Influenza Vaccination of Healthcare Workers in the United States, 1989-2002

Seasonal Influenza Vaccination Coverage Trends Among Adult Populations, U.S., 2010-2016

INTRODUCTION

Influenza is a major cause of morbidity and mortality among adults. The most effective strategy for preventing influenza is annual vaccination. However, vaccination coverage has been suboptimal among adult populations. The purpose of this study is to assess trends in influenza vaccination among adult populations.

METHODS

Data from the 2010-2016 National Health Interview Survey were analyzed in 2018 to estimate vaccination coverage during the 2010-2011 through 2015-2016 seasons. Trends of vaccination in recent years were assessed. Vaccination coverage by race/ethnicity within each group was examined. Multivariable logistic regression and predictive marginal models were conducted to identify factors associated with vaccination, and interactions between race/ethnicity and other demographic and access-to-care characteristics were assessed.

RESULTS

Vaccination coverage among adults aged ≥18 years increased from 38.3% in the 2010-2011 season to 43.4% in the 2015-2016 season, with an average increase of 1.3 percentage points annually. From the 2010-2011 through 2015-2016 seasons, coverage was stable for adults aged ≥65 years and changed by -0.1 to 9.9 percentage points for all other examined subgroups. Coverage in 2015-2016 was 70.4% for adults aged ≥65 years, 46.4% for those aged 50-64 years, and 32.3% for those aged 18-49 years; 47.9% for people aged 18-64 years with high-risk conditions; 64.8% for healthcare personnel; and 50.3% for pregnant women. Among adults aged ≥18 years for the 2015-2016 season, coverage was significantly lower among non-Hispanic blacks and Hispanics compared with non-Hispanic whites.

CONCLUSIONS

Overall, influenza vaccination coverage among adults aged ≥18 years increased during 2010-2016, but it remained below the national target of 70%. Vaccination coverage varied by age, risk status, race/ethnicity, healthcare personnel, and pregnancy status. Targeted efforts are needed to improve coverage and reduce disparities.

Determinants of influenza vaccination among solid organ transplant recipients attending Sicilian reference center

Among solid organ transplant recipients, influenza infection is commonly associated with higher morbidity and mortality than immunocompetent hosts. Therefore, in these subjects influenza vaccination is of paramount importance. The main objective of the study was to assess compliance to vaccination and analyze factors associated with influenza vaccination of solid organ transplant recipients admitted to the Sicilian solid organ transplant Reference Center IRCCS-ISMETT in Palermo during 2014-2015 influenza season. Thirty one (37.8%) out of 82 solid organ transplant recipients were vaccinated against influenza. The main reason for vaccination refusal was fear of adverse reaction (n = 16, 31.4%), impaired health status (n = 14, 27.4%) and low vaccine efficacy (n = 10, 19.6%). Vaccinated solid organ transplant recipients compare with unvaccinated had smaller hospital admissions for infectious respiratory diseases (9.7% Vs 23.5%) during surveillance period. On multivariate analysis the factors positively associated with influenza vaccination were the advice of Reference Center physicians (OR 53.4, p < 0.001) and to perform vaccine against pneumococcus (OR 7.0, p = 0.016). This study showed that Reference Center physicians play a key role on vaccine communication and recommendation for patients at risk and it underlines the effectiveness of influenza vaccination in solid organ transplant recipients. However, it remains that, although physician advice resulted a strong determinant for vaccination, influenza vaccination coverage in this subset of population remains still unsatisfactory.

Influenza vaccination among workers-21 U.S. states, 2013

BACKGROUND

Influenza illnesses can result in missed days at work and societal costs, but influenza vaccination can reduce the risk of disease. Knowledge of vaccination coverage by industry and occupation can help guide prevention efforts and be useful during influenza pandemic planning.

METHODS

Data from 21 states using the 2013 Behavioral Risk Factor Surveillance System industry-occupation module were analyzed. Influenza vaccination coverage was reported by select industry and occupation groups, including health care personnel (HCP) and other occupational groups who may have first priority to receive influenza vaccination during a pandemic (tier 1). The t tests were used to make comparisons between groups.

RESULTS

Influenza vaccination coverage varied by industry and occupation, with high coverage among persons in health care industries and occupations. Approximately half of persons classified as tier 1 received influenza vaccination, and vaccination coverage among tier 1 and HCP groups varied widely by state.

CONCLUSIONS

This report points to the particular industries and occupations where improvement in influenza vaccination coverage is needed. Prior to a pandemic event, more specificity on occupational codes to define exact industries and occupations in each tier group would be beneficial in implementing pandemic influenza vaccination programs and monitoring the success of these programs.

Racial and Ethnic Disparities in Influenza Vaccination among Adults with Chronic Medical Conditions Vary by Age in the United States

BACKGROUND

People living with chronic health conditions exhibit higher risk for developing severe complications from influenza according to the Centers for Diseases Control and Prevention. Although racial and ethnic disparities in influenza vaccination have been documented, it has not been comprehensively determined whether similar disparities are present among the adult population with at least one such condition.

OBJECTIVE

To study if racial and ethnic disparities in relation to influenza vaccination are present in adults suffering from at least one chronic condition and if such inequalities differ between age groups.

METHODS

The Medical Expenditure Panel Survey (2011-2012) was used to study the adult population (age ≥18) who had at least one chronic health condition. Baseline differences in population traits across racial and ethnic groups were identified using a chi-square test. This was conducted among various age groups. In addition, survey logistic regression was utilized to produce odds ratios of receiving influenza vaccination annually between racial and ethnic groups.

RESULTS

The total sample consisted of 15,499 adults living with at least one chronic health condition. The numbers of non-Hispanic whites (whites), non-Hispanic blacks (blacks), and Hispanics were 8,658, 3,585, and 3,256, respectively. Whites (59.93%) were found to have a higher likelihood of self-reporting their receipt of the influenza vaccine in comparison to the black (48.54%) and Hispanic (48.65%) groups (P<0.001). When examining persons aged 50-64 years and ≥65 years, it was noted that the black (54.99%, 62.72%) and Hispanic (53.54%, 64.48%) population had lower rates of influenza vaccine coverage than the white population (59.22%, 77.89) (both P<0.0001). No significant differences between whites and the blacks or Hispanics were found among the groups among adults between 18 and 49 inclusive (P>0.05). After controlling for patient characteristics, the difference in influenza vaccine coverage between whites and the minority groups were no longer significant for adults aged 50-64 years. However, the difference were still statistically significant for those aged ≥65 years.

CONCLUSIONS

In the United States, there are significant disparities in influenza vaccination by race and ethnicity for adults over 65 years with at least one chronic health condition. Future research is needed to help develop more targeted interventions to address these issues and improve influenza vaccination rates.

Influenza Vaccination of Healthcare Personnel by Work Setting and Occupation-U.S., 2014

INTRODUCTION

Routine influenza vaccination of healthcare personnel (HCP) can reduce influenza-related illness and its potentially serious consequences among HCP and their patients. Influenza vaccination has been routinely recommended for HCP since 1984.

METHODS

Data from the 2013 and 2014 National Health Interview Survey were analyzed in 2015. Kaplan-Meier survival estimated the cumulative proportion of HCP reporting 2013-2014 season influenza vaccination. Vaccination coverage by work setting and occupation were assessed. Multivariable logistic regression and predictive marginal analyses identified factors independently associated with vaccination among HCP.

RESULTS

Influenza vaccination coverage was 64.9% among HCP aged ≥18 years (95% CI=60.5%, 69.3%), which was significantly higher compared with non-HCP among the same age group (41.0%, 95% CI=39.8%, 42.1%) (p<0.05). Vaccination coverage was higher among physicians (82.3%) and nurses (77.5%) than other types of HCP (range, 50.2%-65.6%). Coverage was higher among HCP working in hospitals (76.9%) versus other settings (range, 53.9%-60.2%). Characteristics independently associated with an increased likelihood of vaccination among HCP were older age, higher education, having more physician contacts, and having health insurance. Having never been married was independently associated with decreased likelihood of vaccination among HCP.

CONCLUSIONS

Influenza vaccination coverage was higher among HCP than non-HCP, but still below the national target of 90%. Vaccination coverage varied widely by occupation type, work settings, and demographic characteristics. Evidence-based interventions, such as making vaccine available at no cost in the workplace and active promotion of vaccination, are needed to increase influenza vaccination among HCP in all healthcare settings.

Influenza immunization among Canadian health care personnel: a cross-sectional study

BACKGROUND

Influenza immunization coverage among Canadian health care personnel remains below national targets. Targeting this group is of particular importance given their elevated risk of influenza infection, role in transmission and influence on patients' immunization status. We examined influenza immunization coverage in health care personnel in Canada, reasons for not being immunized and the impact of "vaccinate-or-mask" influenza prevention policies.

METHODS

In this national cross-sectional study, we pooled data from the 2007 to 2014 cycles of the Canadian Community Health Survey and restricted it to respondents who reported a health care occupation. Using bootstrapped survey weights, we examined immunization coverage by occupation and by presence of vaccinate-or-mask policies, and reasons for not being immunized. We used modified Poisson regression to estimate the prevalence ratio (PR) of influenza immunization for health care occupations compared with the general working population.

RESULTS

For all survey cycles combined, 50% of 18 446 health care personnel reported receiving seasonal influenza immunization during the previous 12 months, although this varied by occupation type (range 4%-72%). Compared with the general working population, family physicians and general practitioners were most likely to be immunized (PR 3.15, 95% confidence interval [CI] 2.76-3.59), whereas chiropractors, midwives and practitioners of natural healing were least likely (PR 0.17, 95% CI 0.10-0.30). Among those who were not immunized, the most frequently cited reason was the belief that influenza immunization is unnecessary. Introduction of vaccinate-or-mask policies was associated with increased influenza immunization among health care personnel.

INTERPRETATION

Health care personnel are more likely to be immunized against influenza than the general working population, but coverage remains suboptimal overall, and we observed wide variation by occupation type. More efforts are needed to target specific health care occupations with low immunization coverage.

Promotion of flu vaccination among healthcare workers in an Italian academic hospital: An experience with tailored web tools

BACKGROUND

Influenza causes significant mortality particularly among the elderly and high-risk groups. Healthcare workers (HCWs) are at risk of occupational exposure due to contact with patients. Aims of this study was to promote flu shot among HCWs through a multimedia campaign in a large North-Eastern Italian Hospital.

METHODS

The 2013/2014 flu vaccination multimedia campaign addressed to HCWs was developed by maintaining pre-existing tools (letters in pay slip and poster displayed in wards) and creating 4 on-line spots (30") delivered trough the hospital intranet. Campaign effectiveness was assessed in terms of changes in knowledge, attitude and practice comparing data of pre (10 items) and post test (20 items) survey on a randomized sample of HCWs.

RESULTS

Response rates were 92.6% (464/501) in pre-test and 83.2% (417/501) in post-test. 93.8% (391/417) of HCWs reported to awareness of the campaign to promote vaccination. Spots were seen by 59.6% (233/391) of HCWs. Some reasons for vaccine denial, "not believing in vaccine efficacy" (34.7% to 14.9%), "not considering flu as a serious problem" (from 24% to 12.6%), "thinking not to get sick" (28.7% to 18.2%) or "being against the vaccine" (32.7% to 21%), showed a statistically significant reduction after the exposure to the campaign. The "intention to get vaccinated in the next year" instead, raised effectively (13.1% to 36.6%). Vaccinated HCWs rate in 2013-2014 season was 7.6% (221/2910), and 5.6% (164/2910) in 2012-2013 (p<0.005).

CONCLUSIONS

The multimedia campaign succeeded with regard to KAP outcomes, but the vaccination rate is still far from the goal of 90%. Due to their impact, especially on younger age groups, web tools deserve to be better studied as effective approach to convey health information among HCWs.

Factors Associated with Healthcare Worker Acceptance of Vaccination: A Systematic Review and Meta-analysis

Background and objective.

Healthcare workers experience occupational risk of infection and may transmit infections to patients. Vaccination provides an efficient means of protecting workers and patients, but uptake may be low. We sought to identify factors influencing vaccine acceptance by healthcare workers in order to obtain insights leading to more effective vaccination programs in this population.

Design.

Systematic review and meta-analysis.

Methods.

We searched Medline, Embase, and CINAHL databases to identify studies published up to May 2012. Factors influencing vaccination acceptance were devised a priori. Random-effects meta-analysis was performed to generate summary estimates of effect. Heterogeneity and publication bias were explored using statistical tools.

Results.

Thirty-seven studies evaluating a variety of vaccines (against influenza, pertussis, smallpox, anthrax, and hepatitis B) were included. Homogeneous effects on vaccine acceptance were identified with desire for self-protection (odds ratio [OR], 3.42 [95% confidence interval (CI), 2.42–4.82]) and desire to protect family and friends (OR, 3.28 [95% CI, 1.10–9.75]). Concern that vaccine transmits the illness it was meant to prevent decreased acceptance (OR, 0.42 [95% CI, 0.30–0.58]). Differences in physician and nurse acceptance of immunization were seen between Asian and non-Asian studies.

Conclusions.

Consideration of self-protection (rather than absolute disease risk or protection of patients) appears the strongest and most consistent driver of healthcare workers’ decisions to accept vaccination, though other factors may also be impactful, and reasons for between-study divergence in effects is an important area for future research. This finding has important implications for the design of programs to enhance healthcare worker vaccine uptake.

Infect Control Hosp Epidemiol2014;35(6):699–708

The Impact of Vaccine Concerns on Racial/Ethnic Disparities in Influenza Vaccine Uptake Among Health Care Workers

OBJECTIVES

We explored whether collective concerns about the safety, effectiveness, and necessity of influenza vaccines mediate racial/ethnic disparities in vaccine uptake among health care workers (HCWs).

METHODS

We used a self-administered Web-based survey to assess race/ethnicity (exposure), concerns about influenza vaccination (mediator; categorized through latent class analysis), and influenza vaccine uptake (outcome) for the 2012 to 2013 influenza season among HCWs at St. Jude Children's Research Hospital in Memphis, Tennessee. We used mediation analysis to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for the total, direct, and indirect effects of race/ethnicity on influenza vaccine uptake.

RESULTS

Non-Hispanic Blacks had lower influenza vaccine uptake than non-Hispanic Whites (total effect: PR = 0.87; 95% CI = 0.75, 0.99), largely mediated by high concern about influenza vaccines (natural indirect effect: PR = 0.89; 95% CI = 0.84, 0.94; controlled direct effect: PR = 0.98; 95% CI = 0.85, 1.1). Hispanic and Asian HCWs had modestly lower uptake than non-Hispanic Whites, also mediated by high concern about influenza vaccines.

CONCLUSIONS

Racial/ethnic disparities among HCWs could be attenuated if concerns about the safety, effectiveness, and necessity of influenza vaccines were reduced.

Use of a Mandatory Declination Form in a Program for Influenza Vaccination of Healthcare Workers

Objective.

To evaluate the utility and impact of using a declination form in the context of an influenza immunization program for healthcare workers.

Methods.

A combined form for documentation of vaccination consent, medical contraindication(s) for vaccination, or vaccination declination was used during the 2006-2007 influenza season in a healthcare system employing approximately 9,200 nonphysician employees in 3 hospitals; a skilled nursing care facility; a large, multisite, faculty-practice plan; and an administrative building. Responses were entered into a database that contained files from human resources departments, which allowed correlation with job category and work location.

Results.

The overall levels of influenza vaccination coverage of employees increased from 43% (3,892 of 9,050) during the 2005-2006 season to 66.5% (6,123 of 9,214) during the 2006-2007 season. Of 9,214 employees, 1,898 (20.6%) signed the declination statement. Among the occupation groups, nurses had the lowest rate of declining vaccination (13.2% [393 of 2,970]; P < .0001), followed by pharmacy personnel (18.1% [40 of 221]), ancillary personnel with frequent patient contact (21.9% [169 of 771), and all others (24.7% [1,296 of 5,252]). Among the employees who declined vaccination, nurses were the least likely to select the reasons “afraid of needles” (3.8% [15 of 393], vs. 9.1% [137 of 1,505] for all other groups; P < .001) and “fear of getting influenza from the vaccine” (13.5% [53 of 393], vs. 20.5% [309 of 1,505]; P = .002). Seven pregnant nurses had been advised by their obstetricians to avoid vaccination. When declination of influenza vaccination was analyzed by age, 16% of personnel (797 of 4,980) 50 years of age and older declined to be vaccinated, compared with 26% of personnel (1,101 of 4,234) younger than 50 years of age {P < .0001).

Conclusions.

Implementing use of the declination form during the 2006-2007 influenza season was one of several measures that led to a 55% increase in the acceptance of influenza vaccination by healthcare workers in our healthcare system. Although we cannot determine to what degree use of the declination form contributed to the increased rate of vaccination, use of this form helped the vaccination program assess the reasons for declination and will help to focus future vaccination campaigns.

Measurement of Influenza Vaccination Coverage among Healthcare Personnel in US Hospitals

Objective.

To characterize practices related to measuring influenza vaccination rates among healthcare personnel in US hospitals.

Design.

Descriptive survey.

Setting.

Nonfederal, short-stay hospitals that provide general medical and surgical services, identified by use of the 2004 American Hospital Association Annual Survey Database.

Participants.

Healthcare personnel from 996 randomly sampled US hospitals stratified by region and bed size.

Methods.

A self-administered questionnaire was distributed in 2006 to infection control coordinators to gather data on policies and practices related to the provision of the influenza vaccine and on the measurement and reporting of influenza vaccination rates. Descriptive statistics and associations were calculated, and logistic regression was conducted.

Results.

The response rate was 56% (ie, 555 of 996 US hospitals responded to the questionnaire). Weighting accounted for sampling design and nonresponse. Most hospitals provided the influenza vaccine to employees (100%), credentialed medical staff (ie, independent practitioners; 94%), volunteers (86%), and contract staff (83%); provision for students and residents was less frequent (58%). Only 69% of hospitals measured vaccination rates (mean coverage rate, 55%). Most hospitals that measured coverage included employees (98%) in the vaccination rates, whereas contract staff (53%), credentialed medical staff (56%), volunteers (56%), and students and residents (30%) were less commonly included. Among hospitals measuring coverage, 44% included persons for which vaccine was contraindicated, and 51% included persons who refused vaccination. After adjustment for region and size, hospitals with vaccination plans written into policy (odds ratio, 2.0 [95% confidence interval, 1.22–7.67]) or that addressed internally reporting coverage (odds ratio, 4.8 [95% confidence interval, 2.97–7.66]) were more likely to measure coverage than were hospitals without such plans.

Conclusions.

Hospitals vary in terms of the groups of individuals included in influenza vaccination coverage measurements. Standardized measures may improve comparability of hospital-reported vaccination rates. Measuring coverage in a manner that facilitates identification of occupational groups with low vaccination rates may inform development of targeted interventions.

Uptake of influenza vaccination and risk reduction behaviour for respiratory infections: a survey of optometrists in New Zealand

BACKGROUND

The aim was to determine the uptake of seasonal influenza vaccination and risk reduction behaviours among a health professional group with close patient contact, namely, optometrists. This group can have close facial proximity to patients during eye examinations.

METHODS

National telephone survey of optometrists in New Zealand.

RESULTS

Seventy per cent of registered optometrists participated (n = 450 responses). Less than one-third (29.7 per cent, 95% CI: 27.4 to 32.0) of optometrists reported having had the seasonal influenza vaccination in 2012. The major reason given for not being vaccinated was that the vaccination was considered unnecessary (47 per cent) followed by 'time constraints' (28 per cent). During their last respiratory illness, 82 per cent reported working with symptoms and only 16 per cent reported the use of a face mask.

CONCLUSION

There is major scope for increasing uptake of influenza vaccination and other protective behaviour for such health professional groups, especially those characterised by relatively close patient contact. Possible options include educational campaigns and government-funded vaccinators visiting the workplaces of all health-care workers.

Healthcare providers as sources of vaccine-preventable diseases

Vaccine-preventable infectious diseases may be introduced into the healthcare setting and pose a serious risk to vulnerable populations including immunocompromised patients. Healthcare providers (HCPs) are exposed to these pathogens through their daily tasks and may serve as a reservoir for ongoing disease transmission in the healthcare setting. The primary method of protection from work-related infection risk is vaccination that protects not only an individual HCP from disease, but also subsequent patients in contact with that HCP. Individual HCPs and healthcare institutions must balance the ethical and professional responsibility to protect their patients from nosocomial transmission of preventable infections with HCP autonomy. This article reviews known cases of HCP-to-patient transmission of the most common vaccine-preventable infections encountered in the healthcare setting including hepatitis B virus, influenza virus, Bordetella pertussis, varicella-zoster virus, measles, mumps and rubella virus. The impact of HCP vaccination on patient care and current recommendations for HCP vaccination against vaccine-preventable infectious diseases are also reviewed.

Barriers and facilitators to influenza vaccination and vaccine coverage in a cohort of health care personnel

BACKGROUND

Annual influenza vaccination is recommended for health care personnel (HCP). We describe influenza vaccination coverage among HCP during the 2010-2011 season and present reported facilitators of and barriers to vaccination.

METHODS

We enrolled HCP 18 to 65 years of age, working full time, with direct patient contact. Participants completed an Internet-based survey at enrollment and the end of influenza season. In addition to self-reported data, we collected information about the 2010-2011 influenza vaccine from electronic employee health and medical records.

RESULTS

Vaccination coverage was 77% (1,307/1,701). Factors associated with higher vaccination coverage include older age, being married or partnered, working as a physician or dentist, prior history of influenza vaccination, more years in patient care, and higher job satisfaction. Personal protection was reported as the most important reason for vaccination followed closely by convenience, protection of patients, and protection of family and friends. Concerns about perceived vaccine safety and effectiveness and low perceived susceptibility to influenza were the most commonly reported barriers to vaccination. About half of the unvaccinated HCP said they would have been vaccinated if required by their employer.

CONCLUSION

Influenza vaccination in this cohort was relatively high but still fell short of the recommended target of 90% coverage for HCP. Addressing concerns about vaccine safety and effectiveness are possible areas for future education or intervention to improve coverage among HCP.

Employee influenza vaccination in residential care facilities

BACKGROUND

The organizational literature on infection control in residential care facilities is limited. Using a nationally representative dataset, we examined the organizational factors associated with implementing at least 1 influenza-related employee vaccination policy/program, as well as the effect of vaccination policies on health care worker (HCW) influenza vaccine uptake in residential care facilities.

METHODS

The study was a cross-sectional study using data from the 2010 National Survey of Residential Care Facilities. Multivariate logistic regression analysis was used to address the study's objectives.

RESULTS

Facility size, director's educational attainment, and having a written influenza pandemic preparedness plan were significantly associated with the implementation of at least 1 influenza-related employee vaccination policy/program, after controlling for other facility-level factors. Recommending vaccination to employees, providing vaccination on site, providing vaccinations to employees at no cost, and requiring vaccination as a condition of employment were associated with higher employee influenza vaccination rates.

CONCLUSION

Residential care facilities can improve vaccination rates among employees by adopting effective employee vaccination policies.

Seasonal influenza vaccination coverage among adult populations in the United States, 2005-2011

The most effective strategy for preventing influenza is annual vaccination. We analyzed 2005-2011 data from the National Health Interview Survey (NHIS), using Kaplan-Meier survival analysis to estimate cumulative proportions of persons reporting influenza vaccination in the 2004-2005 through 2010-2011 seasons for persons aged ≥18, 18-49, 50-64, and ≥65 years, persons with high-risk conditions, and health-care personnel. We compared vaccination coverage by race/ethnicity within each age and high-risk group. Vaccination coverage among adults aged ≥18 years increased from 27.4% during the 2005-2006 influenza season to 38.1% during the 2010-2011 season, with an average increase of 2.2% annually. From the 2005-2006 season to the 2010-2011 season, coverage increased by 10-12 percentage points for all groups except adults aged ≥65 years. Coverage for the 2010-2011 season was 70.2% for adults aged ≥65 years, 43.7% for adults aged 50-64 years, 36.7% for persons aged 18-49 years with high-risk conditions, and 55.8% for health-care personnel. In most subgroups, coverage during the 2010-2011 season was significantly lower among non-Hispanic blacks and Hispanics than among non-Hispanic whites. Vaccination coverage among adults under age 65 years increased from 2005-2006 through 2010-2011, but substantial racial/ethnic disparities remained in most age groups. Targeted efforts are needed to improve influenza vaccination coverage and reduce disparities.

Using a validated health promotion tool to improve patient safety and increase health care personnel influenza vaccination rates

BACKGROUND

This study employed the risk perception attitude (RPA) framework to determine whether health care personnel (HCP) influenza-related risk perceptions and efficacy beliefs could be used to segment individuals into meaningful groups related to vaccination uptake, absenteeism, and patient safety beliefs.

METHODS

After pilot interviews, a questionnaire was administered to 318 hospital-based HCP (80%) and nonclinical support staff (20%) in Lexington, KY, in 2011. Follow-up interviews were conducted with 29 respondents.

RESULTS

Cluster analysis was used to create 4 groups that correspond to the RPA framework: responsive (high risk, strong efficacy), avoidance (high risk, weak efficacy), proactive (low risk, strong efficacy), and indifference (low risk, weak efficacy). A significant association was found between membership in 1 or more of the 4 RPA groups and the 3 study variables of interest: influenza vaccination uptake (F7,299 = 2.51, P < .05), influenza-related absenteeism (F7,269 = 3.6, P < .001), and perceptions of patient safety climate (F7,304 = 6.21, P < .001). A subset of respondents indicated the principal reasons for not getting vaccinated were "had one before and got sick anyway," "concerned about vaccine safety," and "no convenient time." In follow-up interviews, HCP indicated that employee vaccinations were altruistic, increased herd immunity, and important for patient safety.

CONCLUSION

The RPA framework is a valid health promotion tool for improving patient safety, targeting specific groups for interventions, and improving HCP influenza vaccination rates.

A Time Off Incentive Was Not Associated with Influenza Vaccination Acceptance among Healthcare Workers

Objectives. The national influenza vaccination rate among healthcare workers (HCWs) remains low despite clear benefits to patients, coworkers, and families. We sought to evaluate formally the effect of a one-hour time off incentive on attitudes towards influenza vaccination during the 2011-2012 influenza season. Methods. All HCWs at the Philadelphia Veterans Affairs (VA) Medical Center were invited to complete an anonymous web-based survey. We described respondents' characteristics and attitudes toward influenza vaccination and determined the relationship of specific attitudes with respondents' acceptance of influenza vaccination, using a 5-point Likert scale. Results. We analyzed survey responses from 154 HCWs employed at the Philadelphia VA Medical Center, with a response rate of 8%. Among 121 respondents who reported receiving influenza vaccination, 34 (28%, 95% CI 20–37%) reported agreement with the statement that the time off incentive made a difference in their decision to accept influenza vaccination. Conclusions. Our study provides evidence that modest incentives such as one-hour paid time off will be unlikely to promote influenza vaccination rates within medical facilities. More potent interventions that include mandatory vaccination combined with penalties for noncompliance will likely provide the only means to achieve near-universal influenza vaccination among HCWs.

Impact of the raising immunizations safely and effectively (RISE) program on healthcare worker influenza immunization rates in long term care settings

INTRODUCTION AND RATIONALE

National influenza immunization rates for healthcare workers (HCW) in long-term care (LTC) remain unacceptably low. This poses a serious public health threat to residents. Prior work has suggested high staff turnover rates as a contributing factor to low immunization rates. There is a critical need to identify and deploy successful models of HCW influenza immunization programs to LTC facilities. This report describes one potential model that has been successfully initiated in a network of LTC facilities.

METHODS

All facilities served by a single regional LTC pharmacy were invited to participate in a HCW influenza immunization program. This voluntary immunization program began in 2005 and continues to the present. As part of the program, the pharmacy promoted organizational change by assuming oversight and control of HCW immunization policies and processes for all facilities. Primary and secondary outcomes are the number of facilities reaching HCW influenza immunization rates of 60% and 80%.

RESULTS

Fourteen of the 16 LTC facilities participated. Facilities were diverse and included both nursing and assisted living facilities; unionized and nonunionized facilities; and urban, suburban, and rural facilities. The pharmacy provided educational and communication materials, centralized data collection using a standardized definition for HCW immunization rates, and facility feedback. All 14 LTC facilities achieved the primary goal of 60% and nearly two thirds reached the secondary goal of 80%. Twenty percent reached the new Healthy People 2020 goal of 90%.

CONCLUSION

It is possible for LTC facilities to improve HCW immunization rates using a pharmacy based, voluntary HCW influenza immunization approach. Such an approach may help attenuate the negative influence of staff turnover on HCW immunizations. Attainment of the new Health People 2020 goals still remains a challenge and may require mandatory programs.

Influenza vaccination coverage among patients and healthcare workers in a university hospital during the 2006-2007 influenza season

Despite years of public health effort to increase vaccine uptake among populations recommended for influenza vaccination, immunization rates remain low among patients and healthcare workers (HCWs). The objective of this study was to report on influenza vaccination coverage of patients and HCWs for the same time period in 4 wards of a university hospital. A prospective cross-sectional study was conducted among patients and HCWs between December 11, 2006 and April 15, 2007 and individual factors associated with being vaccinated against influenza were assessed. Results indicated that older patients were significantly more vaccinated than younger patients. Physicians and residents were more likely to be vaccinated that the rest of staff, with possible differences between wards. Immunization of HCWs is a major issue in infection control in hospitals and long-term care facilities. However, the impact of influenza vaccination among HCWs in reducing hospital-acquired influenza and patient morbidity needs to be explored further.

Review: interventions to increase influenza vaccination among healthcare workers in hospitals

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.

A public health initiative to increase annual influenza immunization among hospital health care personnel: the San Diego Hospital Influenza Immunization Partnership

BACKGROUND

A public health department-supported intervention to increase influenza immunization among hospital-based health care practitioners (HCPs) in San Diego County took place between 2005 and 2008. The study included all major hospitals in the county, with a population of approximately 3.5 million.

METHODS

Information on hospital activities was collected from before, during and after initiative activities. Vaccination status and demographics were collected directly from HCP using hospital-based and random-dialed telephone surveys.

RESULTS

Between 2006 and 2008, hospitals increased promotion activities and reported increases in vaccination rates. Based on the random-dialed surveys, HCP influenza vaccination coverage rates did not increase significantly. Vaccination rates were significantly higher in HCPs who reported that employers provided free vaccination and those who believed that their employers mandated influenza vaccination.

CONCLUSIONS

This local public health initiative and concurrent state legislation were effective in increasing employer efforts to promote influenza vaccination; however, population-based surveys of HCPs did not show significant increases in influenza vaccination. Overall, this study suggests that public health leadership, intensive employer promotion activities, and state-required declinations alone were not sufficient to significantly increase HCP influenza vaccination. Policymakers and employers should consider mandates to achieve optimal influenza vaccination among HCPs.

H1N1 and seasonal influenza vaccination of U.S. healthcare personnel, 2010

BACKGROUND

Seasonal influenza vaccination routinely has been recommended for healthcare personnel (HCP) since 1984. The influenza A (H1N1) 2009 monovalent vaccine (H1N1 vaccine) became available in the U.S. in October 2009.

PURPOSE

To assess 2009 H1N1 and seasonal influenza vaccination coverage and identify factors independently associated with vaccination among HCP in the U.S.

METHODS

Data from the 2009-2010 Behavioral Risk Factor Surveillance System (BRFSS) influenza supplemental survey were analyzed in 2011. Multivariable logistic regression and predictive marginal models were performed to identify factors independently associated with vaccination among HCP. The Kaplan-Meier survival analysis procedure was used to estimate the cumulative proportion of people vaccinated.

RESULTS

Among 16,975 HCP surveyed, 2009 H1N1, seasonal, and any-dose vaccination coverage were 34.1% (95% CI=32.7%, 35.5%); 52.4% (95% CI=50.9%, 53.9%); and 58.0% (95% CI=56.5%, 59.5%), respectively, all of which were significantly higher than those for non-HCP (19.1%, 34.9%, and 40.3%, respectively). The H1N1 vaccination coverage among HCP ranged from 18.4% in Mississippi to 56.1% in Massachusetts and seasonal influenza vaccination coverage ranged from 40.4% in Florida to 73.1% in Nebraska. Characteristics independently associated with an increased likelihood of 2009 H1N1, seasonal, and any-dose vaccinations among HCP were as follows: non-Hispanic white, higher income, having a high-risk condition, having health insurance, the ability to see a doctor if needed, and having had a routine checkup in the previous year.

CONCLUSIONS

Vaccination coverage was higher among HCP than non-HCP but still below the national health objective of 90%. Knowledge of national and state-specific H1N1 and seasonal vaccination coverage among HCP is useful for evaluating the vaccination campaign and implementing strategies for increasing yearly seasonal vaccination coverage and improving vaccination coverage among HCP in possible future pandemics.

Impact of the 2009 influenza A (H1N1) pandemic on Canadian health care workers: a survey on vaccination, illness, absenteeism, and personal protective equipment

BACKGROUND

Data are limited on the impact of the 2009 H1N1 influenza A pandemic on health care worker (HCW) vaccination, illness, absenteeism, and personal protective equipment (PPE) use.

METHODS

A survey was completed by HCWs from 14 hospitals participating in the Canadian Nosocomial Infection Surveillance Program who provided direct care to patients with pH1N1 influenza in high-risk units between September and December 2009.

RESULTS

Surveys were returned from 986 HCWs (80% nurses, 14% respiratory therapists, and 6% physicians). HCWs working in an intensive care unit (78%) or a designated influenza ward (67%) were more compliant with wearing an N95 respirator for aerosol-generating medical procedures than those working in an emergency department (47%; P < .001). HCWs who worked in health care for >11 years were more compliant with wearing protective eyewear than those who worked for ≤11 years (69% vs 54%; P < .001). A total of 815 HCWs (83%) reported having received the pH1N1 influenza vaccine, and 372 (38%) reported having received the 2009-2010 seasonal influenza vaccine. Influenza-like illness was reported by 236 (24%) HCWs, 170 of whom (72%) reported missing work.

CONCLUSIONS

Experience working in health care improves PPE use and HCWs in emergency departments should be targeted for interventions to improve PPE compliance. pH1N1 influenza vaccine coverage was high, but seasonal influenza vaccine coverage was low, and significant HCW illness and absenteeism were reported.

Vaccination behaviour influences self-report of influenza vaccination status: a cross-sectional study among health care workers

BACKGROUND

Published influenza vaccination coverage in health care workers (HCW) are calculated using two sources: self-report and vaccination records. The objective of this study was to determine whether self-report is a good proxy for recorded vaccination in HCW, as the degree of the relationship is not known, and whether vaccine behaviour influences self-reporting.

METHODS

A cross-sectional study was conducted using a self-administered survey during September 2010. Considering the vaccination record as the gold standard of vaccination, the properties of self-report as a proxy of the record (sensitivity, specificity, positive predictive value, negative predictive value) were calculated. Concordance between the vaccination campaigns studied (2007-2010) was made using the Kappa index, and discordance was analyzed using McNemar's test.

RESULTS

248 HCW responded. The 95% confidence intervals of coverage according to the vaccination record and to self-report overlapped, except for 2007, and the Kappa index showed a substantial concordance, except for 2007. McNemar's test suggested that differences between discordant cases were not due to chance and it was found that the proportion of unvaccinated discordant cases was higher than that of vaccinated discordant cases.

CONCLUSIONS

In our study population, self-reported influenza vaccination coverage in HCW in the previous two years is a good proxy of the vaccination record. However, vaccination behaviour influences the self-report and explains a trend to overestimate coverage in self-reporting compared to the vaccination record. The sources of coverage should be taken into account whenever comparisons are made.

Influenza vaccination among nurses in Greece

Seasonal influenza has become a serious public health problem worldwide, and vaccination is recognized as the most effective preventative measure. However, data suggest that influenza vaccination rates are generally low among health care workers. The present study showed that the vaccination rates for influenza among nurses are 21.2%.

Estimated costs associated with improving influenza vaccination for health care personnel in a multihospital health system

BACKGROUND

Health care personnel (HCP) are an important target group for influenza vaccination because of their close contact with vulnerable patients. Annual influenza vaccination for HCP is recommended to reduce the spread of influenza and decrease staff illness and absenteeism. UPMC Health System, the largest health system in western Pennsylvania, established a quality improvement project to increase influenza vaccination among its > 50,000 employees by implementing survey-informed interventions. At the completion of the intervention, estimates were prepared of the costs associated with implementing a multifaceted quality improvement intervention to improve HCP influenza vaccination rates in a large multihospital health system.

METHODS

All 11 participating hospitals provided education and publicity regarding influenza vaccination and provided vaccine free of charge at mass vaccination clinics. Two additional strategies-mobile vaccination carts and incentives-were implemented in a factorial design such that the hospitals had either carts, incentives, both strategies, or neither. The minimum and maximum costs per vaccinated employee by type of intervention were estimated using cost data for vaccine/supplies, labor, incentives, and administration.

RESULTS

The average costs per vaccinated employee ranged from $24.55 to $30.43 for incentives and carts, $20.66 to $25.57 for incentives, $23.24 to $26.54 for carts, and $18.03 to $20.60 for education and publicity only. Vaccination rates increased significantly but remained below ideal levels.

CONCLUSIONS

Influenza vaccination rates among nonphysician HCP can be improved using various interventions at a low cost per vaccinated employee. The costs for these nonmandatory interventions were modest compared with the costs typically associated with influenza-related absenteeism.

Institutional requirements for influenza vaccination of healthcare personnel: results from a nationally representative survey of acute care hospitals--United States, 2011

BACKGROUND

Many health professional organizations now endorse influenza vaccination as a condition of employment in healthcare settings. Our objective was to describe institutional requirements for influenza vaccination of healthcare personnel (HCP) among US hospitals during the 2010-2011 influenza season.

METHODS

A survey was mailed in 2011 to a nationally representative sample of 998 acute care hospitals. An institutional requirement was defined as "a policy that requires HCP to receive or decline influenza vaccination, with or without consequences for vaccine refusal." A weighted analysis included univariate analyses and logistic regression.

RESULTS

Of responding hospitals (n = 808; 81.0%), 440 (55.6%) reported institutional requirements for influenza vaccination. Although employees were uniformly subject to requirements, nonemployees often were not. The proportion of requirements with consequences for vaccine refusal was 44.4% (n = 194); where consequences were imposed, nonmedical exemptions were often granted (69.3%). Wearing a mask was the most common consequence (74.2% of 194 requirements); by contrast, 29 hospitals (14.4%) terminated unvaccinated HCP. After adjustment for demographic factors, the following characteristics remained significantly associated with requirements: location in a state requiring HCP to receive or decline influenza vaccine, caring for inpatients that are potentially vulnerable to influenza, use of ≥9 Advisory Committee on Immunization Practices-recommended, evidence-based influenza vaccination campaign strategies, and for-profit ownership.

CONCLUSIONS

Influenza vaccination requirements were prevalent among hospitals of varying size and location. However, few policies were as stringent or as comprehensive as those endorsed by health professional organizations. Because influenza vaccination requirements are a viable alternative for hospitals unable to achieve high coverage through voluntary policies, there is still substantial room for improvement.

Knowledge, attitudes and perceptions of health professionals in relation to A/H1N1 influenza and its vaccine

OBJECTIVE

To determine the intention of health professionals, doctors and nurses, concerning whether or not to be vaccinated against A/H1N1 influenza virus, and their perception of the severity of this pandemic compared with seasonal flu.

MATERIAL AND METHODS

A cross-sectional study was carried out based on an questionnaire e-mailed to health professionals in public healthcare centres in Vitoria between 6 and 16 November 2009; the percentage of respondents who wanted to be vaccinated and who perceived the pandemic flu to carry a high risk of death were calculated.

RESULTS

A total of 115 people completed the questionnaire of whom 61.7% (n=71) were doctors and 38.3% (n=44) were nurses. Of these, 33.3% (n=23) of doctors and 13.6% (n=6) of nurses intended to be vaccinated (p=0.019). Even among those who considered themselves to be at a high risk, 70.6% (n=48) of doctors and 31.7% (n=13) of nurses participating in the study (p=0.001) planned to have the vaccination.

CONCLUSIONS

Most health professionals, and in particular nurses, had no intention to be vaccinated against A/H1N1 influenza virus at the beginning of the vaccination campaign.

Attitudes toward and uptake of H1N1 vaccine among health care workers during the 2009 H1N1 pandemic

Background

Though recommended by many and mandated by some, influenza vaccination rates among health care workers, even in pandemics, remain below optimal levels. The objective of this study was to assess vaccination uptake, attitudes, and distinguishing characteristics (including doctor-nurse differences) of health care workers who did and did not receive the pandemic H1N1 influenza vaccine in late 2009.

Methodology/Principal Findings

In early 2010 we mailed a self-administered survey to 800 physicians and 800 nurses currently licensed and practicing in Minnesota. 1,073 individuals responded (cooperation rate: 69%). 85% and 62% of Minnesota physicians and nurses, respectively, reported being vaccinated. Accurately estimating the risk of vaccine side effects (OR 2.0; 95% CI 1.5–2.7), agreeing with a professional obligation to be vaccinated (OR 10.1; 95% CI 7.1–14.2), an ethical obligation to follow public health authorities' recommendations (OR 9.9; 95% CI 6.6–14.9), and laws mandating pandemic vaccination (OR 3.1; 95% CI 2.3–4.1) were all independently associated with receiving the H1N1 influenza vaccine.

Conclusions/Significance

While a majority of health care workers in one midwestern state reported receiving the pandemic H1N1 vaccine, physicians and nurses differed significantly in vaccination uptake. Several key attitudes and perceptions may influence health care workers' decisions regarding vaccination. These data inform how states might optimally enlist health care workers' support in achieving vaccination goals during a pandemic.

Voluntary to mandatory: evolution of strategies and attitudes toward influenza vaccination of healthcare personnel

BACKGROUND

Assessing the relative success of serial strategies for increasing healthcare personnel (HCP) influenza vaccination rates is important to guide hospital policies to increase vaccine uptake.

OBJECTIVE

To evaluate serial campaigns that include a mandatory HCP vaccination policy and to describe HCP attitudes toward vaccination and reasons for declination.

DESIGN

Retrospective cohort study.

METHODS

We assessed the impact of serial vaccination campaigns on the proportions of HCP who received influenza vaccination during the 2006-2011 influenza seasons. In addition, declination data over these 5 seasons and a 2007 survey of HCP attitudes toward vaccination were collected.

RESULTS

HCP influenza vaccination rates increased from 44.0% (2,863 of 6,510 HCP) to 62.9% (4,037 of 6,414 HCP) after institution of mobile carts, mandatory declination, and peer-to-peer vaccination efforts. Despite maximal attempts to improve accessibility and convenience, 27.2% (66 of 243) of the surveyed HCP were unwilling to wait more than 10 minutes for a free influenza vaccination, and 23.3% (55 of 236) would be indifferent if they were unable to be vaccinated. In this context, institution of a mandatory vaccination campaign requiring unvaccinated HCP to mask during the influenza season increased rates of compliance to over 90% and markedly reduced the proportion of HCP who declined vaccination as a result of preference.

CONCLUSIONS

A mandatory influenza vaccination program for HCP was essential to achieving high vaccination rates, despite years of intensive vaccination campaigns focused on increasing accessibility and convenience. Mandatory vaccination policies appear to successfully capture a large portion of HCP who are not opposed to receipt of the vaccine but who have not made vaccination a priority.

Seroprevalence of pandemic H1N1 antibody among health care workers in Hong Kong following receipt of monovalent 2009 H1N1 influenza vaccine

Background

Healthcare workers in many countries are recommended to receive influenza vaccine to protect themselves as well as patients. A monovalent H1N1 vaccine became available in Hong Kong in December 2009 and around 10% of local healthcare workers had received the vaccine by February 2010.

Methods

We conducted a cross-sectional study of the prevalence of antibody to pandemic (H1N1) 2009 among HCWs in Hong Kong in February–March 2010 following the first pandemic wave and the pH1N1 vaccination campaign. In this study we focus on the subset of healthcare workers who reported receipt of non-adjuvanted monovalent 2009 H1N1 vaccine (Panenza, Sanofi Pasteur). Sera collected from HCWs were tested for antibody against the pH1N1 virus by hemagglutination inhibition (HI) and viral neutralization (VN) assays.

Results

We enrolled 703 HCWs. Among 104 HCWs who reported receipt of pH1N1 vaccine, 54% (95% confidence interval (CI): 44%–63%) had antibody titer ≥1∶40 by HI and 42% (95% CI: 33%–52%) had antibody titer ≥1∶40 by VN. The proportion of HCWs with antibody titer ≥1∶40 by HI and VN significantly decreased with age, and the proportion with antibody titer ≥1∶40 by VN was marginally significantly lower among HCWs who reported prior receipt of 2007–08 seasonal influenza vaccine (odds ratio: 0.43; 95% CI: 0.19–1.00). After adjustment for age, the effect of prior seasonal vaccine receipt was not statistically significant.

Conclusions

Our findings suggest that monovalent H1N1 vaccine may have had suboptimal immunogenicity in HCWs in Hong Kong. Larger studies are required to confirm whether influenza vaccine maintains high efficacy and effectiveness in HCWs.

Swedish nursing and medical students' high vaccination adherence during the influenza A (H1N1) pandemic 2009: insights for pandemic preparedness

The aim of this study was to analyze Swedish health science student decision-making regarding vaccination against pandemic influenza during a national mass vaccination campaign. A questionnaire was distributed to 430 students during the influenza A (H1N1) pandemic in 2009. The data from medical and nursing students were compared and a multiple logistic regression model was applied to identify items independently associated with the decision to be vaccinated. The overall survey response rate was 90%. More medical (93.2%) than nursing students (84.8%) reported that they had received the vaccine (p < 0.01). Only the perception that benefits can outweigh possible side effects was significantly (p < 0.001) associated with the decision to get vaccinated. We recommend that, during pandemics, health science universities focus vaccination information for students on objective risk communication. It should be taken into account that the pandemic information provided by authorities to the general public also affects health care students.

Effectiveness of seasonal influenza vaccination in healthcare workers: a systematic review

Vaccination is considered a key measure to protect vulnerable groups against influenza infection. The objectives of this review are to determine the effect of influenza vaccinations in reducing laboratory-confirmed influenza infections, influenza-like illnesses (ILIs), working days lost among vaccinated HCWs, and associated adverse effects after vaccination. Twenty-two healthcare-related databases and internet resources, as well as reference lists, and the bibliographies of all of the retrieved articles were examined. All randomized controlled trials (RCTs) comparing the effectiveness of any kind of influenza vaccine among all groups of HCWs with a placebo/vaccine other than the influenza vaccine/no intervention were included in the review. Only three RCTs matched the inclusion criteria. There is a limited amount of evidence suggesting that receiving influenza vaccination reduces laboratory-confirmed influenza infections in HCWs. No evidence can be found of influenza vaccinations significantly reducing the incidence of influenza, number of ILI episodes, days with ILI symptoms, or amount of sick leave taken among vaccinated HCWs. There is insufficient data to assess the adverse effects after vaccination. There is no definitive conclusion on the effectiveness of influenza vaccinations in HCWs because of the limited number of related trials. Further research is necessary to evaluate whether annual vaccination is a key measure to protect HCWs against influenza infection and thus increase their confidence in the vaccine. In the mean time, the direction of promoting influenza vaccination to HCWs can be shifted from staff protection to patient protection, with accurate information to address concerns and misconceptions.

Seeking and processing influenza vaccine information: a study of health care workers at a large urban hospital

In response to low influenza vaccination rates among health care workers, health officials have explored determinants of uptake and developed communication interventions. Key to these efforts is how workers seek and attend to vaccine information. We applied a model of risk information seeking and processing to survey 226 physicians and nurses at a large, urban hospital (response rate = 5.7%; cooperation rate = 91.5%). Our goals were to (1) apply the model to a new setting, audience, and issue and (2) explore novel concepts (e.g., source credibility and information usefulness) and moderating relationships among variables. Consistent with previous research, information subjective norms-perceived social pressure to remain informed about vaccination-were a strong predictor of information seeking and systematic processing. Neither source credibility nor information usefulness independently increased explained variance, although they moderated the relationship between norms and communication behavior. We discuss theoretical and practical implications of these findings.

Perceptions and influence of a hospital influenza vaccination policy

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.

Influenza, hepatitis B, and tetanus vaccination coverage among health care personnel in the United States

BACKGROUND

Health care personnel (HCP) are at risk for exposure to and possible transmission of vaccine-preventable diseases. Maintenance of immunity is an essential prevention practice for HCP. We assessed the recent influenza, hepatitis B, and tetanus vaccination coverage among HCP in the United States.

METHODS

We analyzed data from the 2007 National Immunization Survey-Adult restricted to survey respondents aged 18 to 64 years. Influenza, hepatitis B, and tetanus vaccination coverage levels among HCP were assessed. Multivariable logistic regression was conducted to assess factors independently associated with receipt of vaccination among HCP.

RESULTS

Among HCP aged 18 to 64 years, 46.7% (95% confidence interval [CI]: 39.6%-53.8%) had received influenza vaccination for the 2006-2007 season, and 70.4% (95% CI: 63.9%-76.1%) received tetanus vaccination in the past 10 years; 61.7% (95% CI: 52.5%-70.2%) had received 3 or more doses of hepatitis B vaccination among HCP aged 18 to 49 years. Multiple logistic regression analysis showed that being married was associated with influenza vaccination coverage, higher education level was associated with hepatitis B vaccination coverage, and younger age was significantly associated with tetanus vaccination among HCP. Among those HCP who did not receive influenza vaccination, the most common reason reported was respondent concerns about vaccine safety and adverse effects.

CONCLUSION

By 2007, influenza and hepatitis B vaccination coverage among HCP remained well below the Healthy People 2010 objectives. Tetanus vaccination level was 70%, and this study provided a baseline data for tetanus vaccination among HCP. Innovative strategies are needed to further increase vaccination coverage among HCP.

A successful, voluntary, multicomponent statewide effort to reduce health care-associated infections

Health care-associated infections (HAIs) increase morbidity, mortality, and hospital costs. Multiple organizations have worked independently to reduce HAIs. Regional collaborative efforts to reduce HAIs have been less common but may be particularly effective. The authors describe a statewide multicomponent approach implemented by the Iowa Healthcare Collaborative (IHC) to reduce HAIs. IHC's initiatives helped providers improve patient care by becoming engaged in specific projects, improving communication, sharing data, and implementing best practices. Other states could use this approach as a model to engage clinicians in patient safety initiatives and thereby accelerate the rate at which clinical care and health care outcomes are improved.

Influenza vaccination coverage among US nursing home nursing assistants: the role of working conditions

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.

Vaccination of health-care workers against influenza: our obligation to protect patients

Please cite this paper as: Maltezou and Tsakris. (2011) Vaccination of health‐care workers against influenza: our obligation to protect patients. Influenza and Other Respiratory Viruses 5(6), 382–388.

Nosocomial influenza poses a threat for specific groups of patients and is associated not only with the disruption of health‐care services but also excess costs. Although vaccination of health‐care workers (HCWs) has been recommended for almost three decades and constitutes the most convenient and effective means to prevent nosocomial transmission, vaccine uptake within this group remains unacceptably low worldwide. In regard to the pandemic influenza A H1N1, HCWs constitute a priority group for immunization. Nevertheless, low vaccination rates have been documented regarding the influenza pandemic and associated with the onset of nosocomial cases and outbreaks. HCWs, health‐care institutions, and public health bodies have the moral obligation to protect vulnerable patients and therefore weigh the benefits of mandatory vaccination. Key effective interventions, such as the education of HCWs concerning the benefits and safety of influenza vaccination, the reinforcement of on‐site, free of charge vaccinations, and the use of mobile vaccination teams in conjunction with incentives, should be widely implemented.

Determination of factors required to increase uptake of influenza vaccination among hospital-based healthcare workers

A questionnaire study was performed in all eight University Medical Centers in The Netherlands to determine the predictors of influenza vaccination compliance in hospital-based healthcare workers (HCWs). Demographical, behavioural and organisational determinants were assessed based on behavioural and implementation models. Multivariable regression analysis was applied to assess the independent predictors for influenza vaccine uptake. Age >40 years, the presence of a chronic illness, awareness of personal risk and awareness of risk of infecting patients, trust in the effectiveness of the vaccine to reduce the risk of infecting patients, the HCWs' duty to do no harm and their duty to ensure continuity of care, finding vaccination useful despite the constant flow of visitors and having knowledge of the Health Council's advice, social influence and convenient time for vaccination were all independently associated with vaccine uptake. The accuracy of the prediction model was very high (area under the receiver operating curve: 0.95). Intervention programmes to increase influenza vaccine uptake among HCWs should target the relevant determinants identified in this study.

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.

Reflections on the influenza vaccination of healthcare workers

Despite all that is known about the dangers of nosocomial transmission of influenza to the vulnerable patient populations in our healthcare facilities, and the benefits of the influenza vaccination, the low rates of influenza vaccination among healthcare workers (HCWs) internationally shows no sign of significant improvement. With the current voluntary 'opt-in' programmes clearly failing to adequately address this issue, the time has undoubtedly come for a new approach to vaccination to be implemented. Two different approaches to vaccination delivery have been suggested to rectify this situation, mandatory vaccination and 'opt-out' declination forms. It is suggested, however, that these two approaches are inadequate when used by themselves. In order to protect the most vulnerable patients in our healthcare facilities as best we can from serious harm or death caused by nosocomial transmission of influenza, while at the same time respecting HCWs autonomy, and in many jurisdictions, the related legal right to refuse medical treatment, it is recommended that 'op-out' declination forms should be used in conjunction with restricted mandatory vaccination. This 'combined' approach would allow any HCW to refuse the influenza vaccination, but would make the influenza vaccination a mandatory requirement for working in areas where the most vulnerable patients are cared for. Those HCWs not willing to be vaccinated should be required to work in other areas of healthcare.

Increasing influenza and pneumococcal immunization rates in a nursing home network

INTRODUCTION AND RATIONALE

Influenza and pneumonia remain serious health concerns for long-term care (LTC) residents. Vaccination of LTC residents and health care workers are reasonable preventive strategies, although most facilities fall short of Healthy People 2010 goals. Improving immunization rates across multiple LTC facilities remains an elusive challenge. This quality improvement study sought to improve immunization rates across 6 LTC facilities and identify persistent barriers to better performance.

METHODS

In 2002, 6 facilities associated with the University of Pittsburgh Institute on Aging established a quality improvement network addressing immunization rates. The facilities were provided with a written educational toolkit and shared information through an e-mail distribution list. To help determine optimal program structure in future years, 3 of the facilities participated in a single half-day collaborative training session. Change in immunization rates from baseline to year 2 were compared between those participating in the collaborative training and those not participating. Barriers to improved performance were sought from all groups through focus group analysis.

RESULTS

Facilities participating in the single collaborative training program improved immunization rates modestly, whereas facilities not participating in the collaborative training saw decreases in immunization rates. Staff turnover was cited as a significant barrier to improved performance.

DISCUSSION

It may be possible to improve immunization rates in LTC facilities, at least modestly, using a collaborative training process. Staff turnover may be an important barrier to improved LTC immunization rates.