In the season 2013-2014, a campaign to promote influenza vaccination among health care workers (HCWs) was conducted in two Italian hospitals, based on an educational toolkit and attitude and compliance towards vaccination were investigated. Overall, 36% of the HCWs get vaccinated almost once, 2.3% in 2013-14 season for the first time, 57% never, 7% do not know or not remember. The main reason for vaccination was reportedly to avoid taking sick-leave (29.7%); while refusal was guided by the low risk-perception associated with influenza (38.5%). Interventions based only on education and communication seem not to be sufficient; an integrated approach with multiple components is needed to achieve higher coverage rates and to ensure a successful vaccination campaign.