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Perceptions and Influence of a Hospital Influenza Vaccination Policy

  • Elizabeth L. Daugherty (a1), Kathleen A. Speck (a2), Cynthia S. Rand (a1) and Trish M. Perl (a2)



Seasonal influenza is a significant cause of morbidity and mortality in the United States each year. Healthcare worker (HCW) influenza vaccination is associated with both decreased absenteeism among employees and improved outcomes among patients. However, HCW influenza vaccine uptake remains suboptimal. The objective of this study was to characterize HCWs' understanding of and response to a stringent vaccination policy.

Design, Setting, and Participants.

A survey of 928 hospital staff at a tertiary academic medical center in Baltimore during the 2008-2009 influenza season.


Of those surveyed, 75% (n = 695) completed the survey; 623 respondents reported regular patient contact, and 91% of those reported vaccination in the current influenza season. However, only 60% reported consistently receiving the vaccine every year. Of those who were vaccinated, 8% (n = 48) reported being vaccinated for the first time during that influenza season. A significant proportion (42%) of respondents were unaware of the major change in hospital policy regarding vaccination. Influences on the decision to be vaccinated varied significantly between those who are regularly vaccinated and those with inconsistent vaccination habits. Attitudes toward hospital policy varied significantly by race and clinical role.


Although 91% of respondents with regular patient contact reported being vaccinated for influenza in the 2008–2009 season, only 60% reported consistent annual vaccination. Misinformation regarding hospital policies is widespread. Improvements in vaccination rates will likely require multifaceted, targeted efforts focused on specific influences on less adherent groups. The identified variability in influences on the decision to be vaccinated suggests possible targets for future interventions.


Corresponding author

Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Fifth Floor, Baltimore, MD 21205 (


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1. Elder, AG, O'Donnell, B, McCruden, EA, et al. Incidence and recall of influenza in a cohort of Glasgow healthcare workers during the 1993-4 epidemic: results of serum testing and questionnaire. BMJ 1996;313(7067):12411242.
2. Stott, DJ, Kerr, G, Carman, WF. Nosocomial transmission of influenza. Occup Med (Lond) 2002;52(5):249253.
3. Talbot, TR, Bradley, SE, Cosgrove, SE, et al. Influenza vaccination of healthcare workers and vaccine allocation for healthcare workers during vaccine shortages. Infect Control Hosp Epidemiol 2005;26(11):882890.
4. Lester, RT, McGeer, A, Tomlinson, G, et al. Use of, effectiveness of, and attitudes regarding influenza vaccine among house staff. Infect Control Hosp Epidemiol 2003;24(11):839844.
5. Horcajada, JP, Pumarola, T, Martinez, JA, et al. A nosocomial outbreak of influenza during a period without influenza epidemic activity. Eur Respir J 2003;21(2):303307.
6. Wilde, JA, McMillan, JA, Serwint, J, et al. Effectiveness of influenza vaccine in health care professionals: a randomized trial. JAMA 1999;281(10):908913.
7. Potter, J, Stott, DJ, Roberts, MA, et al. Influenza vaccination of health care workers in long-term-care hospitals reduces the mortality of elderly patients. J Infect Dis 1997;175(1):16.
8. Carman, WF, Elder, AG, Wallace, LA, et al. Effects of influenza vaccination of health-care workers on mortality of elderly people in long-term care: a randomised controlled trial. Lancet 2000;355(9198):9397.
9. Hayward, AC, Harling, R, Wetten, S, et al. Effectiveness of an influenza vaccine programme for care home staff to prevent death, morbidity, and health service use among residents: cluster randomised controlled trial. BMJ 2006;333(7581):1241.
10. Fiore, AE, Uyeki, TM, Broder, K, et al. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010. MMWR Recomm Rep 2010;59(RR-8):162.
11. Heimberger, T, Chang, HG, Shaikh, M, et al. Knowledge and attitudes of healthcare workers about influenza: why are they not getting vaccinated? Infect Control Hosp Epidemiol 1995;16(7): 412415.
12. Martinello, RA, Jones, L, Topai, JE. Correlation between healthcare workers' knowledge of influenza vaccine and vaccine receipt. Infect Control Hosp Epidemiol 2003;24(11):845847.
13. Nichol, KL, Hauge, M. Influenza vaccination of healthcare workers. Infect Control Hosp Epidemiol 1997;18(3):189194.
14. Steiner, M, Vermeulen, LC, Mullahy, J, et al. Factors influencing decisions regarding influenza vaccination and treatment: a survey of healthcare workers. Infect Control Hosp Epidemiol 2002;23(10):625627.
15. Weingarten, S, Riedinger, M, Bolton, LB, et al. Barriers to influenza vaccine acceptance: a survey of physicians and nurses. Am J Infect Control 1989;17(4):202207.
16. Lugo, NR. Will carrots or sticks raise influenza immunization rates of health care personnel? Am J Infect Control 2007;35(1):16.
17. Bryant, KA, Stover, B, Cain, L, et al. Improving influenza immunization rates among healthcare workers caring for high-risk pediatric patients. Infect Control Hosp Epidemiol 2004;25(11): 912917.
18. Harbarth, S, Siegrist, CA, Schira, JC, et al. Influenza immunization: improving compliance of healthcare workers. Infect Control Hosp Epidemiol 1998;19(5):337342.
19. Babcock, HM, Gemeinhart, N, Jones, M, et al. Mandatory influenza vaccination of health care workers: translating policy to practice. Clin Infect Dis 2010;50(4):459464.
20. Rakita, RM, Hagar, BA, Crome, P, et al. Mandatory influenza vaccination of healthcare workers: a 5-year study. Infect Control Hosp Epidemiol 2010;31(9):881888.
21. Walker, FJ, Singleton, JA, Lu, P, et al. Influenza vaccination of healthcare workers in the United States, 1989-2002. Infect Control Hosp Epidemiol 2006;27(3):257265.
22. King, WD, Woolhandler, SJ, Brown, AF, et al. Brief report: influenza vaccination and health care workers in the United States. J Gen Intern Med 2006;21(2):181184.
23. Nowalk, MP, Lin, CJ, Zimmerman, RK, et al. Self-reported influenza vaccination rates among health care workers in a large health system. Am J Infect Control 2008;36(8):574581.
24. Boulware, LE, Cooper, LA, Ratner, LE, et al. Race and trust in the health care system. Public Health Rep 2003;118(4):358365.
25. Corbie-Smith, G, Thomas, SB, Williams, MV, et al. Attitudes and beliefs of African Americans toward participation in medical research. J Gen Intern Med 1999;14(9):537546.
26. Nelson, K, Geiger, AM, Mangione, CM. Effect of health beliefs on delays in care for abnormal cervical cytology in a multiethnic population. J Gen Intern Med 2002;17(9):709716.
27. Ang, DC, Monahan, PO, Cronan, TA. Understanding ethnic disparities in the use of total joint arthroplasty: application of the health belief model. Arthritis Rheum 2008;59(1):102108.
28. Wu, TY, West, B, Chen, YW, et al. Health beliefs and practices related to breast cancer screening in Filipino, Chinese and Asian-Indian women. Cancer Detect Prev 2006;30(1):5866.
29. Daugherty, EL, Perl, TM, Needham, DM, et al. The use of personal protective equipment for control of influenza among critical care clinicians: a survey study. Crit Care Med 2009;37(4):12101216.
30. Daugherty, EL, Perl, TM, Rubinson, L, et al. Survey study of the knowledge, attitudes, and expected behaviors of critical care clinicians regarding an influenza pandemic. Infect Control Hosp Epidemiol 2009;30(12): 11431149.

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Perceptions and Influence of a Hospital Influenza Vaccination Policy

  • Elizabeth L. Daugherty (a1), Kathleen A. Speck (a2), Cynthia S. Rand (a1) and Trish M. Perl (a2)


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