Mandatory seasonal influenza vaccination or masking of British Columbia health care workers: Year 1.

OBJECTIVE

The Influenza Prevention Policy ("the Policy") aims to increase seasonal influenza vaccination coverage among British Columbia (BC) health care workers (HCWs).

PARTICIPANTS

HCWs who work in publicly funded facilities and attend patient care areas.

SETTING

The Policy was announced in August 2012 and took effect province-wide during the 2012/13 flu season.

INTERVENTION

BC HCWs are required to receive seasonal influenza vaccination by the start of the flu season (December 1) or wear a mask while at work until the flu season ends (March 30). Vaccinated HCWs need to wear a green dot on their identification tag. HCWs are expected to report noncompliant coworkers. As initially proposed, continued noncompliance with the Policy could result in termination of employment (ultimately this component was put in abeyance).

OUTCOME

For the 2012/13 flu season, 74% of HCWs (35,889/48,818) at acute care facilities received influenza vaccination compared with 40% (23,375/58,212) in 2011/12 (difference in proportion=0.33, 95% confidence interval [CI]: 0.33-0.34, p<0.001). Similarly, staff vaccination rates at residential care facilities increased from 57% (21,535/37,700) for the 2011/12 flu season to 75% (27,617/36,620) in 2012/13 (difference in proportion=0.18, 95% CI: 0.18-0.19, p<0.001). Health care unions claimed that the Policy was coercive, and they launched an unsuccessful grievance with the BC Labour Relations Board.

CONCLUSION

Implementation of the Policy was associated with increased HCW vaccination; the Policy was upheld by an independent arbitrator. Further research is required to correlate HCW vaccination coverage rates with changes in influenza incidence and its complications. Continued stakeholder engagement is vital to achieve a collaborative decision-making process.