infection Prevention in Transplantation

“…Data that providing masks for caregivers, visitors, and healthcare staff that interact closely with patients during respiratory virus season have been described by one center to decrease respiratory viruses in HCT recipients [68]. Influenza vaccination remains an important component of prevention every year and should be addressed through multimodal healthcare vaccine programs for patients, caregivers/ families and healthcare workers [69,70]. The appropriate length of isolation for patients with laboratory proven RVs is debated, as prolonged shedding is a common finding in these patients but viral load thresholds for infectivity are unknown.…”