Face-mask mandate improved flu vaccination rates among HCWs

Esolen LM. Infect Control Hosp Epidemiol. 2011;32:703-705.

Issue: July 2011

The implementation of an influenza vaccination campaign that included a face-mask mandate for all unvaccinated health care workers led to 95% vaccination compliance at Geisinger Medical Centers during 2009, according to findings published in Infection Control and Hospital Epidemiology.

“Establishing a tough and enforceable requirement that any unvaccinated individuals wear a mask for the entire flu season not only produced the vaccination compliance rates we wanted, but avoided unnecessary legal challenges and inspired an amazing amount of team spirit,” Lisa M. Esolen, MD,of Geisinger Health System, told Infectious Disease News. “The folks involved with our flu campaign felt a part of our success story rather than simply a part of mandating vaccination.”

Lisa M. Esolen, MD

As logistical issues regarding the implementation of health care worker (HCW) vaccination programs have stalled such programs, Esolen and colleagues at Geisinger Health System implemented a face-masking requirement during the 2009-2010 influenza vaccination campaign to improve vaccination rates among HCWs.

The analysis included 12,363 HCWs employed at Geisinger Health System throughout Pennsylvania, including Geisinger Medical Center, the main campus, one of two major teaching hospitals, 41 ambulatory care centers, 24 hospital-operated practice sites and three ambulatory surgery centers.

The researchers implemented the masking policy based upon:

Transparency: An electronic template segregating each department and listing department employees was designed, and access was granted to all managers. Adjacent to the employee name was the date of vaccination, whereas non-vaccination resulted in a blank box. Also, placing a “star” sticker on the employee badge when vaccinated provided general awareness of who received the vaccine and, consequently, who did or did not need to mask.
Significant duration: This policy was intended to be protective; therefore, the researchers did not minimize the duration and considered the influenza season and masking requirement as extending from Nov. 1 to March 31.
Clarity: Unvaccinated employees were instructed to place a surgical mask around their neck at the start of every shift and lift it over their face when within 6 feet of a patient. A new mask was needed each shift or whenever it became moistened, soiled or torn.
Accountability: Managers were held accountable for enforcement. Recurrent, noncompliant HCWs were referred to human resources for progressive discipline.

A vaccination process was also implemented that included: Increased vaccination hours; vaccination stations at HCW entrances and outside the cafeteria; and recruiting 150 “flu team captains” to decentralize vaccine supplies with kits containing vaccine, supplies, consent forms and stickers. Vaccinated HCWs were exempt from the masking policy and were identified by two star stickers on their identification badge.

Compared with vaccination compliance rates of 47% in 2007 and 61% in 2008, HCW vaccination compliance rates were 95% for all Geisinger Medical Center employees during 2009 and 92% during 2010.

More than 92% of vaccinations were administered by Nov. 1, 2009; and 97% of all vaccinations were administered for the 2009-2010 season by Dec. 1, 2010, according to the researchers.

“Changing our health care culture to one of safety is a major focus when discussing quality care,” the researchers wrote. “But is culture best changed by mandate? A process that requires the final acquiescence of our HCWs, that still inspires abounding team spirit and peer pressure, and that acknowledges all employees in the accomplishment could have unique value.” – by Ashley DeNyse

Disclosure: The researchers report no relevant financial disclosures.

Follow InfectiousDiseaseNews.com on Twitter.