Using the Intranet To Document Healthcare Worker (HCW) Declination and Participation in a Mandatory Influenza Vaccination Program

Abstract

ISSUE: The Advisory Committee on Immunization Practices (ACIP) and the Healthcare Infection Control Practices Advisory Committee (HICPAC) emphasize HCW vaccination against influenza to prevent disease and transmission to patients. Despite education, incentives and easy access to vaccine our influenza vaccine coverage rate for nearly 20,000 HCWs was 38% in 2004. Because mandatory vaccination was met with resistance due to the perception of coercion, we opted for a strategy of mandatory participation with documentation of declination using the intranet as a tool. PROJECT: To establish an intranet web site where employees were required to document participation, declination or vaccination. The site was accessible on all computers and work stations. Employees logged on using their identification number and selected vaccine received, vaccine contraindicated or vaccine declined. Declining employees automatically received education about vaccination. A Microsoft ® Structured Query Language database was created and linked to a Human Resource database. Administrators were provided feedback on participation rates. The site provided information about where to obtain vaccine, and a place to ask questions linked by e-mail to an Infection Control Practitioner for prompt response. Employees were notified of the program via letter. Reminders were provided through managers and newsletters. Vaccination rates were not provided to managers or administrators. The site was activated October 17, 2005. RESULTS: As of December 1, 2005, 79% of employees (16,138 / 20,361) participated by accessing the intranet: 50% (10,291) indicated vaccine received; 25.9% (5269) declined; 2.8% (578) declined based on contraindications. Self-reported vaccination included 50% of the Division of Medicine and 45% of the Division of Nursing. Declination was 21% and 30% respectively. Departmental data is available for all patient care locations. There were few complaints as employees understood vaccination data was confidential. LESSONS LEARNED: The intranet provided an inexpensive tool for measuring and timely reporting of HCW participation, declination and vaccination rates. Data management was accomplished without significant expense and cumbersome paperwork. The site provided education to large numbers of employees which may have influenced the increase in the vaccination rate. Real time monitoring by location or occupation allows for targeting interventions where rates are low. Detailed departmental data allows for planning future targeted educational programs. The same tool can be used to document other programs such as fit-testing and TB screening.