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Worksite: Seasonal Influenza Vaccinations Using Interventions with On-Site, Free, Actively Promoted Vaccinations – Healthcare Workers


What the CPSTF Found

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 45 studies (search period through March 2008). The review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to worksite health promotion.


On-site, free, and actively promoted influenza vaccination interventions provide access to vaccinations for workers at the healthcare facility in which recipients normally work and at no cost to the workers. They announce vaccination availability through formal worksite announcements, such as in newsletters, e-mails, or paycheck inserts. By providing the vaccination at the worksite, employers reduce the temporal, geographic, and financial barriers that can prevent a worker from getting vaccinated.

Summary of Results

Forty-five studies qualified for the review and examined changes in vaccination coverage, changes in influenza cases, or worker productivity.

  • Change in vaccination coverage: median increase of 21.0 percentage points (interquartile interval: 11 to 34 percentage points; 41 studies)
  • Change in influenza cases:
    • Among patients: median relative decrease of 11.3% (3 studies)
    • Nosocomial infections (acquired during visits to hospitals or other healthcare settings): median relative decrease of 78.0% (4 studies)
  • Change in worker productivity was not reported in the qualifying studies.

Summary of Economic Evidence

Three studies were included in the economic review, one each from the U.S., Canada, and U.K. The small body of evidence indicates cost-savings but a firm conclusion cannot be reached. Monetary values are reported in 2007 U.S dollars.

  • The U.S study indicated substantial savings for a hospital where nosocomial influenza infections declined from six to one following the campaign. In this study, the cost to treat one infection was estimated at $7,000. Net benefit could not be calculated because the cost of intervention was not reported.
  • A net benefit of $58 to $65 per vaccinated employee was reported in a study conducted in a Canadian hospital. Benefits were based on productivity gains alone and did not consider nosocomial infections.
  • The U.K study reported a cost of $692 per life year saved for a program that vaccinated staff responsible for the care of high-risk patients. The program was cost-saving when the estimate included averted work absences due to influenza.


Results from the review are applicable to workers in medium and large hospitals and long-term care facilities, including nurses and physicians.

Evidence Gaps

CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

The following outlines evidence gaps for these interventions to promote seasonal influenza vaccinations among healthcare workers: on-site, free, actively promoted vaccinations; and actively promoted off-site vaccinations.

Although the body of evidence is strong, the field would benefit from research into the following questions:

  • How do the observed successes in large hospitals and long-term care facilities translate to coalitions of smaller healthcare facilities that may share health promotion resources or family practice clinics that operate on their own?
  • In what ways do current interventions with on-site, no-cost, actively promoted influenza vaccinations create, add to, reduce, or eliminate disparities among sub-groups of HCP?
  • What additional barriers should implementers address to achieve influenza vaccination coverage of greater than 90% among HCP?

Finally, as was shown in the review for general worksites, the overall body of knowledge for off-site, promoted interventions is weak. With only one study with small and non-significant effect measure, in spite of the study’s use of rigorous methods, in the body of literature that analyzed this approach, we were unable to conclude on its effectiveness.

Study Characteristics

  • All 45 studies evaluated interventions with free, on-site, actively promoted influenza vaccinations alone and when combined with additional interventions including provision of information, efforts to enhance access, activities to change attitudes and norms, and policy changes.
  • Studies evaluated interventions conducted in medium and large hospitals, and in long-term care facilities.
  • Studies were conducted mostly in the United States, Europe, and Canada; however, the body of evidence included studies from Singapore, Brazil, South Korea, and Australia.