Background: Influenza remains a significant contributor to morbidity and mortality in the United States. Health care workers (HCW) can be both victims and vectors of influenza. Influenza vaccination of HCW is protective for both caregivers and patients, but voluntary programs generally fail to achieve rates recommended by the Centers for Disease Control and Prevention. Despite a complex, multifaceted influenza program initiated in 1996 that included significant education and promotion as well as free on-site vaccination, annual Aurora Health Care caregiver immunization rates remained in the mid-70s until adoption of a “condition of employment” strategy in 2011.

Purpose: Discuss the annual effectiveness of the program at achieving caregiver vaccination.

Methods: A steering committee and subgroups meet regularly to evaluate exemption requests, vaccine supply/distribution/ordering, immunization rates and general program overview. In July 2016, an online wellness survey of influenza program perceptions was offered to all Aurora caregivers.

Results: In the 2016–2017 flu season, 97.3% of HCW were vaccinated. New medical exemption requests have varied from 72 to 127 per year, with a decreasing trend again reflecting the prevalence of permanent exemption. The number of approved annual religious exemptions grew from 39 in 2011 to 64 in 2016– 2017. Since the initial year of implementation, when resignation of 11 HCW was attributed to the vaccination requirement, the number of such resignations has dwindled to 2. Caregiver perceptions: 1,931 caregivers completed the online survey (approximately 6.4% of all employees). A 5-point Likert scale was used to assess level of agreement with several statements. Caregivers expressed the highest level of agreement with the statement that “the program makes it convenient to get vaccinated” (89% agree or strongly agree) and the lowest level agreement with “the program keeps me healthier” (54% agree or strongly agree).

Conclusion: An influenza program as a condition of employment leads to high levels of immunization of HCW, with minimal impact on HCW retention and satisfactory satisfaction among HCW.