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Policies and Practices for Improving Influenza Immunization Rates Among Healthcare Workers

  • Adam O. Goldstein (a1), Jean E. Kincade (a2), George Gamble (a1) and Rachel S. Bearman (a1)



To determine the attitudes, policies, and barriers for requiring annual versus voluntary influenza vaccinations for the staff of healthcare institutions in North Carolina.


Five different types of institutions serving at-risk elderly populations throughout North Carolina were chosen for study, including hospitals, home health agencies, nursing homes, dialysis centers, and assisted living facilities. Infection control managers completed a 45-question telephone survey on policies for annual influenza vaccinations for employees, incentives to encourage immunizations, support for mandatory influenza vaccinations for workers, barriers to employee vaccinations, and support for a state law to mandate influenza immunizations for employees with patient care contact.


Of 312 institutions, 268 (86%) participated in the study. Only 38% of institutions reported having formal written employee influenza vaccination policies, and only 2% actually mandated annual employee vaccinations. Reported barriers to increasing healthcare worker annual influenza vaccinations included “fear of side effects” and “perceived ineffectiveness of the flu vaccine.” Almost half of the respondents would support mandating influenza vaccinations for all healthcare workers with direct patient contact.


A state-wide survey of the receptivity, policies, and implications of mandated employee influenza vaccinations among healthcare institutions serving the elderly in North Carolina found written policies uncommon and most of the mechanisms used to increase vaccinations voluntary. Efforts should be tailored to individuals, institutions, and healthcare systems to dramatically increase employee immunization rates.


Corresponding author

Department of Family Medicine, University of North Carolina at Chapel Hill School of Medicine, CB 7595, Chapel Hill, NC 27514


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