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Rykowska D, Sobierajski T, Okarska-Napierała M, Wanke-Rytt M, Kuchar E. Influenza vaccination from the perspective of health care workers at university hospitals. PLoS One 2023; 18:e0288470. [PMID: 37478110 PMCID: PMC10361510 DOI: 10.1371/journal.pone.0288470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 06/28/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND The influenza vaccination rate of healthcare workers (HWs) in Poland is low. Before implementing methods for promoting influenza vaccination, it is crucial to identify attitudes towards vaccination. We aimed to examine the knowledge and attitudes towards influenza vaccination of HWs at university hospitals. Moreover, we evaluated the incentives for getting influenza vaccination among HWs. METHODS From September 2020 to October 2020, we surveyed HWs in one children's hospital and two adults' hospitals in Warsaw (Poland). We included only fully and correctly completed surveys into final analysis. RESULTS A total of 950 questionnaires (85% women, 45% <40 years old, 33% physicians and 48% nurses, 56% working in a children's hospital) were evaluated. Of all HWs, 25% declared they were vaccinated and 54% planned to get vaccinated in the next season. We have analyzed attitudes towards influenza vaccination and motivations to get vaccinated. CONCLUSIONS Among HWs in academic hospitals, males, people <40 years old, physicians and those working in children's hospital are more likely to get vaccinated and their attitudes towards influenza vaccination are more positive. Of those less likely to get vaccinated, people >40 years old and nurses could be effectively persuaded by free and on-site influenza vaccination. Moreover, free access to vaccination is the strongest motivator for vaccination among all HWs. The attitudes towards mandatory influenza vaccination differ sharply among HWs-while physicians are ready to accept it, nurses are not. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04569019.
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Affiliation(s)
- Dominika Rykowska
- Department of Pediatrics with Clinical Assessment Unit, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Sobierajski
- Faculty of Applied Social Sciences and Resocialization, University of Warsaw, Warsaw, Poland
| | | | - Monika Wanke-Rytt
- Department of Pediatrics with Clinical Assessment Unit, Medical University of Warsaw, Warsaw, Poland
| | - Ernest Kuchar
- Department of Pediatrics with Clinical Assessment Unit, Medical University of Warsaw, Warsaw, Poland
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Flu and COVID-19 Vaccination: What Happens to the Flu Shot When the Campaigns Overlap? Experience from a Large Italian Research Hospital. Vaccines (Basel) 2022; 10:vaccines10060976. [PMID: 35746583 PMCID: PMC9228127 DOI: 10.3390/vaccines10060976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 12/14/2022] Open
Abstract
Influenza represents a threat to global health and health care workers (HCWs) have an increased risk of contracting the influenza virus in the workplace. The COVID-19 pandemic has brought back the importance of influenza vaccination, as the influenza virus can circulate together with SARS-CoV-2. The aim of this report is to describe the actual flu vaccination coverage among healthcare workers of a research hospital and the trend changes, with respect to the past flu vaccination campaigns, in light of the present pandemic and COVID-19 vaccination. A Pearson’s χ2 test was used to test the correlation of flu vaccination coverage, across all professional categories, between the last two years. A linear regression model was adopted to predict the total vaccination coverage of this year. A statistically significant decrease (p < 0.01) was observed in vaccination coverage among all the professional categories with a 50% reduction in vaccination trends between the last two years. Analyzing the data from the previous six flu vaccination campaigns, the expected value, according to the linear regression model, was estimated to be 38.5% while the observed value was 24%. The decrease in vaccination coverage may be due to the fear of the pandemic situation and especially to the uncertainty related to the consequences of a concurrent administration which may overload the immune system or may be more reactogenic. The COVID-19 pandemic represents an opportunity to promote and support large-scale influenza vaccination among HCWs through structured programs, adequate funding, and tailored communication strategies.
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Sutcliffe K, Kneale D, Thomas J. 'Leading from the front' implementation increases the success of influenza vaccination drives among healthcare workers: a reanalysis of systematic review evidence using Intervention Component Analysis (ICA) and Qualitative Comparative Analysis (QCA). BMC Health Serv Res 2022; 22:653. [PMID: 35578203 PMCID: PMC9108687 DOI: 10.1186/s12913-022-08001-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 04/22/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Seasonal influenza vaccination of healthcare workers (HCW) is widely recommended to protect staff and patients. A previous systematic review examined interventions to encourage uptake finding that hard mandates, such as loss of employment for non-vaccination, were more effective than soft mandates, such as signing a declination form, or other interventions such as incentives. Despite these overarching patterns the authors of the review concluded that 'substantial heterogeneity' remained requiring further analysis. This paper reanalyses the evidence using Intervention Component Analysis (ICA) and Qualitative Comparative Analysis (QCA) to examine whether the strategies used to implement interventions explain the residual heterogeneity. METHODS We used ICA to extract implementation features and trialists' reflections on what underpinned the success of the intervention they evaluated. The ICA findings then informed and structured two QCA analyses to systematically examine associations between implementation features and intervention outcomes. Analysis 1 examined hard mandate studies. Analysis 2 examined soft mandates and other interventions. RESULTS In Analysis 1 ICA revealed the significance of 'leading from the front' rather than 'top-down' implementation of hard mandates. Four key features underpinned this: providing education prior to implementation; two-way engagement so HCW can voice concerns prior to implementation; previous use of other strategies so that institutions 'don't-go-in-cold' with hard-mandates; and support from institutional leadership. QCA revealed that either of two configurations were associated with greater success of hard mandates. The first involves two-way engagement, leadership support and a 'don't-go-in-cold' approach. The second involves leadership support, education and a 'don't-go-in-cold' approach. Reapplying the 'leading from the front' theory in Analysis 2 revealed similar patterns. CONCLUSIONS Regardless of intervention type a 'leading from the front' approach to implementation will likely enhance intervention success. While the results pertain to flu vaccination among HCWs, the components identified here may be relevant to public health campaigns regarding COVID-19 vaccination.
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Affiliation(s)
- Katy Sutcliffe
- EPPI-Centre, Social Research Institute, UCL Institute of Education, University College London, London, UK.
| | - Dylan Kneale
- EPPI-Centre, Social Research Institute, UCL Institute of Education, University College London, London, UK
| | - James Thomas
- EPPI-Centre, Social Research Institute, UCL Institute of Education, University College London, London, UK
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Frisina PG, Ingraffia ST, Brown TR, Munene EN, Pletcher JR, Kolligian J. Increasing influenza immunization rates among healthcare providers in an ambulatory-based, University Healthcare Setting☆. Int J Qual Health Care 2020; 31:698-703. [PMID: 30624657 DOI: 10.1093/intqhc/mzy247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 10/18/2018] [Accepted: 12/14/2018] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Despite its 'best practice' status as an intervention to combat healthcare-related influenza, many healthcare personnel (HCP) do not seek vaccinations themselves. The objective of this study was to achieve the Healthy People [HP] 2020's influenza vaccination goal of 90% among our HCP. DESIGN The study utilized the model for improvement, consisting of Plan-Do-Study-Act (PDSA) cycles. Each influenza season served as a PDSA cycle until the HP 2020 vaccination goal was achieved. The quality improvement (QI) study was conducted over four influenza seasons (i.e. 2014-15; 2015-16; 2016-17 and 2017-18). SETTING The study's setting was an ambulatory-based, university health center within a suburban university located in central New Jersey. PARTICIPANTS Adapting the National Vaccine Advisory Committee's definition of HCP, clinical and non-clinical staff members (n = 110) participated in the QI-study. INTERVENTIONS QI-interventions were centered on staff education/outreach, improved accessibility to influenza vaccines and frequent communication to staff over several PDSA cycles. MAIN OUTCOME & RESULTS The QI-interventions significantly increased our overall vaccination coverage on our influenza vaccination status survey from 70.2% (2011-14 influenza seasons; n = 102) to 84.9% (2014-15 influenza season; n = 93) in PDSA 1, and 91.1% (2015-16 influenza season; n = 90) in PDSA cycle 2 (χ2 = 309.53, P < 0.001). Vaccination rates remained above the 90% performance goal during our quality control/assurance measuring periods (i.e. the 2016-18 influenza seasons). CONCLUSIONS This study demonstrates that influenza vaccination coverage can significantly improve among HCP through the application of concurrent and multifaceted QI-interventions.
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Affiliation(s)
- Pasquale G Frisina
- Department of Quality and Performance Improvement, McCosh Health Center, Princeton University, University Health Services, Princeton, New Jersey NJ, USA
| | - Sara T Ingraffia
- Department of Quality and Performance Improvement, McCosh Health Center, Princeton University, University Health Services, Princeton, New Jersey NJ, USA
| | - Tanesha R Brown
- Department of Quality and Performance Improvement, McCosh Health Center, Princeton University, University Health Services, Princeton, New Jersey NJ, USA
| | - Esther N Munene
- Department of Quality and Performance Improvement, McCosh Health Center, Princeton University, University Health Services, Princeton, New Jersey NJ, USA
| | - Jonathan R Pletcher
- Department of Quality and Performance Improvement, McCosh Health Center, Princeton University, University Health Services, Princeton, New Jersey NJ, USA
| | - John Kolligian
- Department of Quality and Performance Improvement, McCosh Health Center, Princeton University, University Health Services, Princeton, New Jersey NJ, USA
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Attitudes of Nursing Home Staff Towards Influenza Vaccination: Opinions and Factors Influencing Hesitancy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17061851. [PMID: 32178426 PMCID: PMC7143910 DOI: 10.3390/ijerph17061851] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 03/09/2020] [Accepted: 03/11/2020] [Indexed: 11/17/2022]
Abstract
Seasonal influenza is recognized to be a significant public health problem and a cause of death, especially in fragile persons. In nursing homes (NHs), vaccination for both residents and staff is the best preventive strategy. However, professionals' immunization rates are far from reaching the international recommended values. This study aims to describe the adherence and attitudes of NH staff towards flu vaccination and to explore staff hesitancy. A questionnaire was developed based on a literature review and on the 3Cs (confidence, complacency, convenience) of the WHO framework and administered among the staff of four NHs of a province in the northeast of Italy. Results demonstrated a low adherence towards annual vaccination (i.e., only 3% declared getting the flu vaccination each year). Complacency, confidence and convenience all showed a significant impact on the attitude towards vaccination both in univariate and multivariable analysis, with complacency being the most strongly associated area. The area of confidence resulted in strongly challenging factors. Only 24.8% of interviewees appeared trustful towards the efficacy of receiving immunization and 34% declared safety issues. Insights from the study can support the implementation of effective interventions to improve vaccination adherence in NHs. Specifically, increasing complacency by raising awareness related to the risks of influenza appears to be an essential strategy to effectively promote vaccination uptake.
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Van Hooste WLC, Bekaert M. To Be or Not to Be Vaccinated? The Ethical Aspects of Influenza Vaccination among Healthcare Workers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16203981. [PMID: 31635299 PMCID: PMC6844122 DOI: 10.3390/ijerph16203981] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 10/12/2019] [Accepted: 10/16/2019] [Indexed: 11/16/2022]
Abstract
Influenza is a highly contagious airborne disease with a significant morbidity and mortality burden. Seasonal influenza (SI) vaccination has been recommended for healthcare workers (HCWs) for many years. Despite many efforts to encourage HCWs to be immunized against influenza, vaccination uptake remains suboptimal. Sometimes there is a significant sign of improvement, only if numerous measures are taken. Is 'the evidence' and 'rationale' sufficient enough to support mandatory influenza vaccination policies? Most voluntary policies to increase vaccination rates among HCWs have not been very effective. How to close the gap between desired and current vaccination rates? Whether (semi)mandatory policies are justified is an ethical issue. By means of a MEDLINE search, we synthesized the most relevant publications to try to answer these questions. Neither the 'clinical' Hippocratic ethics (the Georgetown Mantra: autonomy, beneficence, non-maleficence, and justice), nor the 'public health' ethics frameworks resolve the question completely. Therefore, recently the 'components of justice' framework was added to the ethical debate. Most options to increase the uptake arouse little ethical controversy, except mandatory policies. The success of vaccination will largely depend upon the way the ethical challenges like professional duty and ethics (deontology), self-determination, vaccine hesitance, and refusal ('conscientious objector') are dealt with.
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Affiliation(s)
- Wim Leo Celina Van Hooste
- Occupational Health Services-External Service for Prevention and Protection at Work, Opvoedingstraat 143, B-9000 Gent, Belgium.
| | - Micheline Bekaert
- Occupational Health Services-External Service for Prevention and Protection at Work, Opvoedingstraat 143, B-9000 Gent, Belgium.
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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.
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Affiliation(s)
| | - Gina Lockwood
- 1 Connecticut Children's Medical Center, Hartford, CT
| | | | - Donna Donovan
- 1 Connecticut Children's Medical Center, Hartford, CT
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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.
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Lytras T, Kopsachilis F, Mouratidou E, Papamichail D, Bonovas S. Interventions to increase seasonal influenza vaccine coverage in healthcare workers: A systematic review and meta-regression analysis. Hum Vaccin Immunother 2017; 12:671-81. [PMID: 26619125 DOI: 10.1080/21645515.2015.1106656] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
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.
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Affiliation(s)
- Theodore Lytras
- a Department of Epidemiological Surveillance and Intervention , Hellenic Centre for Disease Control and Prevention , Athens , Greece.,b Centre for Research in Environmental Epidemiology (CREAL) , Barcelona , Spain.,c Department of Experimental and Health Sciences , Universitat Pompeu Fabra (UPF) , Barcelona , Spain
| | - Frixos Kopsachilis
- d Department of Occupational and Industrial Hygiene , National School of Public Health , Athens , Greece
| | - Elisavet Mouratidou
- a Department of Epidemiological Surveillance and Intervention , Hellenic Centre for Disease Control and Prevention , Athens , Greece
| | - Dimitris Papamichail
- e Department of Child Health , National School of Public Health , Athens , Greece
| | - Stefanos Bonovas
- f Humanitas Clinical and Research Center , Rozzano , Milan , Italy
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Patel GP, Crank CW, Black S. Therapeutic Interventions for the Treatment and Control of Influenza. J Pharm Technol 2016. [DOI: 10.1177/875512250702300204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective:To review antiviral management of influenza and discuss recent developments in antiviral resistance.Data Sources:Literature retrieval was accessed through MEDLINE/PubMed (1977–February 2007) using the terms influenza, resistance, adamantanes, and neuraminidase inhibitors, treatment, and prevention. In addition, reference citations from identified publications were reviewed.Study Selection and Data Extraction:All articles in English identified from the data sources were evaluated.Data Synthesis:Infection with influenza is associated with 36,000 deaths and more than 200,000 hospitalizations in the US each year and results in a large economic burden on society. We reviewed 7 trials describing management of influenza; the results showed that 92% of influenza cases demonstrated adamantane resistance in 2005. Selection of treatment for influenza with a neuraminidase inhibitor should be based on patient preference, past medical history, and managed care restrictions since one agent has not demonstrated superiority. Early initiation of treatment, within 12 hours of symptom onset (compared with 48 h), has resulted in illness being shortened by more than 3 days. Conclusions shown in the trials reviewed here regarding the consequences of increasing incidence of influenza A resistance include: viral surveillance cultures are important, influenza has a significant global impact, and inappropriate use of antiinfective agents results in local and global resistance.Conclusions:Therapeutic options for the management of influenza include the neuraminidase inhibitors, zanamavir and oseltamivir. Unfortunately, new classes of antiviral drugs for influenza will not be forthcoming in the near future. Adamantane resistance is now commonly demonstrated in influenza. At this time, efforts should be made to minimize patient risk for infection.
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Affiliation(s)
- Gourang P Patel
- GOURANG P PATEL PharmD BCPS, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Rush University Medical Center and Rush Medical College, Chicago, IL
| | - Christopher W Crank
- CHRISTOPHER W CRANK PharmD BCPS, Section of Infectious Disease, Department of Internal Medicine, Rush University Medical Center and Rush Medical College
| | - Stephanie Black
- STEPHANIE BLACK MD, Section of Infectious Disease, Department of Internal Medicine, Rush University Medical Center and Rush Medical College
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Lee LM. Adding justice to the clinical and public health ethics arguments for mandatory seasonal influenza immunisation for healthcare workers. JOURNAL OF MEDICAL ETHICS 2015; 41:682-686. [PMID: 25687674 DOI: 10.1136/medethics-2014-102557] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 01/14/2015] [Indexed: 06/04/2023]
Abstract
Ethical considerations from both the clinical and public health perspectives have been used to examine whether it is ethically permissible to mandate the seasonal influenza vaccine for healthcare workers (HCWs). Both frameworks have resulted in arguments for and against the requirement. Neither perspective resolves the question fully. By adding components of justice to the argument, I seek to provide a more fulsome ethical defence for requiring seasonal influenza immunisation for HCWs. Two critical components of a just society support requiring vaccination: fairness of opportunity and the obligation to follow democratically formulated rules. The fairness of opportunity is informed by Rawls' two principles of justice. The obligation to follow democratically formulated rules allows us to focus simultaneously on freedom, plurality and solidarity. Justice requires equitable participation in and benefit from cooperative schemes to gain or profit socially as individuals and as a community. And to be just, HCW immunisation exemptions should be limited to medical contraindications only. In addition to the HCWs fiduciary duty to do what is best for the patient and the public health duty to protect the community with effective and minimally intrusive interventions, HCWs are members of a just society in which all members have an obligation to participate equitably in order to partake in the benefits of membership.
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Carrots and Sticks: Achieving High Healthcare Personnel Influenza Vaccination Rates without a Mandate. Infect Control Hosp Epidemiol 2015; 36:717-24. [DOI: 10.1017/ice.2015.47] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVEAchieving high healthcare personnel (HCP) influenza vaccination rates has typically required mandating vaccination, which is often challenging to implement. Our objective was to achieve >90% employee influenza vaccination without a mandate.DESIGNProspective quality improvement initiativeSETTING AND PARTICIPANTSAll employees of a 2-hospital, 1,100-bed, community-based academic healthcare system.METHODSThe multimodal HCP vaccination campaign consisted of a mandatory declination policy, mask-wearing for non-vaccinated HCP, highly visible “I’m vaccinated” hanging badges, improved vaccination tracking, weekly compliance reports to managers and vice presidents, disciplinary measures for noncompliant HCP, vaccination stations at facility entrances, and inclusion of a target employee vaccination rate (>75%) metric in the annual employee bonus program. The campaign was implemented in the 2011–2012 influenza season and continued throughout the 2012–2013 through 2014–2015 influenza seasons. Employee compliance, vaccination, exemption and declination rates were calculated and compared with those of the seasons prior to the intervention.RESULTSCompared with vaccination rates of 57%–72% in the 3 years preceding the intervention, employee influenza vaccination increased to 92% in year 1 and 93% in years 2–4 (P<.001). The proportion of employees declaring medical/religious exemptions or declining vaccination decreased during the 4 years of the program (respectively, 1.2% to 0.5%,P<.001; 4.4% to 3.8%,P=.001).CONCLUSIONSAn integrated multimodal approach incorporating peer pressure, accountability, and financial incentives was associated with increased employee vaccination rate from ≤72% to ≥92%, which has been sustained for 4 influenza seasons. Such programs may provide a model for behavioral change within healthcare organizations.Infect Control Hosp Epidemiol2015;00(0): 1–8
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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.
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Health care worker influenza vaccination in Oregon nursing homes: correlates of facility characteristics. J Am Med Dir Assoc 2014; 15:847-8. [PMID: 25284164 DOI: 10.1016/j.jamda.2014.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 08/12/2014] [Indexed: 11/22/2022]
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Winston L, Wagner S, Chan S. Healthcare workers under a mandated H1N1 vaccination policy with employment termination penalty: a survey to assess employee perception. Vaccine 2014; 32:4786-90. [PMID: 24996124 DOI: 10.1016/j.vaccine.2014.06.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Revised: 04/21/2014] [Accepted: 06/02/2014] [Indexed: 11/26/2022]
Abstract
The ethical debate over mandatory healthcare worker (HCW) influenza vaccination is a heated one. Our study hospital instituted a mandatory employee influenza vaccination policy for the 2009-2010 influenza season during the highly publicized pandemic of the H1N1 "Swine Flu." Under this mandate there was no informed declination option, and termination of employment was the consequence for noncompliance. Our objective was to examine HCW perceptions of the H1N1 influenza virus, the vaccine, and the strict mandated vaccination policy. A survey was designed, distributed, and anonymously collected. In total, 202 completed questionnaires were obtained via accidental sampling by the investigators achieving a 100% response rate. Data analysis showed that 31.7% of surveyed HCWs felt the mandate was an infringement on their rights and 3.5% of HCWs would electively seek employment elsewhere. Significantly more nurses and clerks/technicians were opposed to the mandate compared to other types of employees. 96% felt that the mandating hospital should be liable should a significant adverse effect occur from receiving the vaccine. While the mandate helped to increase HCW influenza vaccination rates dramatically, the strict consequence of employment termination created negative feelings of coercion. Adopting a policy that includes a declination option with mandatory masking during influenza season might be a more widely acceptable and still adequate approach.
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Affiliation(s)
- Lori Winston
- CEP America, Kaweah Delta Health Care District, Visalia, CA, United States; University of California at Irvine and American University of Antigua, United States.
| | - Stephanie Wagner
- Infinity Healthcare, Sacred Heart Hospital Eau Claire, WI, United States
| | - Shu Chan
- Presence Resurrection Medical Center, Chicago, IL, United States; University of Illinois at Chicago, United States
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Sullivan SJ, Jacobson R, Poland GA. Mandating influenza vaccination for healthcare workers. Expert Rev Vaccines 2014; 8:1469-74. [DOI: 10.1586/erv.09.118] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Zimmerman RK. Ethical analyses of institutional measures to increase health care worker influenza vaccination rates. Vaccine 2013; 31:6172-6. [PMID: 24188752 DOI: 10.1016/j.vaccine.2013.10.066] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 10/18/2013] [Accepted: 10/22/2013] [Indexed: 10/26/2022]
Abstract
Health care worker (HCW) influenza vaccination rates are modest. This paper provides a detailed ethical analysis of the major options to increase HCW vaccination rates, comparing how major ethical theories would address the options. The main categories of interventions to raise rates include education, incentives, easy access, competition with rewards, assessment and feedback, declination, mandates with alternative infection control measures, and mandates with administrative action as consequences. The aforementioned interventions, except mandates, arouse little ethical controversy. However, these efforts are time and work intensive and rarely achieve vaccination rates higher than about 70%. The primary concerns voiced about mandates are loss of autonomy, injustice, lack of due process, and subsuming the individual for institutional ends. Proponents of mandates argue that they are ethical based on beneficence, non-maleficence, and duty. A number of professional associations support mandates. Arguments by analogy can be made by mandates for HCW vaccination against other diseases. The ethical systems used in the analyses include evolutionary ethics, utilitarianism, principalism (autonomy, beneficence, non-maleficence, and justice), Kantism, and altruism. Across these systems, the most commonly preferred options are easy access, assessment and feedback, declinations, and mandates with infection control measures as consequences for non-compliance. Given the ethical imperatives of non-maleficence and beneficence, the limited success of lower intensive interventions, and the need for putting patient safety ahead of HCW convenience, mandates with additional infection control measures as consequences for non-compliance are preferred. For those who opt out of vaccination due to conscience concerns, such mandates provide a means to remain employed but not put patient safety at risk.
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Affiliation(s)
- Richard K Zimmerman
- Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh, 3518 Fifth Avenue, Pittsburgh, PA 15261, United States.
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Simpson CR, McMenamin J. Pandemic influenza vaccination for healthcare workers in primary care: good progress, but higher uptake required. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2013; 21:246-7. [PMID: 22885562 DOI: 10.4104/pcrj.2012.00081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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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.
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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: 107] [Impact Index Per Article: 8.9] [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.
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Affiliation(s)
- Helge Hollmeyer
- International Health Regulations Coordination Department, World Health Organization, Geneva, Switzerland.
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Llupià A, García-Basteiro AL, Olivé V, Costas L, Ríos J, Quesada S, Varela P, Bayas JM, Trilla A. New interventions to increase influenza vaccination rates in health care workers. Am J Infect Control 2010; 38:476-81. [PMID: 20421140 DOI: 10.1016/j.ajic.2010.01.013] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2009] [Revised: 01/20/2010] [Accepted: 01/20/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND The most effective strategy for avoiding nosocomial influenza outbreaks is through vaccination of health care workers (HCWs). In Spain, HCW vaccination coverage rarely exceeds 25%. The objective of this study was to determine whether an active vaccination campaign promoting communication among HCWs increased influenza vaccination coverage rates and permitted a shorter campaign. METHODS This was a before-after trial, comparing free mobile vaccination teams without and with strategies promoting HCW involvement by means of weekly educational and promotional messages through electronic mail, including 2 prize draws for vaccinated HCWs and a Web page including pictures of vaccinated HCWs and all senior hospital management. Weekly coverages were publicized, the staff of mobile units was increased, and their routes in the hospital were advertised. The study population was >4500 HCWs (permanent and temporary staff) at a Spanish university hospital during the 2007-08 and 2008-09 influenza seasons. RESULTS Coverage was 23% (95% confidence interval [CI], 22.5%-24.9%) in the 2007-08 season and 37% (95% CI, 34.7%-37.4%) in 2008-09 season. The vaccination rate was highest in HCWs aged > or =65 years and in physicians. The weekly vaccination rates were significantly higher for the 2008-09 season compared with the 2007-08 season except for the first and third weeks; for example, in week 2, the rate was 1.7 HCWs per 100 persons-week (95% CI, 1.3-2.1) in 2007-08, compared with 3.7 HCWs per 100 persons-week (95% CI, 3.2-4.4) in 2009-09. Rate increases were concentrated in the first weeks of the program, with a peak occurring in week 3 during the 2007-08 season and in week 2 during the 2008-09 season. CONCLUSION This intervention improved influenza vaccination coverage of HCWs and allowed more rapid achievement of higher coverage.
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Affiliation(s)
- Anna Llupià
- Preventive Medicine and Epidemiology Unit, Institut d'investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic of Barcelona, Barcelona, Spain.
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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.
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Anikeeva O, Braunack-Mayer A, Rogers W. Requiring influenza vaccination for health care workers. Am J Public Health 2008; 99:24-9. [PMID: 19008501 DOI: 10.2105/ajph.2008.136440] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Annual influenza vaccination for health care workers has the potential to benefit health care professionals, their patients, and their families by reducing the transmission of influenza in the health care setting. Furthermore, staff vaccination programs are cost-effective for health care institutions because of reduced staff illness and absenteeism. Despite international recommendations and strong ethical arguments for annual influenza immunization for health care professionals, staff utilization of vaccination remains low. We have analyzed the ethical implications of a variety of efforts to increase vaccination rates, including mandatory influenza vaccination. A program of incentives and sanctions may increase health care worker compliance with fewer ethical impediments than mandatory vaccination.
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Affiliation(s)
- Olga Anikeeva
- Discipline of Public Health, School of Population Health and Clinical Practice, Mail Drop 207, The University of Adelaide, Adelaide SA 5005, Australia
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What's public? What's private? Policy trade-offs and the debate over mandatory annual influenza vaccination for health care workers. Canadian Journal of Public Health 2008. [PMID: 18615940 PMCID: PMC6975919 DOI: 10.1007/bf03405472] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Policy decisions about public health services differ from those for personal health services. Both require trade-offs between such policy goals as liberty, security, efficiency, and equity. In public health, however, decisions about who will approve, pay for, and deliver services are often accompanied by decisions on when and how to compel individual behaviour. Policy becomes complex because different stakeholders interpret evidence differently: stakeholders may assign different weights to policy goals and may even define the same goals differently. In the debate over mandatory annual influenza vaccination for health care workers, for example, proponents as well as opponents of mandatory vaccination may convey arguments in security terms. Those in favour of mandatory vaccination emphasize subclinical infections and duty of care (public security) while those opposed emphasize risk of adverse events (personal security). Proponents assert less worker absenteeism (efficiency) while opponents stress coercion and alternate personal infection control measures (liberty and individual rights/responsibilities). Consequently, stakeholders talk past each other. Determining the place of mandatory influenza vaccination for health care workers thus demands reconciling policy trade-offs and clarifying the underlying disputes hidden in the language of the policy debate.
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