Mandatory vaccinations are a touchy subject for many healthcare workers who are concerned about maintaining their ability to make personal choices regarding their own healthcare. However, BJC HealthCare in St. Louis achieved an influenza vaccination rate of more than 98 percent for its 26,000 employees after the nonprofit health system made flu shots mandatory in 2008, according to a study published in the journal Clinical Infectious Diseases. BJC's experience mirrors that of Virginia Mason Medical Center in Seattle, which has realized staff immunization rates higher than 95 percent since implementing mandatory flu shots in 2004.
BJC had not been able to achieve its target of 80 percent employee vaccinations during the 10 years the system had offered free flu shots and education programs to employees at its 13 hospitals and other organizations in St. Louis, southern Illinois and mid-Missouri. BJC's employee vaccination rate was 54 percent in 2006 (slightly above the national average for healthcare workers). So in 2007, BJC asked employees who chose not to get a flu shot to sign a statement that they understood the risks of noncompliance--a move that resulted in a vaccination rate of 71 percent.
In 2008, BJC made the flu vaccine mandatory for all employees, including those who have no direct patient contact. However, the mandate did not apply to most physicians affiliated with BJC because they are in private practice or employed by the Washington University School of Medicine.
Workers could request religious or medical exemptions to the mandate, but few employees actually sought them. Human resources reviewed religious exemption requests, and occupational health nurses reviewed medical exemption requests. In total, 25,561 (98.4 percent) of BJC employees received the flu vaccine; 90 employees (.3 percent) received religious exemptions; and 321 (1.2 percent) received medical exemptions. BJC terminated eight employees who were neither vaccinated nor granted an exemption.
The study authors also plan to review compliance for 2009, when BJC required employees to obtain both the seasonal flu vaccine and the H1N1 vaccine.