Mandatory employee vaccination policy with termination for non-compliance increases vaccine coverage in a large, not-for-profit health system

Background: Vaccination of healthcare personnel (HCP) protects both the employee and vulnerable patients from vaccine-preventable diseases (VPD). Various implementation strategies have been tried. The positive effect of mandatory influenza vaccination of HCP has been described. However, the effect of mandatory employee vaccination policies on vaccines other than seasonal influenza is not well studied.

Methods: Intermountain Healthcare is a large, not-for-profit health system based in Salt Lake City, Utah, which includes 22 hospitals and over 32,000 employees. Due to suboptimal HCP vaccination rates, Intermountain implemented a new policy for all employees beginning on January 1, 2010 that required either update of vaccination status or signing a waiver. Required vaccinations included seasonal influenza, MMR, Tdap, varicella, and Hepatitis B. Despite high compliance with the policy, actual vaccination rates remained below goal. In response, a system-wide mandatory policy of immunization or documentation of immunity (using ACIP recommendations) was implemented on August 1, 2011. Medical and religious exemptions were allowed, but required approval. Non-compliance resulted in termination of employment. We retrospectively reviewed employee vaccination rates from 2007-2011. We developed Poisson-regression models to assess for a change in immunization rates across the study periods. 

Results: In 2011, 32,092 of 32,483 (99%) received influenza vaccination, increased from 75-86% in prior years (p<0.01). Compliance rates for other VPDs are shown in the figure. Only 283 (<1%) employees received exemptions: 211/253 (83%) medical exemptions and 72/86 (87%) religious exemptions were granted. Twelve employees were terminated due to noncompliance, and 23 retired or left.

Conclusion: A mandatory employee vaccination or documented immunity policy with termination for noncompliance successfully increased coverage rates within a large, not-for-profit healthcare system spanning a large geographic area when aggressive voluntary measures failed. Seasonal influenza vaccination rates increased to 99%, and vaccination rates of other required vaccines increased as well. Employee termination was rare.