Flu-shot mandate nets 98% vaccination rate in Mo. health system

A St. Louis-area health system achieved 98% influenza immunization among its 26,000-plus employees after making the vaccine mandatory in 2008.

The results at BJC HealthCare were documented in a Feb. 15 study in the journal Clinical Infectious Diseases.

The system already had seen its vaccination rate improve from 54% to 71% in 2007 with a policy requiring its employed doctors, nurses, other health professionals and employees to get immunized or sign a statement declining the shot.

Nationally, the flu-shot rate among health care workers has hovered at just below 45%, according to the Centers for Disease Control and Prevention. But BJC officials were eager to push the immunization rate up higher and faster and opted for a mandate, said Hilary M. Babcock, MD, MPH, lead author of the study (link).

"Our goal is not to put all of our time and effort into getting declination statements," said Dr. Babcock, medical director of occupational health and infectious diseases at BJC's teaching hospitals, Barnes-Jewish Hospital and St. Louis Children's Hospital. "What we are really aiming for is to get people vaccinated. That's what we decided we should put the emphasis on."

Workers -- including doctors, though most BJC physicians are not employees -- were required to get vaccinated unless they qualified for a medical or religious exemption. Eight employees, none of whom was a physician, did not comply with the policy and were fired.

The Virginia Mason Medical Center in Washington state implemented a flu-shot mandate in 2004 and has achieved immunization rates exceeding 95% since then. The BJC experience shows that a mandatory approach also can work in a multi-site health system, Dr. Babcock said. The nonprofit BJC has 11 acute care hospitals and three extended care facilities, as well as employed physician groups and occupational medicine, behavioral health and home care services.

"Whenever you talk about an initiative such as this, everyone gets really worried that it gets really big and it's hard to coordinate one policy across multiple facilities and different places with different implementation strategies," said Dr. Babcock, who is also an assistant professor of medicine in the infectious diseases division at the Washington University School of Medicine in St. Louis. "We wanted to share our experience that [the mandate] was very successful on this scale."

Protecting patients from contracting the flu in medical settings justifies mandatory health worker immunization, according to the American College of Physicians, the Assn. for Professionals in Infection Control and Epidemiology, the National Patient Safety Foundation, and the Infectious Diseases Society of America, which publishes the Clinical Infectious Diseases journal.

In November 2009, the American Medical Association House of Delegates directed the Association to study the ethical and scientific merits of mandating influenza immunization for health professionals.