400. Outcomes of “Carrot-vs.-Stick” Approaches to Employee Influenza Vaccination in a Large Cancer Center with High Baseline Compliance Rates
Session: Poster Abstract Session: Occupational Health
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C

Background:   During respiratory virus season, influenza is a major cause of morbidity and mortality in cancer and transplant patients.  Since outbreaks have been linked to healthcare workers, efforts to improve vaccine penetrance are critical to influenza prevention.  However, best practices for improving vaccination rates in healthcare organizations with high baseline compliance are not known.

Methods:   Influenza vaccine compliance at the Seattle Cancer Care Alliance in Seattle, WA was over 80% from 2007-2010.  Strategies during these years included education, mobile vaccine carts, and a passive declination form.  In 2011, in addition to these practices, a shortened 8 week campaign was planned with individual incentives for achieving a high-level of compliance center-wide (“carrot”).  In 2012, in contrast, declining staff were required to complete an online training module, a post-test and provide informed declination one on one with occupational health staff within 6 weeks (”stick”).  Kaplan-Meier survival estimates of the first 60 days after the start of each vaccination campaign were used to compare 2010-2012 seasons.

Results:  All health center staff were eligible to receive influenza vaccine between 2010-2012. The percentage of employees that did and did not provide direct patient care were similar between seasons (p=0.20).  Overall there was a significant difference in the percentage of staff vaccinated by year: 88% (1170/1327) in 2010, 92% (1382/1495) in 2011, and 96% (1599/1657) in 2012 (p<0.001), but when considering only staff providing direct patient care, rates were similar between strategies (p=0.51).  Survival estimates showed significant differences in vaccine acceptance among the three approaches (global log-rank p<.0001; Figure 1). Both new approaches improved upon baseline rates (2010 vs. 2011 [p=0.0001]; 2010 vs. 2012 [p<.0001), but the 2012 (stick) strategy was significantly better than 2011 (carrot) (p<.0001).  Over 50% of employees were vaccinated in the first two weeks of each campaign, consistent with a high level of baseline compliance.

Conclusion: In a center with high background seasonal influenza vaccine compliance, a multifaceted staff vaccination program that included active informed declination was significantly more effective than one offering individual incentives.


Zach Stednick, MPH1, Sara Podczervinski, RN, MPH2, Lois Helbert, RN2, Judith Davies, MN, RN, COHN-S1, Barbara Jagels, RN, MHA, CPHQ2, Ted Gooley, PhD1, Corey Casper, MD, MPH, FIDSA1,2,3 and Steven Pergam, MD, MPH1,2,3, (1)Fred Hutchinson Cancer Research Center, Seattle, WA, (2)Seattle Cancer Care Alliance, Seattle, WA, (3)Department of Medicine, University of Washington, Seattle, WA


Z. Stednick, None

S. Podczervinski, None

L. Helbert, None

J. Davies, None

B. Jagels, None

T. Gooley, None

C. Casper, None

S. Pergam, None

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