In 2010, the Society for Healthcare Epidemiology published a recommendation that annual influenza vaccination of healthcare workers be made a condition of employment despite no high-level evidence to support this recommendation. A better strategy for reducing the transmission of respiratory viruses in the healthcare setting would be to encourage vaccination and reduce presenteeism, which is very common among healthcare workers with influenza-like illness. In a hospital with a baseline vaccination compliance of 70%, reducing presenteeism by 2% has the equivalent impact of mandating vaccination in terms of the number of healthcare workers with influenza-like illness at work. Expectations for compliance with interventions to improve the quality of care should be correlated tightly to the underlying evidence to support the intervention, reserving mandates for interventions with very high quality supporting evidence.
Keywords: healthcare workers; infection prevention; influenza vaccine.