Partnering with nursing service improves health care worker influenza vaccination rates

Interventions to increase seasonal influenza vaccine coverage in healthcare workers: A systematic review and meta-regression analysis

Influenza vaccination is recommended for healthcare workers (HCWs), but coverage is often low. We reviewed studies evaluating interventions to increase seasonal influenza vaccination coverage in HCWs, including a meta-regression analysis to quantify the effect of each component. Fourty-six eligible studies were identified. Domains conferring a high risk of bias were identified in most studies. Mandatory vaccination was the most effective intervention component (Risk Ratio of being unvaccinated [RRunvacc] = 0.18, 95% CI: 0.08-0.45), followed by "soft" mandates such as declination statements (RRunvacc = 0.64, 95% CI: 0.45-0.92), increased awareness (RRunvacc = 0.83, 95% CI: 0.71-0.97) and increased access (RRunvacc = 0.88, 95% CI: 0.78-1.00). For incentives the difference was not significant, while for education no effect was observed. Heterogeneity was substantial (τ(2) = 0.083). These results indicate that effective alternatives to mandatory HCWs influenza vaccination do exist, and need to be further explored in future studies.

Increasing Influenza Immunization Rates Among Retail Employees: An Evidence-Based Approach

Influenza has a significant impact on the health of Americans and the U.S. economy. Annual influenza immunization can decrease the burden of influenza-related illnesses for both employees and employers. This project evaluated a nurse practitioner–led intervention to increase influenza immunization rates among retail employees from August through December of the 2015-2016 influenza season. The sample included employees from retail locations with on-site convenience care clinics staffed by nurse practitioners. This quality improvement project used a pre–post implementation evaluation design and compared influenza immunization rates of employees, before and after an intervention, at one worksite, and influenza immunization rates of employees, who did not receive the same intervention, at a comparison site. The intervention site employees were immunized at a higher rate than employees at the comparison site. Interventions, including health care professional–led education, program promotion, on-site access to and no-cost immunizations, choice of immunization delivery, and incentives, should be considered to increase immunization rates among employees.

Recommended Health Care Personnel Immunization: Exploring Immunization Rates, Motivators, and Barriers to Immunization in Health Care Personnel

Immunization rates among health care personnel (HCP) have remained low despite advances in vaccine development with reported rates ranging from 27% to 72% for commonly recommended vaccines. Within the United States, HCP are placing patients, families, and themselves at considerable risk for vaccine-preventable diseases. A significant source of infection, HCP are carriers of infectious agents and often unknowingly transmit these contagious diseases while experiencing minimal or no symptoms. This study examined the current immunization rates of HCP for influenza, tetanus, diphtheria, and pertussis (Tdap), and hepatitis B in Nebraska, as well as identified motivators and barriers to vaccination. Nebraska HCP surveyed included physicians, physician assistants, nurse practitioners, registered nurses, licensed practical nurses, medical assistants, nursing assistants, and clerical or administrative staff of nonrestricted ethnic backgrounds age 19 years and older. Nebraska HCP immunization rates were statistically above the national rates. Motivators and barriers were also identified for each vaccine.

Healthcare worker influenza declination form program

BACKGROUND

Health care worker (HCW) vaccination rates have been low for many years (approximately 50%). Our goal was to implement an influenza declination form program (DFP) to assess feasibility, participation, HCW vaccination, and costs.

METHODS

This was a prospective interventional pilot study using mixed methods to evaluate the DFP implementation processes and outcomes. We conducted a formative evaluation and interviews; data were transcribed and coded into themes. Secondary outcomes included self-reported HCW influenza vaccine uptake (pre-/postsurvey) and program costs; data were evaluated using descriptive and bivariate analyses.

RESULTS

The DFP was compatible with ongoing strategies and unit culture. Barriers included multiple hospital shifts and competing demands. Facilitators included complementary ongoing strategies and leadership engagement. HCW vaccination rates were higher post- versus preimplementation (77.4% vs 53.5%, P =.01). To implement the DFP at site 1, using a mobile flu cart, 100% of declination forms were completed in 42.5 staff hours over <2 months. At site 2, using a vaccination table on all staff meeting days, 49% of forms were completed in 26.5 staff hours over 4.5 months. Average cost of staff time was $2,093 per site.

CONCLUSION

DFP implementation required limited resources and resulted in increased HCW influenza vaccine rates; this may have positive clinical implications for influenza infection control/prevention.

Strategies for addressing vaccine hesitancy - A systematic review

The purpose of this systematic review is to identify, describe and assess the potential effectiveness of strategies to respond to issues of vaccine hesitancy that have been implemented and evaluated across diverse global contexts.

METHODS

A systematic review of peer reviewed (January 2007-October 2013) and grey literature (up to October 2013) was conducted using a broad search strategy, built to capture multiple dimensions of public trust, confidence and hesitancy concerning vaccines. This search strategy was applied and adapted across several databases and organizational websites. Descriptive analyses were undertaken for 166 (peer reviewed) and 15 (grey literature) evaluation studies. In addition, the quality of evidence relating to a series of PICO (population, intervention, comparison/control, outcomes) questions defined by the SAGE Working Group on Vaccine Hesitancy (WG) was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria; data were analyzed using Review Manager.

RESULTS

Across the literature, few strategies to address vaccine hesitancy were found to have been evaluated for impact on either vaccination uptake and/or changes in knowledge, awareness or attitude (only 14% of peer reviewed and 25% of grey literature). The majority of evaluation studies were based in the Americas and primarily focused on influenza, human papillomavirus (HPV) and childhood vaccines. In low- and middle-income regions, the focus was on diphtheria, tetanus and pertussis, and polio. Across all regions, most interventions were multi-component and the majority of strategies focused on raising knowledge and awareness. Thirteen relevant studies were used for the GRADE assessment that indicated evidence of moderate quality for the use of social mobilization, mass media, communication tool-based training for health-care workers, non-financial incentives and reminder/recall-based interventions. Overall, our results showed that multicomponent and dialogue-based interventions were most effective. However, given the complexity of vaccine hesitancy and the limited evidence available on how it can be addressed, identified strategies should be carefully tailored according to the target population, their reasons for hesitancy, and the specific context.

Description of an Influenza Vaccination Campaign and Use of a Randomized Survey to Determine Participation Rates

Objectives.

To describe the procedures used during an influenza immunization program and the use of a randomized survey to quantify the vaccination rate among healthcare workers with and without patient contact.

Design.

Influenza immunization vaccination program and a randomized survey.

Setting.

Johns Hopkins University and Health System.

Methods.

The 2008/2009 Johns Hopkins Influenza Immunization Program was administered to 40,000 employees, including 10,763 healthcare workers. A 10% randomized sample (1,084) of individuals were interviewed to evaluate the vaccination rate among healthcare workers with direct patient contact.

Results.

Between September 23, 2008, and April 30, 2009, a total of 16,079 vaccinations were administered. Ninety-four percent (94.5%) of persons who were vaccinated received the vaccine in the first 7 weeks of the campaign. The randomized survey demonstrated an overall vaccination rate of 71.3% (95% confidence interval, 68.6%-74.0%) and a vaccination rate for employees with direct patient contact of 82.8% (95% confidence interval, 80.1%-85.5%). The main reason (25.3%) for declining the program vaccine was because the employee had received documented vaccination elsewhere.

Conclusions.

The methods used to increase participation in the recent immunization program were successful, and a randomized survey to assess participation was found to be an efficient means of evaluating the workforce's level of potential immunity to the influenza virus.

Linking emergency preparedness and health care worker vaccination against influenza: a novel approach

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.

Control of influenza in healthcare settings: early lessons from the 2009 pandemic

PURPOSE OF REVIEW

The emergence of 2009 pandemic H1N1 influenza A (pH1N1) has provided a unique challenge to influenza control in healthcare settings. We provide an overview of the early lessons from the 2009 pandemic.

RECENT FINDINGS

The modes of influenza transmission and their contributions to the development of infections remain unclear. Recent studies in the guinea pig model have demonstrated airborne transmission, but data from human studies and outbreaks are inconclusive. Data on physical interventions to prevent transmission support the use of hand hygiene, gowns, gloves, face shields and respiratory protection. The effectiveness of surgical masks compared to N95 respirators has been investigated, and there is evidence from one trial that surgical masks are noninferior to N95 respirators in preventing infection. Experiences with mandatory vaccination suggest that this is a highly successful approach to increase healthcare personnel vaccination rates. Lessons from pH1N1 have multiple implications for future pandemic preparedness planning.

SUMMARY

Further research is needed on appropriate respiratory protection for influenza. Mandatory vaccination programs should be considered in all healthcare settings. Pandemic preparedness plans should be revised, focusing on flexibility, communication, stockpiling of essential supplies, and staffing support for infection control.

Controversies in vaccine mandates

Policies that mandate immunization have always been controversial. The controversies take different forms in different contexts. For routine childhood immunizations, many parents have fears about both short- and long-term side effects. Parental worries change as the rate of vaccination in the community changes. When most children are vaccinated, parents worry more about side effects than they do about disease. Because of these worries, immunization rates go down. As immunization rates go down, disease rates go up, and parents worry less about side effects of vaccination and more about the complications of the diseases. Immunization rates then go up. For teenagers, controversies arise about the criteria that should guide policies that mandate, rather than merely recommend and encourage, certain immunizations. In particular, policy makers have questioned whether immunizations for human papillomavirus, or other diseases that are not contagious, should be required. For healthcare workers, debates have focused on the strength of institutional mandates. For years, experts have recommended that all healthcare workers be immunized against influenza. Immunizations for other infections including pertussis, measles, mumps, and hepatitis are encouraged but few hospitals have mandated such immunizations-instead, they rely on incentives and education. Pandemics present a different set of problems as people demand vaccines that are in short supply. These issues erupt into controversy on a regular basis. Physicians and policy makers must respond both in their individual practices and as advisory experts to national and state agencies. The articles in this volume will discuss the evolution of national immunization programs in these various settings. We will critically examine the role of vaccine mandates. We will discuss ways that practitioners and public health officials should deal with vaccine refusal. We will contrast responses of the population as a whole, within the healthcare setting, and in the setting of pandemic influenza.