1
|
Influence of critically appraising exemption requests from healthcare personnel along a spectrum of influenza vaccine hesitancy. Infect Control Hosp Epidemiol 2022; 43:1672-1678. [DOI: 10.1017/ice.2021.513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Objectives:
This study was performed to assess whether an intervention for critically appraising influenza vaccine exemption requests from healthcare personnel (HCP) affected (1) the overall rate of influenza vaccine exemption within a healthcare institution and/or (2) the rates of postintervention vaccine acceptance among those who inconsistently request exemption from annual vaccination and those who consistently request exemption from vaccination.
Design:
Retrospective, before-and-after intervention study.
Setting:
We conducted the study at a single academic medical center.
Participants:
This study included 29,663 HCP.
Methods:
Between 2010 and 2019, HCP were permitted to request an exemption from influenza vaccination without critical appraisal of exemption requests. After January 2019, medical center policy required critical appraisal of exemption requests. Of those employed 3 or more years who requested an exemption at least once during the preintervention period (n = 1,177), those with unchanging exemption reasons annually were termed “consistent exempters.” Those who changed reasons or accepted vaccination n ≥ 1 times were termed “inconsistent exempters.”
Results:
The overall exemption rate from influenza vaccine decreased from 3.8% to 1.2% (P < .001; N = 29,663) after the intervention. Of those requesting exemption at least once before the intervention, 329 (28.0%) of 1,177 were consistent exempters and 878 (72.0%) were inconsistent exempters. Of inconsistent exempters employed after the intervention, 442 (88.9%) of 497 accepted vaccine postintervention compared with 118 (59.6%) of 198 consistent exempters (P < .001). Of all exempters who changed from exemption to acceptance after the intervention, 442 (78.9%) of 560 were inconsistent exempters.
Conclusions:
Critical appraisal of HCP exemption requests promotes influenza vaccine acceptance, and acceptance by inconsistent exempters drives the effect of the intervention. Analysis of changes in annual exemption requests represents a novel objective method for describing those on the spectrum of vaccine hesitancy.
Collapse
|
2
|
Gualano MR, Corradi A, Voglino G, Catozzi D, Olivero E, Corezzi M, Bert F, Siliquini R. Healthcare Workers' (HCWs) attitudes towards mandatory influenza vaccination: A systematic review and meta-analysis. Vaccine 2021; 39:901-914. [PMID: 33451776 DOI: 10.1016/j.vaccine.2020.12.061] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/15/2020] [Accepted: 12/20/2020] [Indexed: 02/08/2023]
Abstract
Influenza is a disease responsible for thousands of deaths every year. Although healthcare workers (HCWs) represent a way of contagion for patients, vaccination coverage among them is low. Mandatory vaccination has been proposed, but controversies remain. This systematic review and meta-analysis aimed to assess the acceptance of mandatory vaccination by HCWs, and to investigate associated characteristics. MEDLINE, Scopus, Embase, PsycInfo, CINAHL and Web of Science were used to search for studies assessing the topic. PRISMA statements were followed. Of the 13,457 univocal records found, 52 studies were included in the systematic review and 40 in the meta-analysis. The pooled proportion of HCWs accepting the policy was of 61% (95% CI: 53%- 68%) but with great heterogeneity between continents (from 54% in Europe to 69% in Asia) and in different professionals (from 40% in nurses to 80% in students). Vaccinated HCWs agreed more frequently with mandatory vaccination than non-vaccinated ones. More studies that consider mandatory vaccination acceptance as the main outcome are needed, but the results of this study confirm that in some settings the majority of HCWs favour mandatory vaccination. This, combined with effects that a flu epidemic could have if overlapped to pandemics with similar symptoms, requires renewed considerations on mandatory vaccination.
Collapse
Affiliation(s)
- Maria Rosaria Gualano
- Department of Public Health and Paediatric Sciences, University of Turin, Torino, Italy
| | - Alessio Corradi
- Department of Public Health and Paediatric Sciences, University of Turin, Torino, Italy
| | - Gianluca Voglino
- Department of Public Health and Paediatric Sciences, University of Turin, Torino, Italy.
| | - Dario Catozzi
- Department of Public Health and Paediatric Sciences, University of Turin, Torino, Italy
| | - Elena Olivero
- Department of Public Health and Paediatric Sciences, University of Turin, Torino, Italy
| | - Michele Corezzi
- Department of Public Health and Paediatric Sciences, University of Turin, Torino, Italy
| | - Fabrizio Bert
- Department of Public Health and Paediatric Sciences, University of Turin, Torino, Italy; AOU City of Health and Science of Turin, Turin, Italy
| | - Roberta Siliquini
- Department of Public Health and Paediatric Sciences, University of Turin, Torino, Italy; AOU City of Health and Science of Turin, Turin, Italy
| |
Collapse
|
3
|
Godinot LD, Sicsic J, Lachatre M, Bouvet E, Abiteboul D, Rouveix E, Pellissier G, Raude J, Mueller JE. Quantifying preferences around vaccination against frequent, mild disease with risk for vulnerable persons: A discrete choice experiment among French hospital health care workers. Vaccine 2021; 39:805-814. [PMID: 33419603 DOI: 10.1016/j.vaccine.2020.12.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
The individual determinants of vaccine acceptance among health workers (HCWs) have been described in the literature, but there is little evidence regarding the impact of vaccine characteristics and contextual factors (e.g., incentives, communication) on vaccination intentions. We developed a single profile discrete choice experiment (DCE) to assess the impact of seven attributes on stated vaccination intention against an unnamed disease, described as frequent with rapid clinical evolution and epidemic potential (similar to influenza or pertussis). Attributes evaluated vaccine characteristics (effectiveness, security profile), inter-individual aspects (epidemic risk, controversy, potential for indirect protection, vaccine coverage) and incentives (e.g., badge, hierarchical injunction). A total of 1214 French hospital-based HCWs, recruited through professional organizations, completed the online DCE questionnaire. The relative impact of each attribute was estimated using random effects logit models on the whole sample and among specific subgroups. Overall, 52% of included HCWs were vaccinated against influenza during 2017-18 and the average vaccination acceptance rate across all scenarios was 58%. Aside from the management stance, all attributes' levels had significant impact on vaccination decisions. Poor vaccine safety had the most detrimental impact on stated acceptance (OR 0.04 for the level controversy around vaccine safety). The most motivating factor was protection of family (OR 2.41) and contribution to disease control (OR 2.34). Other motivating factors included improved vaccine effectiveness (OR 2.22), high uptake among colleagues (OR 1.89) and epidemic risk declared by health authorities (OR 1.76). Social incentives (e.g., a badge I'm vaccinated) were dissuasive (OR 0.47). Compared to HCWs previously vaccinated against influenza, unvaccinated HCWs who were favorable to vaccination in general were most sensitive towards improved vaccine effectiveness. Our study suggests that vaccine safety considerations dominate vaccine decision-making among French HCWs, while adapted communication on indirect protection and social conformism can contribute to increase vaccination acceptance.
Collapse
Affiliation(s)
| | | | - Marie Lachatre
- Research Group for the Prevention of Occupational Infections in Healthcare Workers (GERES), Paris, France; Centre d'Investigation Clinique Cochin Pasteur CIC 1417, Hôpital Cochin, AP-HP, Paris, France
| | - Elisabeth Bouvet
- Research Group for the Prevention of Occupational Infections in Healthcare Workers (GERES), Paris, France; Haute autorité de santé (HAS), Commission technique des vaccinations (CTV), La Plaine Saint Denis, France
| | - Dominique Abiteboul
- Research Group for the Prevention of Occupational Infections in Healthcare Workers (GERES), Paris, France
| | - Elisabeth Rouveix
- Research Group for the Prevention of Occupational Infections in Healthcare Workers (GERES), Paris, France; CHU Ambroise Paré, Assistance Publique Hôpitaux de Paris (APHP,) Université Paris Saclay, France
| | - Gérard Pellissier
- Research Group for the Prevention of Occupational Infections in Healthcare Workers (GERES), Paris, France
| | - Jocelyn Raude
- EHESP French School of Public Health, Paris and Rennes, France; Unité des Virus Émergents (UVE: Aix-Marseille Univ - IRD 190 - Inserm 1207 - IHU Méditerranée Infection), Marseille, France
| | - Judith E Mueller
- EHESP French School of Public Health, Paris and Rennes, France; Institut Pasteur, Paris, France
| |
Collapse
|
4
|
Lazarus JV, Ratzan SC, Palayew A, Gostin LO, Larson HJ, Rabin K, Kimball S, El-Mohandes A. A global survey of potential acceptance of a COVID-19 vaccine. Nat Med 2020; 27:225-228. [PMID: 33082575 PMCID: PMC7573523 DOI: 10.1038/s41591-020-1124-9] [Citation(s) in RCA: 1573] [Impact Index Per Article: 393.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/08/2020] [Indexed: 12/02/2022]
Abstract
Several coronavirus disease 2019 (COVID-19) vaccines are currently in human trials. In June 2020, we surveyed 13,426 people in 19 countries to determine potential acceptance rates and factors influencing acceptance of a COVID-19 vaccine. Of these, 71.5% of participants reported that they would be very or somewhat likely to take a COVID-19 vaccine, and 48.1% reported that they would accept their employer’s recommendation to do so. Differences in acceptance rates ranged from almost 90% (in China) to less than 55% (in Russia). Respondents reporting higher levels of trust in information from government sources were more likely to accept a vaccine and take their employer’s advice to do so. Survey data from across 19 countries reveal heterogeneity in attitudes toward acceptance of a COVID-19 vaccine and suggest that trust in government is associated with vaccine confidence.
Collapse
Affiliation(s)
- Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain.
| | - Scott C Ratzan
- City University of New York (CUNY) Graduate School of Public Health & Health Policy, New York NY, USA
| | - Adam Palayew
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | | | - Heidi J Larson
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kenneth Rabin
- City University of New York (CUNY) Graduate School of Public Health & Health Policy, New York NY, USA
| | | | - Ayman El-Mohandes
- City University of New York (CUNY) Graduate School of Public Health & Health Policy, New York NY, USA
| |
Collapse
|
5
|
Mandatory policies for influenza vaccination: Views of managers and healthcare workers in England. Vaccine 2019; 37:69-75. [PMID: 30470641 DOI: 10.1016/j.vaccine.2018.11.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 11/08/2018] [Accepted: 11/13/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Mandatory policies have the potential to increase uptake of influenza ('flu') vaccination among healthcare workers (HCWs), but concerns have been expressed about their acceptability and effectiveness. We explored views on three mandatory policies (declination forms, face masks or reduced patient contact, and mandatory vaccination) among both HCWs and flu vaccination programme managers in the National Health Service (NHS) in England. METHOD A mixed method approach was employed. An online cross-sectional survey was conducted with staff responsible for implementing influenza campaigns in NHS trusts (healthcare organisations) in England (n = 72 trusts). The survey measured perceived effectiveness of the three mandatory policies and perceived support for them among HCWs. Qualitative interviews were conducted in four trusts, with influenza campaign managers (n = 24) and with HCWs who had the opportunity to receive the influenza vaccination (n = 32). Interviews explored respondents' views of the three strategies and were analysed thematically using QSR NVivo 11 All data were collected shortly after the 2016/2017 influenza season. RESULTS In the survey, views varied on the effectiveness of the three policies and none of the interventions were thought to be strongly supported by HCWs, with particularly low levels of support perceived for mandatory vaccination and for face masks or reduced patient contact. The qualitative interviews revealed substantial concerns around the practicability and enforceability of mandatory policies and the potential discriminatory effect on HCWs who made a principled decision or had medical reasons for exemption. Additional doubts were also expressed regarding the effectiveness of face masks and their potential to worry patients, and the ethics of compelling staff to accept medical intervention. DISCUSSION Mandatory vaccination and face masks would not be strongly supported if introduced in the UK. If declination forms are adopted, they should be used in a constructive intelligence-gathering manner which avoids stigmatising HCWs.
Collapse
|
6
|
Ali I, Ijaz M, Rehman IU, Rahim A, Ata H. Knowledge, Attitude, Awareness, and Barriers Toward Influenza Vaccination Among Medical Doctors at Tertiary Care Health Settings in Peshawar, Pakistan-A Cross-Sectional Study. Front Public Health 2018; 6:173. [PMID: 29998091 PMCID: PMC6030373 DOI: 10.3389/fpubh.2018.00173] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 05/25/2018] [Indexed: 11/13/2022] Open
Abstract
Objective: This study intends to evaluate the knowledge, attitude and awareness of medical doctors toward influenza vaccination and the reasons for not getting vaccinated. Methods: A cross-sectional study was carried out among medical doctors in three major tertiary care health settings in Peshawar, Khyber Pakhtunkhwa (KP), Pakistan. A web-based, pre-tested questionnaire was used for data collection. Results: A total of (n = 300) medical doctors were invited, however only (n = 215) participated in the study with a response rate of 71.7%. Among the participants, 95.3% (n = 205) were males with a mean age of 28.67 ± 3.89 years. By designation, 121(56.3%) were trainee medical officers and 40 (18.6%) were house officers. The majority 102(47.4%) had a job experience of 1-2 years. Of the total sample, 38 (17.7%) doctors reported having received some kind of vaccination, whereas only 19 (8.84%) were vaccinated against influenza. The results identified that the major barriers toward influenza vaccinations included (1) Unfamiliarity with Influenza vaccination availability (Relative Importance Index RII = 0.830), (2) Unavailability of Influenza vaccines due to lack of proper storage area in the institution (RII = 0.634), (3) Cost of vaccine (RII = 0.608), and (4) insufficient staff to administer vaccine (RII = 0.589). Additionally, 156 (72.6%) of doctors were not aware of the influenza immunization recommendation and guidelines published by the Advisory Committee on Immunization Practices (ACIP) and Centre for Disease Control and Prevention (CDC). Physicians obtained a high score (8.27 ± 1.61) of knowledge and understanding regarding influenza and its vaccination followed by medical officers (8.06 ± 1.37). Linear Regression analysis revealed that gender was significantly associated with the knowledge score with males having a higher score (8.0± 1.39) than females (6.80 ± 1.61 β = -1.254 and CI [-2.152 to -0.355], p = 0.006). Conclusion: A very low proportion of doctors were vaccinated against influenza, despite the published guidelines and recommendations. Strategies that address multiple aspects like increasing awareness and the importance of the influenza vaccine, the international recommendations and enhancing access and availability of the vaccine are needed to improve its coverage and health outcomes.
Collapse
Affiliation(s)
- Iftikhar Ali
- Department of Pharmacy, University of Swabi, Swabi, Pakistan
- Department of Pharmacy Services, Northwest General Hospital and Research Center, Peshawar, Pakistan
- Paraplegic Center, Peshawar, Pakistan
| | - Muhammad Ijaz
- Department of Medicine, Gajju Khan Medical College, Swabi, Pakistan
| | - Inayat U. Rehman
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
- Department of Pharmacy, Abdul Wali Khan University Mardan, Mardan, Pakistan
| | - Afaq Rahim
- Department of Medicine, Khyber Teaching Hospital, Peshawar, Pakistan
| | - Humera Ata
- Department of International Maternal and Child Health, Uppsala University, Uppsala, Sweden
| |
Collapse
|
7
|
Benin AL, Lockwood G, Creatore T, Donovan D, Predmore M, MacArthur S. Improving Mandatory Vaccination Against Influenza: Minimizing Anxiety of Employees to Maximize Health of Patients. Am J Med Qual 2018; 33:372-382. [PMID: 29301403 DOI: 10.1177/1062860617748738] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective was to describe qualitatively the attitudes among employees toward mandatory vaccination against influenza to ultimately improve such programs and prevent hospital-acquired influenza. Qualitative interviews were conducted with 21 employees at a freestanding children's hospital. Analysis of interview transcripts used grounded theory and the constant comparative method; codes were iteratively revised and refined as themes emerged. Themes emerged elucidating promoters and concerns. Promoters included a desire to protect self, family, and patients; perception of vaccination as part of professional responsibility; and free vaccination as a benefit from the organization. Concerns included negative feelings surrounding the forced nature and substantial anxiety about the physical injection. Participants expressed a strong desire for a private, compassionate, unhurried environment for the injection. Managing personal anxiety and a desire for privacy emerged as strong concerns among health care workers getting vaccinated at work. This information enabled future improvements in the mandatory vaccination campaign.
Collapse
Affiliation(s)
| | - Gina Lockwood
- 1 Connecticut Children's Medical Center, Hartford, CT
| | | | - Donna Donovan
- 1 Connecticut Children's Medical Center, Hartford, CT
| | | | | |
Collapse
|
8
|
Yue X, Black C, Ball S, Donahue S, De Perio MA, Laney AS, Greby S. Workplace interventions associated with influenza vaccination coverage among health care personnel in ambulatory care settings during the 2013-2014 and 2014-2015 influenza seasons. Am J Infect Control 2017; 45:1243-1248. [PMID: 28684126 DOI: 10.1016/j.ajic.2017.05.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 05/12/2017] [Accepted: 05/15/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Vaccination of health care personnel (HCP) can reduce influenza-related morbidity and mortality among HCP and their patients. This study investigated workplace policies associated with influenza vaccination among HCP who work in ambulatory care settings without influenza vaccination requirements. METHODS Data were obtained from online surveys conducted during April 2014 and April 2015 among nonprobability samples of HCP recruited from 2 preexisting national opt-in Internet panels. Respondents were asked about their vaccination status and workplace policies and interventions related to vaccination. Logistic regression models were used to assess the independent associations between each workplace intervention and influenza vaccination while controlling for occupation, age, and race or ethnicity. RESULTS Among HCP working in ambulatory care settings without a vaccination requirement (n = 866), 65.7% reported receiving influenza vaccination for the previous influenza season. Increased vaccination coverage was independently associated with free onsite vaccination for 1 day (prevalence ratio [PR], 1.38; 95% confidence interval [CI], 1.07-1.78 or >1 day PR, 1.58; 95% CI, 1.29-1.94) and employers sending personal vaccination reminders (PR, 1.20; 95% CI, 0.99-1.46). Age ≥65 years (PR, 1.30; 95% CI, 1.07-1.56) and working as a clinical professional (PR, 1.26; 95% CI, 1.06-1.50) or clinical nonprofessional (PR, 1.28; 95% CI, 1.03-1.60) were also associated with higher coverage. Vaccination coverage increased with increasing numbers of workplace interventions. CONCLUSIONS Implementing workplace vaccination interventions in ambulatory care settings, including free onsite influenza vaccination that is actively promoted, could help increase influenza vaccination among HCP.
Collapse
|
9
|
Podczervinski S, Stednick Z, Helbert L, Davies J, Jagels B, Gooley T, Casper C, Pergam SA. Employee influenza vaccination in a large cancer center with high baseline compliance rates: comparison of carrot versus stick approaches. Am J Infect Control 2015; 43:228-33. [PMID: 25728148 DOI: 10.1016/j.ajic.2014.11.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 11/21/2014] [Accepted: 11/24/2014] [Indexed: 10/23/2022]
Abstract
BACKGROUND Influenza is a major complication in patients with cancer and hematopoietic cell transplant recipients. We set out to maximize influenza vaccination rates in health care personnel at our large ambulatory cancer center with high baseline compliance and to assess alternatives to mandatory policies. METHODS Baseline influenza vaccine compliance rates at our center were >85%. During 2011 an incentive-based "carrot" campaign was implemented, and in 2012 a penalty-based "stick" approach to declining staff was required. Yearly approaches were compared using Kaplan-Meier survival estimates. RESULTS Both the incentive and penalty approaches significantly improved the baseline rates of vaccination (2010 vs 2011 P = .0001 and 2010 vs 2012 P < .0001), and 2012 significantly improved over 2011 (P < .0001). Staff with direct patient contact had significantly higher rates of vaccination compared with those with indirect and minimal contact in every campaign year, except in the penalty-driven campaign from 2012 (P < .001, P < .001, and P = .24 and P < .001, P < .001, and P = .17, respectively). CONCLUSIONS A multifaceted staff vaccination program that included education, training, and active declination was more effective than a program offering incentives. Improvements in vaccination rates in the penalty-driven campaign were driven by staff without direct care responsibilities. High compliance with systemwide influenza vaccination was achieved without requiring mandatory vaccination.
Collapse
|
10
|
Zimmerman RK, Nowalk MP, Lin CJ, Raymund M, Fox DE, Harper JD, Tanis MD, Willis BC. Factorial Design for Improving Influenza Vaccination Among Employees of a Large Health System. Infect Control Hosp Epidemiol 2015; 30:691-7. [DOI: 10.1086/598343] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective.As healthcare personnel (HCP) influenza vaccination becomes a quality indicator for healthcare facilities, effective inter¬ventions are needed. This study was designed to test a factorial design to improve HCP vaccination rates.Design.A before-after trial with education, publicity, and free and easily accessible influenza vaccines used a factorial design to determine the effect of mobile vaccination carts and incentives on vaccination rates of HCP, who were divided into groups on the basis of their level of patient contact (ie, business and/or administrative role, indirect patient contact, and direct patient contact).Setting.Eleven acute care facilities in a large health system.Participants.More than 26,000 nonphysician employees.Results.Influenza vaccination rates increased significantly in most facilities and increased system-wide from 32.4% to 39.6% (P < .001). In the baseline year, business unit employee vaccination rates were significantly higher than among HCP with patient contact; rates did not differ significantly across groups in the intervention year. In logistic regression that accounted for demographic characteristics, intervention year, and other factors, the use of incentives and/or mobile carts that provided access to vaccine at the work unit significantly increased the likelihood of vaccination among HCP with direct and indirect patient contact, compared with control sites.Conclusions.Interventions to improve vaccination rates are differentially effective among HCP with varying levels of patient contact. Mobile carts appear to remove access barriers, whereas incentives may motivate HCP to be vaccinated. Education and publicity may be sufficient for workers in business or administrative positions. Interventions tailored by worker type are likely to be most successful for improving HCP vaccination rates.
Collapse
|
11
|
Talbot TR, Babcock H, Caplan AL, Cotton D, Maragakis LL, Poland GA, Septimus EJ, Tapper ML, Weber DJ. Revised SHEA Position Paper: Influenza Vaccination of Healthcare Personnel. Infect Control Hosp Epidemiol 2015; 31:987-95. [PMID: 20807037 DOI: 10.1086/656558] [Citation(s) in RCA: 155] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Executive SummaryThis document serves as an update and companion piece to the 2005 Society for Healthcare Epidemiology of America (SHEA) Position Paper entitled “Influenza Vaccination of Healthcare Workers and Vaccine Allocation for Healthcare Workers During Vaccine Shortages.” In large part, the discussion about the rationale for influenza vaccination of healthcare personnel (HCP), the strategies designed to improve influenza vaccination rates in this population, and the recommendations made in the 2005 paper still stand. This position paper notes new evidence released since publication of the 2005 paper and strengthens SHEA's position on the importance of influenza vaccination of HCP. This document does not discuss vaccine allocation during times of vaccine shortage, because the 2005 SHEA Position Paper still serves as the Society's official statement on that issue.
Collapse
Affiliation(s)
- Thomas R Talbot
- Departments of Medicine and Preventive Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Rakita RM, Hagar BA, Crome P, Lammert JK. Mandatory Influenza Vaccination of Healthcare Workers: A 5-Year Study. Infect Control Hosp Epidemiol 2015; 31:881-8. [DOI: 10.1086/656210] [Citation(s) in RCA: 195] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background.The rate of influenza vaccination among healthcare workers (HCWs) is low, despite a good rationale and strong recommendations for vaccination from many health organizations.Objective.To increase influenza vaccination rates by instituting the first mandatory influenza vaccination program for HCWs.Design and Setting.A 5-year study (from 2005 to 2010) at Virginia Mason Medical Center, a tertiary care, multispecialty medical center in Seattle, Washington, with approximately 5,000 employees.Methods.All HCWs of the medical center were required to receive influenza vaccination. HCWs who were granted an accommodation for medical or religious reasons were required to wear a mask at work during influenza season. The main outcome measure was rate of influenza vaccination among HCWs.Results.In the first year of the program, there were a total of 4,703 HCWs, of whom 4,588 (97.6%) were vaccinated, and influenza vaccination rates of more than 98% were sustained over the subsequent 4 years of our study. Less than 0.7% of HCWs were granted an accommodation for medical or religious reasons and were required to wear a mask at work during influenza season, and less than 0.2% of HCWs refused vaccination and left Virginia Mason Medical Center.Conclusion.A mandatory influenza vaccination program for HCWs is feasible, results in extremely high vaccination rates, and can be sustained over the course of several years.
Collapse
|
13
|
Poland GA, Ofstead CL, Tucker SJ, Beebe TJ. Receptivity to Mandatory Influenza Vaccination Policies for Healthcare Workers Among Registered Nurses Working on Inpatient Units. Infect Control Hosp Epidemiol 2015; 29:170-3. [DOI: 10.1086/526432] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A survey that included questions about preferred methods of influenza prevention was completed by 513 registered nurses working on inpatient units. Vaccination was the preferred influenza prevention method among 83.0% of respondents. Of 506 respondents, 283 (56.0%) stated that mandatory influenza vaccination was appropriate for healthcare workers, and 394 (59.4%) of 512 RNs reported that they would support a policy requiring annual influenza vaccination for healthcare workers that allowed for informed declination.
Collapse
|
14
|
Awali RA, Samuel PS, Marwaha B, Ahmad N, Gupta P, Kumar V, Ellsworth J, Flanagan E, Upfal M, Russell J, Kaplan C, Kaye KS, Chopra T. Understanding health care personnel's attitudes toward mandatory influenza vaccination. Am J Infect Control 2014; 42:649-52. [PMID: 24837116 DOI: 10.1016/j.ajic.2014.02.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 02/26/2014] [Accepted: 02/27/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND This study investigated the factors influencing influenza vaccination rates among health care personnel (HCP) and explored HCP's attitudes toward a policy of mandatory vaccination. METHODS In September 2012, a 33-item Web-based questionnaire was administered to 3,054 HCP employed at a tertiary care hospital in metropolitan Detroit. RESULTS There was a significant increase in the rate of influenza vaccination, from 80% in the 2010-2011 influenza season (before the mandated influenza vaccine) to 93% in 2011-2012 (after the mandate) (P < .0001). Logistic regression showed that HCP with a history of previous influenza vaccination were 7 times more likely than their peers without this history to receive the vaccine in 2011-2012. A pro-mandate attitude toward influenza vaccination was a significant predictor of receiving the vaccine after adjusting for demographics, history of previous vaccination, awareness of the hospital's mandatory vaccination policy, and patient contact while providing care (P = .01). CONCLUSIONS The increased rate of influenza vaccination among HCP was driven by both an awareness of the mandatory policy and a pro-mandate attitude toward vaccination. The findings of this study call for better education of HCP on the influenza vaccine along with enforcement of a mandatory vaccination policy.
Collapse
|
15
|
Galanakis E, D'Ancona F, Jansen A, Lopalco PL. The issue of mandatory vaccination for healthcare workers in Europe. Expert Rev Vaccines 2013; 13:277-83. [PMID: 24350731 DOI: 10.1586/14760584.2014.869174] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Mandatory policies have occasionally been implemented, targeting optimal vaccination uptake among healthcare workers (HCWs). Herein, we analyze the existing recommendations in European countries and discuss the feasibility of implementing mandatory vaccination for HCWs. As reflected by a survey among vaccine experts from 29 European countries, guidelines on HCW vaccination were issued in all countries, though with substantial differences in targeted diseases, HCW groups and type of recommendation. Mandatory policies were only exceptionally implemented. Results from a second survey suggested that such policies would not become easily adopted, and recommendations might work better if focusing on specific HCW groups and appropriate diseases such as hepatitis B, influenza and measles. In conclusion, guidelines for HCW vaccination, but not mandatory policies, are widely adopted in Europe. Recommendations targeting specific HCW groups and diseases might be better accepted and facilitate higher vaccine uptake than policies vaguely targeting all HCW groups.
Collapse
Affiliation(s)
- Emmanouil Galanakis
- Department of Paediatrics and Interfaculty Graduate Programme in Bioethics, University of Crete, Heraklion 710 03, Greece
| | | | | | | | | |
Collapse
|
16
|
Lim YC, Seale H. Examining the views of key stakeholders regarding the provision of occupational influenza vaccination for healthcare workers in Australia. Vaccine 2013; 32:606-10. [PMID: 24291538 DOI: 10.1016/j.vaccine.2013.11.063] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 11/06/2013] [Accepted: 11/15/2013] [Indexed: 11/29/2022]
Abstract
Annual vaccination of hospital healthcare workers (HCWs) may be an effective measure to reduce the transmission of healthcare associated influenza. However, vaccine coverage rates among HCWs in most public Australian hospitals are below satisfactory for a number of reasons. This study aimed to examine the opinions of key health stakeholders on current issues regarding HCW influenza vaccination. A qualitative study involving semi-structured interviews was undertaken with key Australian health stakeholders representing different organizations and sectors involved in influenza vaccination and policy. Amongst the participants, there was overwhelming support for HCW influenza vaccination. They viewed vaccination as one of the most important preventive measures for healthcare associated influenza and generally agreed that vaccination of HCWs reduces the overall risk of transmission to patients. However, there were contradictory attitudes regarding the evidence available for justifying the impact of vaccinating HCWs against influenza. Amongst the stakeholders interviewed, there was support for continuing to promote influenza vaccination for HCWs via the conventional framework. Participants recommended that hospitals continue to use conventional, voluntary strategies to increase vaccine coverage such as education and mobile carts. Given that the World Health Organization has included HCWs as a target group for influenza vaccination, Australian hospitals may need to start considering the use of mandatory policies in the near future.
Collapse
Affiliation(s)
- Yi Chen Lim
- UNSW Medicine, University of New South Wales, New South Wales, Australia.
| | - Holly Seale
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, New South Wales, Australia.
| |
Collapse
|
17
|
Galanakis E, Jansen A, Lopalco PL, Giesecke J. Ethics of mandatory vaccination for healthcare workers. ACTA ACUST UNITED AC 2013; 18:20627. [PMID: 24229791 DOI: 10.2807/1560-7917.es2013.18.45.20627] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Healthcare workers (HCWs) are at increased risk of contracting infections at work and further transmitting them to colleagues and patients. Immune HCWs would be protected themselves and act as a barrier against the spread of infections and maintain healthcare delivery during outbreaks, but vaccine uptake rates in HCWs have often been low. In order to achieve adequate immunisation rates in HCWs, mandatory vaccination policies are occasionally implemented by healthcare authorities, but such policies have raised considerable controversy. Here we review the background of this debate, analyse arguments for and against mandatory vaccination policies, and consider the principles and virtues of clinical, professional, institutional and public health ethics. We conclude that there is a moral imperative for HCWs to be immune and for healthcare institutions to ensure HCW vaccination, in particular for those working in settings with high-risk groups of patients. If voluntary uptake of vaccination by HCWs is not optimal, patients’ welfare, public health and also the HCW’s own health interests should outweigh concerns about individual autonomy: fair mandatory vaccination policies for HCWs might be acceptable. Differences in diseases, patient and HCW groups at risk and available vaccines should be taken into consideration when adopting the optimal policy.
Collapse
Affiliation(s)
- E Galanakis
- Department of Paediatrics and Joint Graduate Programme in Bioethics, University of Crete, Heraklion, Greece
| | | | | | | |
Collapse
|
18
|
Thompson MG, McIntyre AF, Naleway AL, Black C, Kennedy ED, Ball S, Walker DK, Henkle EM, Gaglani MJ. Potential influence of seasonal influenza vaccination requirement versus traditional vaccine promotion strategies on unvaccinated healthcare personnel. Vaccine 2013; 31:3915-21. [DOI: 10.1016/j.vaccine.2013.06.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 06/10/2013] [Accepted: 06/13/2013] [Indexed: 10/26/2022]
|
19
|
Antommaria AHM. An ethical analysis of mandatory influenza vaccination of health care personnel: implementing fairly and balancing benefits and burdens. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2013; 13:30-37. [PMID: 23952830 DOI: 10.1080/15265161.2013.814731] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Health care institutions have paid increasing attention to preventing nosocomial transmission of influenza through vaccination of health care personnel. While multifaceted voluntary interventions have increased vaccination rates, proponents of mandatory programs contend the rates remain unacceptably low. Conventional bioethical analyses of mandatory programs are inadequate; they fail to account for the obligations of nonprofessional personnel or to justify the weights assigned to different ethical principles. Using an ethics framework for public health permits a fuller analysis. The framework's focus on fairness accentuates the potential differences between the risk of transmitting infection and employment status, and the need to equitably evaluate exemptions. The framework's emphasis on balancing benefits and burdens highlights the need to justify a specific goal and questions the need to exclude all nonmedical exemptions. While mandatory vaccination programs are justifiable, greater attention should be paid to their implementation.
Collapse
|
20
|
Hollmeyer H, Hayden F, Mounts A, Buchholz U. Review: interventions to increase influenza vaccination among healthcare workers in hospitals. Influenza Other Respir Viruses 2012; 7:604-21. [PMID: 22984794 PMCID: PMC5781006 DOI: 10.1111/irv.12002] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Please cite this paper as: Hollmeyer et al. (2012) Review: interventions to increase influenza vaccination among healthcare workers in hospitals. Influenza and Other Respiratory Viruses 7(4), 604–621. Annual influenza vaccination rates among hospital healthcare workers (HCW) are almost universally low despite recommendations from WHO and public health authorities in many countries. To assist in the development of successful vaccination programmes, we reviewed studies where interventions aimed to increase the uptake of influenza vaccination among hospital HCW. We searched PUBMED from 1990 up to December 2011 for publications with predetermined search strategies and of pre‐defined criteria for inclusion or exclusion. We evaluated a large number of ‘intervention programmes’ each employing one or more ‘intervention components’ or strategies, such as easy access to vaccine or educational activities, with the goal to raise influenza vaccine uptake rates in hospital HCW during one influenza season. Included studies reported results of intervention programmes and compared the uptake with the season prior to the intervention (historical control) or to another intervention programme within the same season that started from the same set of baseline activities. Twenty‐five studies performed in eight countries met our selection criteria and described 45 distinct intervention programmes. Most studies used their own facility as historical control and evaluated only one season. The following elements were used in intervention programmes that increased vaccine uptake: provision of free vaccine, easy access to the vaccine (e.g. through mobile carts or on‐site vaccination), knowledge and behaviour modification through educational activities and/or reminders and/or incentives, management or organizational changes, such as the assignment of personnel dedicated to the intervention programme, long‐term implementation of the strategy, requiring active declination and mandatory immunization policies. The number of these components applied appeared to be proportional to the increase in uptake. If influenza uptake in hospital HCW is to be increased on sustained basis, hospital managers need to be committed to conduct a well‐designed long‐term intervention programme that includes a variety of co‐ordinated managerial and organizational elements.
Collapse
Affiliation(s)
- Helge Hollmeyer
- International Health Regulations Coordination Department, World Health Organization, Geneva, Switzerland.
| | | | | | | |
Collapse
|
21
|
Thompson MG, Gaglani MJ, Naleway A, Ball S, Henkle EM, Sokolow LZ, Brennan B, Zhou H, Foster L, Black C, Kennedy ED, Bozeman S, Grohskopf LA, Shay DK. The expected emotional benefits of influenza vaccination strongly affect pre-season intentions and subsequent vaccination among healthcare personnel. Vaccine 2012; 30:3557-65. [PMID: 22475860 PMCID: PMC5901693 DOI: 10.1016/j.vaccine.2012.03.062] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 02/13/2012] [Accepted: 03/20/2012] [Indexed: 01/07/2023]
Abstract
BACKGROUND The relative importance of different attitudes in predicting vaccination among healthcare personnel (HCP) is unclear. We hypothesized that HCP who feel at risk without vaccination or say they would regret not getting vaccinated would be more likely to get vaccinated than HCP who do not expect these emotional benefits. METHODS A prospective cohort of 1544 HCP with direct patient care was enrolled from September 18 to December 18, 2010 at Scott & White Healthcare in Texas and Kaiser Permanente Northwest in Oregon and Washington. An Internet-based questionnaire assessed pre-season intention to be vaccinated and included 12 questions on attitudes about vaccination: single-item measures of perceived susceptibility and vaccine effectiveness, 5 items that were summed to form a concerns about vaccine scale, and 5 items summed to form an emotional benefits of vaccination scale. Influenza vaccination status for the 2010-2011 season and for 5 prior seasons was confirmed by medical record extraction. RESULTS There were significant differences between vaccinated and unvaccinated HCP on all attitude items; 72% of vaccinated HCP agreed that they "worry less about getting the flu" if vaccinated, compared to only 26% of the unvaccinated (odds ratio=7.4, 95% confidence interval=5.8-9.5). In a multivariate model, the emotional benefits scale was the strongest predictor of 2010-2011 seasonal influenza vaccination, after adjusting for other attitude measures, prior vaccination history, and pre-season intention to be vaccinated. The predictive value of the emotional benefits scale was strongest for HCP with low pre-season intention to be vaccinated, where HCP vaccine receipt was 15% versus 83% for those with low versus high scores on the emotional benefits scale. CONCLUSIONS The expected emotional benefits of vaccination strongly affect seasonal influenza vaccination among HCP, even after taking into account other attitudes, pre-season intentions, and prior vaccination history. These attitudes are promising targets for future vaccination campaigns.
Collapse
Affiliation(s)
- Mark G Thompson
- Influenza Division, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Daugherty EL, Speck KA, Rand CS, Perl TM. Perceptions and influence of a hospital influenza vaccination policy. Infect Control Hosp Epidemiol 2011; 32:449-55. [PMID: 21515975 DOI: 10.1086/659406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Seasonal influenza is a significant cause of morbidity and mortality in the United States each year. Healthcare worker (HCW) influenza vaccination is associated with both decreased absenteeism among employees and improved outcomes among patients. However, HCW influenza vaccine uptake remains suboptimal. The objective of this study was to characterize HCWs' understanding of and response to a stringent vaccination policy. DESIGN, SETTING, AND PARTICIPANTS A survey of 928 hospital staff at a tertiary academic medical center in Baltimore during the 2008-2009 influenza season. RESULTS Of those surveyed, 75% (n = 695) completed the survey; 623 respondents reported regular patient contact, and 91% of those reported vaccination in the current influenza season. However, only 60% reported consistently receiving the vaccine every year. Of those who were vaccinated, 8% (n = 48) reported being vaccinated for the first time during that influenza season. A significant proportion (42%) of respondents were unaware of the major change in hospital policy regarding vaccination. Influences on the decision to be vaccinated varied significantly between those who are regularly vaccinated and those with inconsistent vaccination habits. Attitudes toward hospital policy varied significantly by race and clinical role. CONCLUSIONS Although 91% of respondents with regular patient contact reported being vaccinated for influenza in the 2008-2009 season, only 60% reported consistent annual vaccination. Misinformation regarding hospital policies is widespread. Improvements in vaccination rates will likely require multifaceted, targeted efforts focused on specific influences on less adherent groups. The identified variability in influences on the decision to be vaccinated suggests possible targets for future interventions.
Collapse
Affiliation(s)
- Elizabeth L Daugherty
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Fifth Floor, Baltimore, Maryland 21205, USA.
| | | | | | | |
Collapse
|
23
|
Groenewold M, Baron S, Tak S, Allred N. Influenza vaccination coverage among US nursing home nursing assistants: the role of working conditions. J Am Med Dir Assoc 2011; 13:85.e17-23. [PMID: 22208764 DOI: 10.1016/j.jamda.2011.02.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Accepted: 02/16/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To estimate influenza vaccination coverage among nursing assistants (NAs) working in US nursing homes, and to identify demographic and occupational predictors of vaccination status among NAs. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional analysis of data on 2873 NAs from the 2004 National Nursing Assistant Survey. Multivariable-adjusted vaccination coverage (prevalence) ratios for demographic and occupational characteristics were calculated using Poisson regression. MEASUREMENTS Outcome variable was NAs' influenza vaccination status, yes or no, based on the question, "During the past 12 months, did you receive a flu shot?" RESULTS Coverage for all NAs working in US nursing homes was estimated to be 37.1%. NAs 45 or older were more likely to be vaccinated than younger NAs (prevalence ratio [PR] = 1.23, 95% confidence interval [CI]: 1.07-1.41). Significant negative associations with vaccination status were found for NAs who were non-Hispanic blacks (PR = 0.82, 95% CI: 0.70-0.97), disagreed that they were respected/rewarded for their work (PR = 0.85, 95% CI: 0.71-1.00), worked at for-profit facilities (PR = 0.83, 95% CI: 0.72-0.95), and reported receiving fewer than 7 of 15 nonwage job benefits (PR = 0.77, 95% CI: 0.67-0.90). CONCLUSION Influenza coverage among nursing home NAs appears to be similar to nationally reported coverage estimates among health care providers in the United States in general. In addition to individual characteristics, occupational characteristics reflective of working conditions are associated with vaccination status among NAs, suggesting that further research into these types of associations may be useful in identifying which institutions may benefit from outreach efforts and types of interventions to increase vaccination coverage.
Collapse
Affiliation(s)
- Matthew Groenewold
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Alice Hamilton Laboratory, Cincinnati, OH 45226, USA.
| | | | | | | |
Collapse
|
24
|
Gavazzi G, Filali-Zegzouti Y, Guyon AC, De Wazieres B, Lejeune B, Golmard JL, Belmin J, Piette F, Rothan-Tondeur M. French healthcare workers in geriatric healthcare settings staunchly opposed to influenza vaccination: The VESTA study. Vaccine 2011; 29:1611-6. [DOI: 10.1016/j.vaccine.2010.12.067] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Revised: 12/04/2010] [Accepted: 12/17/2010] [Indexed: 10/18/2022]
|
25
|
Fortaleza CR, Fortaleza CMCB. Knowledge and attitudes of health care workers from intensive care units regarding nosocomial transmission of influenza: a study on the immediate pre-pandemic period. J Venom Anim Toxins Incl Trop Dis 2011. [DOI: 10.1590/s1678-91992011000200007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
26
|
Cavalcante RDS, Jorge AMZ, Fortaleza CMCB. Predictors of adherence to influenza vaccination for healthcare workers from a teaching hospital: a study in the prepandemic era. Rev Soc Bras Med Trop 2010; 43:611-4. [DOI: 10.1590/s0037-86822010000600001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Accepted: 08/20/2010] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION: Even before the 2009 pandemics, influenza in healthcare workers (HCW) was a known threat to patient safety, while Influenza vaccine coverage in the same group was generally low. Identification of predictors for HCW adherence to Influenza vaccination has challenged infection control committees. METHODS: Our group conducted a cross-sectional survey in December 2007, interviewing 125 HCWs from a teaching hospital to identify adherence predictors for Influenza vaccination. The outcomes of interest were: A - adherence to the 2007 vaccination campaign; B - adherence to at least three yearly campaigns in the past five years. Demographic and professional data were assessed through univariate and multivariate analysis. RESULTS: Of the HCWs interviewed, 43.2% were vaccinated against Influenza in 2007. However, only 34.3% of HCWs working in healthcare for more than five years had adhered to at least three of the last five vaccination campaigns. Multivariate analysis showed that working in a pediatric unit (OR = 7.35, 95%CI = 1.90-28.44, p = 0.004) and number of years in the job (OR = 1.32, 95%CI = 1.00-1.74, p = 0.049) were significant predictors of adherence to the 2007 campaign. Physicians returned the worst outcome performances in A (OR = 0.40, 95%CI = 0.16-0.97, p = 0.04) and B (OR = 0.17, 95%CI = 0.05-0.60, p = 0.006). CONCLUSIONS: Strategies to improve adherence to Influenza vaccination should focus on physicians and newly-recruited HCWs. New studies are required to assess the impact of the recent Influenza A pandemics on HCW-directed immunization policies.
Collapse
|
27
|
Crupi RS, Di John D, Mangubat PM, Asnis D, Devera J, Maguire P, Palevsky SL. Linking emergency preparedness and health care worker vaccination against influenza: a novel approach. Jt Comm J Qual Patient Saf 2010; 36:499-503. [PMID: 21090019 PMCID: PMC7106101 DOI: 10.1016/s1553-7250(10)36073-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Health care workers (HCWs) can acquire and transmit influenza to their patients and coworkers, even while asymptomatic. The U.S. Healthy People 2010 initiative set a national goal of 60% coverage for HCW influenza vaccination by 2010. Yet vaccination rates remain low. In the 2008–2009 influenza season, Flushing Hospital Medical Center (FHMC; New York) adopted a “push/pull” point-of-dispensing (POD) vaccination model that was derived from emergency preparedness planning for mass vaccination and/or prophylaxis to respond to an infectious disease outbreak, whether occurring naturally or due to bioterrorism. Launch of the HCW Vaccination Program In mid-September 2008, a two-week HCW vaccination program was launched using a sequential POD approach. In Push POD, teams assigned to specific patient units educated all HCWs about influenza vaccination and offered on-site vaccination; vaccinated HCWs received a 2009 identification (ID) validation sticker. In Pull POD, HCWs could enter the hospital only through one entrance; all other employee entrances were “locked down.” A 2009 ID validation sticker was required for entry and to punch in for duty. Employees without the new validation sticker were directed to a nearby vaccination team. After the Push/Pull POD was completed, the employee vaccination drive at FHMC was continued for the remainder of the influenza season by the Employee Health Service. Results Using this model, in two days 72% of the employees were reached, with 54% of those reached accepting vaccination. Conclusions This model provides a novel approach for institutions to improve their HCW influenza vaccination rates within a limited period through exercising emergency preparedness plans for infectious disease outbreaks.
Collapse
Affiliation(s)
- Robert S Crupi
- Department of Emergency Medicine, Flushing Hospital Medical Center, Flushing, New York, USA.
| | | | | | | | | | | | | |
Collapse
|
28
|
Vaccination of health care workers for influenza: promote safety culture, not coercion. Canadian Journal of Public Health 2010. [PMID: 20629446 DOI: 10.1007/bf03403845] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES In British Columbia (BC), Canada, all health care facilities must have a written staff policy on influenza immunization that includes notice that non-immunized staff can be excluded from work without pay during an influenza outbreak in the facility. In light of this policy, our objectives were to explore the views of BC health care workers (HCWs) regarding how best to promote vaccine uptake. METHODS Long-term care, and acute and community health sites in three of six health regions were divided into thirds, according to their previous season's vaccine uptake rates, and the upper and lower thirds targeted. Ten focus groups were held. NVivo software (QSR International) and a separate editing style were used for analysis. RESULTS Four dominant themes emerged: knowledge, communication, perceived punitive nature of workplace policy, and safety climate. HCWs across all focus groups noted that influenza campaign communications should include reinforcement of basic infection control, workplace health and healthy lifestyle choices that affect overall health. HCWs indicated that they wanted a workplace policy that is easy to understand, respectful of individual choice and not punitive. CONCLUSIONS Our findings highlight the importance of comprehensive approaches, a message that has not appeared as strongly in previous literature. Focus group participants pointed out the importance of health and safety at work generally and felt that creating a healthy workplace culture is necessary to promoting vaccine uptake. Future vaccine promotion initiatives should be integrated into facility-wide workplace health campaigns and care taken to ensure that vaccination campaigns do not appear coercive to HCWs.
Collapse
|
29
|
Ajenjo MC, Woeltje KF, Babcock HM, Gemeinhart N, Jones M, Fraser VJ. Influenza vaccination among healthcare workers: ten-year experience of a large healthcare organization. Infect Control Hosp Epidemiol 2010; 31:233-40. [PMID: 20055666 DOI: 10.1086/650449] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To describe the results of different measures implemented to improve adherence to the healthcare worker (HCW) influenza immunization program at BJC HealthCare during the period from 1997 through 2007. DESIGN Descriptive retrospective study. SETTING BJC HealthCare, a 13-hospital nonprofit healthcare organization in the Midwest. METHODS We reviewed and analyzed HCW influenza vaccination data from all BJC HealthCare Occupational Health Services and hospitals during the period from 1997 through 2007. Occupational health staff, infection prevention personnel, and key influenza vaccination campaign leaders were also interviewed regarding implementation measures during the study years. RESULTS At the end of 2007, BJC HealthCare had approximately 26,000 employees. With the use of multiple progressive interventions, influenza vaccination rates among BJC employees increased from 45% in 1997 to 72% in 2007 (P < .001). The influenza vaccination rate in 2007 was significantly higher than in 2006: 72%, compared with 54% (P < .001). Five hospitals had influenza vaccination rates that exceeded the target goal of 80% in 2007. The most successful interventions were adding influenza vaccination rates to the quality scorecard incentive program and the use of declination statements, both of which were implemented in 2007. The most important barriers to success identified by interview respondents were HCWs' misconceptions about influenza vaccination and a perceived lack of leadership support. CONCLUSIONS Influenza vaccination rates among HCWs significantly improved with multiple interventions over the years. However, the BJC HealthCare influenza vaccination target of 80% was not attained at all hospitals with these measures. More aggressive interventions, such as implementing mandatory influenza vaccination policies, are needed to achieve higher vaccination rates.
Collapse
Affiliation(s)
- M Cristina Ajenjo
- Infectious Disease Division, Washington University in St. Louis School of Medicine, St Louis, Missouri 63110, USA
| | | | | | | | | | | |
Collapse
|
30
|
Lautenbach E, Saint S, Henderson DK, Harris AD. Initial response of health care institutions to emergence of H1N1 influenza: experiences, obstacles, and perceived future needs. Clin Infect Dis 2010; 50:523-7. [PMID: 20064038 DOI: 10.1086/650169] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The emergence of H1N1 influenza is cause for great concern. Although one of the most important components of the response to the H1N1 crisis is the work of health care epidemiology professionals, the beliefs and experiences of this community are unknown, and the optimal approach to managing H1N1 in the future has not been delineated. METHODS To assess attitudes and responses of health care epidemiology professionals to the H1N1 influenza crisis, we conducted a cross-sectional survey of members of the Society for Healthcare Epidemiology of America. We assessed beliefs regarding (1) importance of H1N1, (2) institutional preparedness, (3) time spent on the H1N1 crisis, and (4) the institution's response to H1N1. RESULTS Of 323 respondents, 195 (60.4%) reported that their hospitals were well prepared for a pandemic. Furthermore, the majority reported that senior administrators provided adequate political support and resources (85.1% and 80.2%, respectively) to respond to H1N1. However, 163 (50.9%) respondents reported that other important infection prevention activities were neglected during the H1N1 crisis. Shortages of antiviral medication were reported by 99 (30.7%) respondents. Furthermore, 126 (39.0%) reported that personal stockpiling of antiviral medications occurred at their institution, and 166 (51.4%) reported that institutional actions were initiated to prevent personal stockpiling. Also, 294 (91.0%) respondents believed that H1N1 influenza would reappear later this year. Vaccine development, health care worker education, and revisions of pandemic influenza plans were identified as the most important future initiatives. Finally, 251 (77.7%) respondents felt that health care workers should be mandated to receive influenza vaccine. CONCLUSIONS Although generally institutions are well prepared for the H1N1 crisis, substantial revisions of pandemic preparedness plans appear to be necessary. Future efforts to optimize the response to H1N1 should include curtailing personal stockpiling of antivirals and vaccine development with consideration of mandatory vaccination of health care workers.
Collapse
Affiliation(s)
- Ebbing Lautenbach
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-6021, USA.
| | | | | | | |
Collapse
|
31
|
Partnering with nursing service improves health care worker influenza vaccination rates. Am J Infect Control 2009; 37:484-9. [PMID: 19361886 DOI: 10.1016/j.ajic.2008.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2008] [Revised: 12/26/2008] [Accepted: 12/30/2008] [Indexed: 11/24/2022]
Abstract
BACKGROUND Increasing the influenza vaccination rate in health care workers (HCWs) promotes patient safety as well as employee health. The average HCW influenza vaccination rate is approximately 35%. Various studies have analyzed the reasons for the low vaccination rate in HCWs and developed strategies aimed at increasing this rate. METHODS At the study hospital, the Nursing Department was contacted to recruit influenza (flu) coordinators from the various hospital departments to coordinate administration of influenza vaccinations in their respective departments, with the aim of increasing HCW vaccination rates. The flu coordinators received education about the influenza vaccine along with lists of employees, vaccination supplies, and consent/declination forms. Each flu coordinator was responsible for contacting the employees in his or her department/unit. Both consent and declination responses were documented. RESULTS Of the hospital's 3238 employees (including physicians), a total of 2534 were contacted (78%). Of these, 2008 consented to receive the influenza vaccine and 526 declined. This represented a 37% increase in the total number of HCWs contacted and a 20% increase in vaccine recipients over the previous influenza season. CONCLUSIONS Partnering with the Nursing Department increased the accessibility to and acceptance of influenza vaccination among HCWs. The HCWs reported positive experiences about receiving the vaccine in the work environment.
Collapse
|
32
|
Influenza vaccination for healthcare workers: from a simple concept to a resistant issue? Aging Clin Exp Res 2009; 21:216-21. [PMID: 19571645 DOI: 10.1007/bf03324908] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Different strategies for the management of influenza epidemics are particularly important in elderly population. High morbidity and mortality rates are associated with influenza in the elderly, and annual vaccination against flu is considered to be the best cost-effective strategy. However, its efficiency is reduced in older adults and only half of them are protected. Several studies show that vaccinating healthcare workers is an efficient way of decreasing mortality rates in nursing home residents within influenza season. National and international public health authorities recommend therefore healthcare worker vaccinations for up to 5 years. However, influenza healthcare worker vaccination coverages are still low. Here we summarize data regarding the justification of healthcare worker vaccination, the efficiency of this strategy, the reasons of the reluctance of vaccination, the means and results of interventional programs and, then, focus on the debate of a mandatory healthcare worker influenza vaccination. Because several interventional programs are efficient but still need high financial and human support, only a strong political-will can improve this chosen strategy.
Collapse
|
33
|
|
34
|
Influenza vaccination compliance among health care workers in a German university hospital. Infection 2008; 37:197-202. [PMID: 19139807 DOI: 10.1007/s15010-008-8200-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Accepted: 08/06/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Since 1988, the Standing Committee on Vaccination (STIKO) at the Robert Koch-Institute, Berlin, has explicitly recommended that health-care workers (HCWs) should be vaccinated against seasonal influenza. However, acceptance of the influenza vaccination by medical personnel is low. METHODS This study analyzes factors associated with the compliance of HCWs with the seasonal influenza vaccination on the basis of three different anonymized questionnaires during two consecutive influenza seasons: 2006/2007 and 2007/2008. The questionnaires covered details of demographics, frequency of previous vaccinations, reasons for accepting or declining the vaccination, and the HCW's knowledge of the influenza vaccine and influenza itself. RESULTS Our study showed that physicians were significantly more likely to have been vaccinated than nurses (38.8% vs 17.4%; p < 0.0001). The main reasons for noncompliance included: supposition of a low risk of infection, fear of side effects, the belief that the influenza vaccine might trigger the influenza virus infection, and scepticism about the effectiveness of the influenza vaccination. CONCLUSION Our findings confirm the importance of a comprehensive approach to the vaccination, ensuring that HCWs are correctly informed about the vaccine and that it is convenient to receive it.
Collapse
|
35
|
Bloomfield SF, Exner M, Dietlein E. [Prevention of infection through hygiene in the home and community. The need for a family-centred approach]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2008; 51:1258-63. [PMID: 19043753 PMCID: PMC7080011 DOI: 10.1007/s00103-008-0695-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Over the past 20 years, infectious disease has moved back up the health agenda, prompting new emphasis on developing strategies for prevention and control, including reduction of spread of infection within the family at home and in their social and work lives outside the home. This paper reviews the various issues that have contributed to this trend. In response to the need for a science-based approach to home hygiene, the International Scientific Forum on Home Hygiene has developed an approach based on risk management which involves identifying the critical control points for preventing the spread of infectious diseases in the home. If we are to be successful in achieving behaviour change in the community, we need to develop a family-centred approach which ensures an understanding of infectious disease agents and their mechanism of spread.
Collapse
Affiliation(s)
- S. F. Bloomfield
- International Scientific Forum on Home Hygiene and London School of Hygiene and Tropical Medicine, London, GB
| | - Martin Exner
- Universität Bonn, Bonn, BRD
- Institut für Hygiene und Öffentliche Gesundheit der Universität Bonn, Sigmund Freud Straße 25, 53105 Bonn, BRD
| | | |
Collapse
|
36
|
The ethics of mandatory vaccination against influenza for health care workers. Vaccine 2008; 26:5562-6. [DOI: 10.1016/j.vaccine.2008.08.002] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2008] [Revised: 07/18/2008] [Accepted: 08/04/2008] [Indexed: 11/22/2022]
|
37
|
Mehta M, Pastor C, Shah B. Achieving optimal influenza vaccination rates: a survey-based study of healthcare workers in an urban hospital. J Hosp Infect 2008; 70:76-9. [DOI: 10.1016/j.jhin.2008.04.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2007] [Accepted: 04/18/2008] [Indexed: 10/21/2022]
|
38
|
Duclos A, Bouhour D, Baptiste C, Launay O, Guiso N. Assessment of individual vaccine status in a vaccinology experts' group. J Eval Clin Pract 2008; 14:610-4. [PMID: 19126179 DOI: 10.1111/j.1365-2753.2008.00946.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
RATIONALE Worldwide, experts in vaccinology have promoted the broad annual coverage of health care workers with the influenza vaccine. Furthermore, pertussis vaccination is now recommended for young adults and health care workers working with newborns. AIM To analyse the compliance with these guidelines among experts responsible for the development or dissemination of national immunization schedules. METHOD A cross-sectional survey was conducted in a vaccinology workshop group of French experts, using a self-administered questionnaire. RESULTS Among 44 experts, the average rate of influenza vaccination was 69.5% (95% confidence interval, 61.6% to 77.3%) between the 2003/04 and 2005/06 flu seasons, whereas the rate of pertussis vaccination during this period was only 30%. The main reasons that the experts gave for not being vaccinated were a lack of time or simply not remembering to do so. CONCLUSION Experts had low coverage rates for influenza and pertussis vaccination. To improve these rates, a multifaceted intervention combining audit and feedback strategy with a vaccine day is planned.
Collapse
Affiliation(s)
- Antoine Duclos
- Département d'Information Médicale des Hospices Civils de Lyon, Pôle IMER, Lyon, France.
| | | | | | | | | | | |
Collapse
|
39
|
Lyon AK, Davies T, Tahir M, Spraggett B. The English Seasonal Flu Immunization Programme for Poultry Workers 2007: a challenging task. J Public Health (Oxf) 2008; 30:245-50. [PMID: 18567571 DOI: 10.1093/pubmed/fdn046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND English Primary Care Trusts (PCTs) immunized the poultry worker population with the seasonal influenza vaccine in the 2007 winter season. METHODS In Warwickshire, the provision of vaccinations progressed in two phases: four weekday evening clinics were offered initially, then one weekend clinic was offered, plus on-site vaccination at three farms and vaccination in general practice. RESULTS There were 253 registered premises in Warwickshire. Eighty-eight persons were vaccinated in five clinics; 131 persons were immunized on-site. Nobody attended their general practice for vaccination; the overall uptake rate was 32%, far exceeding the expected 20%. CONCLUSION On-site vaccination during working hours was by far the most effective method of vaccinating this population; community clinics were not cost-effective, nor were general practices apparently accessed. The number of workers recorded in the contact list of registered poultry premises provided by DEFRA/DH has been shown to be unreliable; this has implications for the future implementation and evaluation of this programme. Immigrant workers within the poultry worker population make communication about the benefits of vaccination and access to primary care an issue, both factors which impact on uptake. Strategies for engaging smaller farms, immigrant and non-registered workers need to be developed.
Collapse
Affiliation(s)
- A K Lyon
- South Birmingham PCT, Birmingham B38 8SR, UK.
| | | | | | | |
Collapse
|
40
|
Chan SSW. Influenza vaccination for healthcare workers: Is it really as effective as we claim? Vaccine 2008; 26:3189. [DOI: 10.1016/j.vaccine.2008.03.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2008] [Accepted: 03/25/2008] [Indexed: 11/28/2022]
|