Vaccination against influenza: UK health care workers not on-message

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 worker compliance with seasonal and pandemic influenza vaccination

Healthcare workers (HCWs) can be an important source of transmission of influenza to patients and family members, and their well-being is fundamental to the maintenance of healthcare services during influenza outbreaks and pandemics. Unfortunately, studies have shown consistently low levels of compliance with influenza vaccination among HCWs, a finding that became particularly pronounced during recent pandemic vaccination campaigns. Among the variables associated with vaccine acceptance in this group are demographic factors, fears and concerns over vaccine safety and efficacy, perceptions of risk and personal vulnerability, past vaccination behaviours and experience with influenza illness, as well as certain situational and organisational constructs. We report the findings of a review of the literature on these factors and highlight some important challenges in interpreting the data. In particular, we point out the need for longitudinal study designs, as well as focused research and interventions that are adapted to the most resistant HCW groups. Multi-pronged strategies are an important step forward in ensuring that future influenza vaccination campaigns, whether directed at seasonal or pandemic strains, will be successful in ensuring broad coverage among HCWs.

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.

Knowledge, attitude, and practices about the seasonal influenza vaccination among healthcare workers in Srinagar, India

Please cite this paper as: Bali NK et al. (2012) Knowledge, attitude, and practices about the seasonal influenza vaccination among healthcare workers in Srinagar, India. Influenza and Other Respiratory Viruses 7(4), 540–545.

Background  Healthcare workers (HCWs) universally have a poor uptake of influenza vaccination. However, no data are available from India.

Objective  To explore knowledge, attitudes, and practices associated with influenza vaccination in HCWs in a temperate climate area in northern India.

Patients and Methods  A self‐administered questionnaire was offered to all HCWs in three major hospitals of Srinagar and information sought on motivations, perceptions, preferences and practices regarding influenza vaccination.

Results  Of the 1750 questionnaires received, 1421 (81%) were returned. Only 62 (4·4%) HCWs had ever received influenza vaccination even as 1348 (95%) believed that influenza poses adverse potential consequences for themselves or their contacts; 1144 (81%) were aware of a vaccine against influenza and 830 (58%) of its local availability. Reasons cited by 1359 participants for not being vaccinated included ignorance about vaccine availability (435; 32%), skepticism about efficacy (248; 18%), busy schedule (166; 12%), fear of side effects (70; 4%), and a perception of not being‐at‐risk (82; 6%). Sixty‐one percent (865) believed that vaccine programs are motivated by profit. Eighty‐eight percent opined for mandatory vaccination for HCWs caring for the high‐risk patients, as a part of ‘employee health program’. Most of the participants intended to get vaccinated in the current year even as 684 (48%) held that vaccines could cause unknown illness and 444 (31%) believed their adverse effects to be underreported.

Conclusion  Influenza vaccination coverage among HCWs is dismally low in Srinagar; poor knowledge of vaccine availability and misperceptions about vaccine effectiveness, fear of adverse effects and obliviousness to being‐at‐risk being important barriers. Multifaceted, adaptable measures need to be invoked urgently to increase the coverage.

Development and testing of an instrument to assess nurses' knowledge, risk perception, health beliefs and behaviours related to influenza vaccination

AIMS AND OBJECTIVES

To develop an instrument to measure nurses' knowledge, risk perception and health beliefs towards influenza and influenza vaccination and their vaccination behaviours and evaluate its construct validity and internal consistency reliability.

BACKGROUND

Although instruments to assess predictors of nurses' vaccination behaviours have been developed, their validity and reliability have not been reported.

DESIGN

Instrument development and initial validity and reliability testing.

METHODS

The instrument was developed drawing on a literature review and expert consultation and was refined through pilot work. A cross-sectional survey using a revised version of the instrument was conducted among a convenience sample of 520 registered nurses (response rate 77.4%). Cronbach's alpha coefficient was calculated to determine internal consistency of the sub-scale in the instrument. Principal components analysis with varimax rotation was carried out to evaluate the instrument's construct validity and examine its internal structure.

RESULTS

Cronbach's alpha coefficients for the three newly developed scales ranged from 0.70-0.76. Principal components analysis produced a good fit and confirmed the internal design of the instrument. In the seasonal influenza knowledge sub-scale four factors explained 44.8% of the total variance; in the H1N1 knowledge sub-scale two factors explained 44.7% of the total variance. Three factors in the risk perception scale contributed 50.5% of the total variance and two factors in the vaccination behaviours scale contributed 62.1% of the total variance.

CONCLUSIONS

An instrument has been developed to assess nurses' knowledge, risk perception and health beliefs towards influenza and influenza vaccination and their vaccination behaviours. The instrument was valid and reliable for the setting where it was used.

RELEVANCE TO CLINICAL PRACTICE

This instrument could be used to assess nurses' knowledge, risk perception, health beliefs towards influenza and influenza vaccination and their vaccination behaviours. The three newly developed scales could also be used independently to measure variables influencing nurses' vaccination practices.

How to develop a program to increase influenza vaccine uptake among workers in health care settings?

Background

Apart from direct protection and reduced productivity loss during epidemics, the main reason to immunize healthcare workers (HCWs) against influenza is to provide indirect protection of frail patients through reduced transmission in healthcare settings. Because the vaccine uptake among HCWs remains far below the health objectives, systematic programs are needed to take full advantage of such vaccination. In an earlier report, we showed a mean 9% increase of vaccine uptake among HCWs in nursing homes that implemented a systematic program compared with control homes, with higher rates in those homes that implemented more program elements. Here, we report in detail the process of the development of the implementation program to enable researchers and practitioners to develop intervention programs tailored to their setting.

Methods

We applied the intervention mapping (IM) method to develop a theory- and evidence-based intervention program to change vaccination behaviour among HCWs in nursing homes.

Results

After a comprehensive needs assessment, we were able to specify proximal program objectives and selected methods and strategies for inducing behavioural change. By consensus, we decided on planning of three main program components, i.e., an outreach visit to all nursing homes, plenary information meetings, and the appointment of a program coordinator -- preferably a physician -- in each home. Finally, we planned program adoption, implementation, and evaluation.

Conclusion

The IM methodology resulted in a systematic, comprehensive, and transparent procedure of program development. A potentially effective intervention program to change influenza vaccination behaviour among HCWs was developed, and its impact was assessed in a clustered randomised controlled trial.

Prioritizing healthcare worker vaccinations on the basis of social network analysis

OBJECTIVE

To use social network analysis to design more effective strategies for vaccinating healthcare workers against influenza.

DESIGN

An agent-based simulation.

SETTING

A simulation based on a 700-bed hospital.

METHODS

We first observed human contacts (defined as approach within approximately 0.9 m) performed by 15 categories of healthcare workers (eg, floor nurses, intensive care unit nurses, staff physicians, phlebotomists, and respiratory therapists). We then constructed a series of contact graphs to represent the social network of the hospital and used these graphs to run agent-based simulations to model the spread of influenza. A targeted vaccination strategy that preferentially vaccinated more "connected" healthcare workers was compared with other vaccination strategies during simulations with various base vaccination rates, vaccine effectiveness, probability of transmission, duration of infection, and patient length of stay.

RESULTS

We recorded 6,654 contacts by 148 workers during 606 hours of observations from January through December 2006. Unit clerks, X-ray technicians, residents and fellows, transporters, and physical and occupational therapists had the most contacts. When repeated contacts with the same individual were excluded, transporters, unit clerks, X-ray technicians, physical and occupational therapists, and social workers had the most contacts. Preferentially vaccinating healthcare workers in more connected job categories yielded a substantially lower attack rate and fewer infections than a random vaccination strategy for all simulation parameters.

CONCLUSIONS

Social network models can be used to derive more effective vaccination policies, which are crucial during vaccine shortages or in facilities with low vaccination rates. Local vaccination priorities can be determined in any healthcare facility with only a modest investment in collection of observational data on different types of healthcare workers. Our findings and methods (ie, social network analysis and computational simulation) have implications for the design of effective interventions to control a broad range of healthcare-associated infections.

A statewide system for improving influenza vaccination rates in hospital employees

OBJECTIVE

To describe and report the progress of a provider-initiated approach to increase influenza immunization rates for healthcare workers.

DESIGN

Observational study.

SETTING

The State of Iowa.

SUBJECTS

Acute care hospitals in Iowa.

METHODS

Hospitals reported rates of employee influenza vaccination to a provider-based collaborative during 2 influenza seasons (2006-2007 and 2007-2008). Hospital characteristics related to higher vaccination rates were examined.

RESULTS

One hundred (87.0%) of 115 Iowa hospitals and/or health systems participated in season 1; individual hospital vaccination rates ranged from 43.5% to 99.2% (mean, 72.4%; median, 73.1%). In season 2, 115 (100%) of 115 Iowa hospitals and/or health systems participated. Individual hospital vaccination rates ranged from 53.6% to 100% (mean, 79.5%; median, 82.0%). In both seasons, urban and large hospitals had vaccination rates that were 6.3% to 7.6% lower than those of hospitals in other locations. Hospitals that used declination statements had influenza vaccination rates 12.6% higher than hospitals that did not use declination statements in season 2.

CONCLUSION

The initial vaccination rates were high for healthcare workers in Iowa, especially in smaller rural hospitals, and rates increased during season 2. The successful voluntary approach for reporting influenza vaccination rates that we describe provides an efficient platform for collecting and disseminating other statewide measures of healthcare quality.

Which determinants should be targeted to increase influenza vaccination uptake among health care workers in nursing homes?

Although health care workers (HCWs) have been recommended to be immunized against influenza, vaccine uptake remains low. So far, research on determinants of influenza vaccination among HCWs has been limited by design, population or theoretical framework. Therefore we conducted a questionnaire study in Dutch nursing homes to assess which demographical, behavioural and organisational determinants were associated with influenza vaccine uptake among HCWs. We were able to accurately predict vaccine uptake based on a 13-item prediction model including two demographical, nine behavioural and two organisational determinants developed with data from 1,125 respondents (response rate 60%). To further increase influenza vaccine uptake, implementation programs should target these determinants.

Willingness of healthcare workers to accept voluntary stockpiled H5N1 vaccine in advance of pandemic activity

Healthcare workers may be at risk during the next influenza pandemic. Priming with stockpiled vaccine may protect staff and reduce nosocomial transmission. Despite campaigns to increase seasonal influenza vaccine coverage, uptake among healthcare workers is generally low; creating uncertainty whether they would participate in pre-pandemic vaccine programmes. We conducted a cross-sectional questionnaire survey of healthcare workers in a UK hospital during, and 6 months after, a period of media reporting of an H5N1 outbreak at a commercial UK poultry farm. A total of 520 questionnaires were returned, representing 20% of frontline workforce. More respondents indicated willingness to accept stockpiled H5N1 vaccine during the period of media attention than after (166/262, 63.4% vs. 134/258, 51.9%; p=0.009). Following multivariate analysis, factors associated with willingness to accept H5N1 vaccine included: previous seasonal vaccine (OR 6.2, 95% CI 3.0-12.8, p<0.0001), awareness of occupational seasonal vaccine campaigns (OR 2.2, 95% CI 1.4-3.5, p=0.001), belief that seasonal vaccine benefits themselves (OR 2.5, 95% CI 1.6-4.0, p<0.0001) or the hospital (OR 3.6, 95% CI 2.3-5.8, p<0.0001), belief that pandemic risk is high/moderate (OR 14.1, 95% CI 7.6-26.1, p<0.0001) and would threaten healthcare workers (OR 2.9, 95% CI 1.8-4.5, p<0.0001). Those who would not accept vaccine (220 respondents, 42.7%) if offered before the pandemic do not perceive pandemic influenza as a serious threat, and have concerns regarding vaccine safety. A majority of healthcare workers are amenable to accept stockpiled H5N1 vaccine if offered in advance of pandemic activity.

Influenza vaccination compliance among health care workers in a German university hospital

BACKGROUND

Since 1988, the Standing Committee on Vaccination (STIKO) at the Robert Koch-Institute, Berlin, has explicitly recommended that health-care workers (HCWs) should be vaccinated against seasonal influenza. However, acceptance of the influenza vaccination by medical personnel is low.

METHODS

This study analyzes factors associated with the compliance of HCWs with the seasonal influenza vaccination on the basis of three different anonymized questionnaires during two consecutive influenza seasons: 2006/2007 and 2007/2008. The questionnaires covered details of demographics, frequency of previous vaccinations, reasons for accepting or declining the vaccination, and the HCW's knowledge of the influenza vaccine and influenza itself.

RESULTS

Our study showed that physicians were significantly more likely to have been vaccinated than nurses (38.8% vs 17.4%; p < 0.0001). The main reasons for noncompliance included: supposition of a low risk of infection, fear of side effects, the belief that the influenza vaccine might trigger the influenza virus infection, and scepticism about the effectiveness of the influenza vaccination.

CONCLUSION

Our findings confirm the importance of a comprehensive approach to the vaccination, ensuring that HCWs are correctly informed about the vaccine and that it is convenient to receive it.

Use of a pandemic preparedness drill to increase rates of influenza vaccination among healthcare workers

OBJECTIVE

To determine the effect of a pandemic influenza preparedness drill on the rate of influenza vaccination among healthcare workers (HCWs).

DESIGN

Before-after intervention trial.

SETTING

The University of Iowa Hospitals and Clinics (UIHC), a large, academic medical center, during 2005.

SUBJECTS

Staff members at UIHC.

METHODS

UIHC conducted a pandemic influenza preparedness drill that included a goal of vaccinating a large number of HCWs in 6 days without disrupting patient care. Peer vaccination and mobile vaccination teams were used to vaccinate HCWs, educational tools were distributed to encourage HCWs to be vaccinated, and resources were allocated on the basis of daily vaccination reports. Logit models were used to compare vaccination rates achieved during the 2005 vaccination drill with the vaccination rates achieved during the 2003 vaccination campaign.

RESULTS

UIHC vaccinated 54% of HCWs (2,934 of 5,467) who provided direct patient care in 6 days. In 2 additional weeks, this rate increased to 66% (3,625 of 5,467). Overall, 66% of resident physicians (311 of 470) and 63% of nursing staff (1,429 of 2,255) were vaccinated. Vaccination rates in 2005 were significantly higher than the hospitalwide rate of 41% (5,741 of 14,086) in 2003.

CONCLUSIONS

UIHC dramatically increased the influenza vaccination rate among HCWs by conducting a pandemic influenza preparedness drill. Additionally, the drill allowed us to conduct a bioemergency drill in a realistic scenario, use innovative methods for vaccine delivery, and secure administrative support for future influenza vaccination campaigns. Our study demonstrates how a drill can be used to improve vaccination rates significantly.

Elements of influenza vaccination programs that predict higher vaccination rates: results of an emerging infections network survey

INTRODUCTION

To address suboptimal influenza vaccination rates among health care workers, the Healthcare Infection Control Practices Advisory Committee and the Advisory Committee on Immunization Practices recently issued recommendations designed to increase the number of health care workers vaccinated against influenza. The purpose of the present study was to determine how widely these recommendations have been implemented and to identify important elements of successful influenza vaccine programs.

METHODS

The Infectious Diseases Society of America Emerging Infections Network surveyed 991 infectious diseases consultants. Infectious diseases consultants were asked about vaccination programs and vaccination rates at their respective institutions. Multinomial logistic regression models based on proportional odds were used to determine predictors of vaccination-rate categories. All program elements were significant univariable factors in predicting vaccination rates. Because the program elements were highly associated with one another, principal components analysis was used to find combinations of the covariates that would serve as optimal predictors of higher vaccination rates.

RESULTS

Most infectious diseases consultants indicated that the vaccination rate for all health care workers in their institution had a range of 41%-60%. Vaccination rates were significantly higher in institutions that required signed declination statements (P = .004). In the model based on principal components analysis for predicting institutional vaccination rates, only the first principal component warranted retention (P < .001). In this component, the program elements weighted the most heavily were (1) offering the influenza vaccine free of charge, (2) providing adequate staff and resources, and (3) educating targeted groups of health care workers. Requiring signed declinations was not heavily weighted.

CONCLUSION

Influenza vaccination rates remain suboptimal, and hospitals have not completely implemented the Healthcare Infection Control Practices Advisory Committee-Advisory Committee on Immunization Practices recommendations to maximize vaccination rates.

Influenza vaccination of recommended adult populations, U.S., 1989-2005

OBJECTIVE

To assess influenza vaccination coverage among recommended adult populations in the United States.

METHODS

Data from the 1989 to 2005 National Health Interview Surveys (NHISs), weighted to reflect the civilian, non-institutionalized U.S. population, were analyzed to determine self-reported levels of influenza vaccination among persons aged >or=65 years, persons with high-risk conditions, health care workers (HCW), pregnant women, and persons living in households with at least one identified person at high risk of complications from influenza infection. We stratified data by race/ethnicity to identify racial/ethnic disparities.

RESULTS

Vaccination coverage levels among all recommended adult populations peaked in 2004, then declined in 2005 in association with the 2004-2005 vaccine shortage. Coverage for adults >or=65 years of age increased from 30.1% (95% confidence interval [CI]: 28.8-31.3) in 1989 to 70.0% (68.0-71.5) in 2004. In 2004, coverage was 40.7% (39.0-42.5) for all adults 50-64 years, 27.2% (24.6-29.9) for adults aged 18-49 years with high-risk conditions, 43.2% (39.9-46.6) for health care workers, 21.1% (19.1-23.4) for non-high-risk adults aged 18-64 years with a high-risk household member, and 14.4% (8.8-22.9) for pregnant women. Among each of the recommended adult sub-groups, vaccination coverage was higher for non-Hispanic whites compared to minority groups.

CONCLUSIONS

By 1997, influenza vaccination coverage had exceeded the national 2000 objective of 60% among persons aged >or=65 years, but by 2004 still remains well below the national 2010 target of 90%. Coverage levels for other groups targeted for influenza vaccination also are far short of the Healthy People 2000 and 2010 goals of 60% for persons aged 18-64 years with high-risk conditions, health care workers, and pregnant women. A concerted effort to increase provider adoption of standards for adult immunization, public awareness, and stable vaccine supplies are needed to improve influenza vaccination rates among recommended groups, and to reduce racial and ethnic disparities.

Does vaccinating ED health care workers against influenza reduce sickness absenteeism?

This study aims to investigate the association between influenza vaccination of health care workers (HCWs) and sickness absenteeism. A retrospective cohort study was conducted in an emergency department (ED) of an acute care hospital. All full-time HCWs except physicians (73 nurses and health care attendants) were included. Influenza vaccine was administered to HCWs on a voluntary basis commencing November 2004. Absenteeism due to influenza-like illness during the period from January to October 2005 was noted. The mean number of cumulative sick leave days per person was smaller (1.0 days against 1.75 days) in vaccine recipients than in vaccine nonrecipients although the difference was not statistically significant. A significantly larger proportion of subjects took sick leave because of influenza-like illness in the vaccine nonrecipient group (55% against 30.3%, P = .034).

CONCLUSION

Influenza vaccination of HCWs in the ED setting is significantly associated with a fewer number of HCWs requiring sick leave.

Vaccination contre la grippe: résultats d'une enquête sur la couverture vaccinale du personnel hospitalier à l'hôpital de la Croix-Rousse (hôpitaux de Lyon)

INTRODUCTION

The aim of this study was to evaluate the vaccinal status among Croix-Rousse Hospital workers, attitude towards this vaccination, and the information delivered in order to promote this vaccination.

METHODS

Questionnaires were delivered by electronic mailing.

RESULTS

Six hundred (and) twenty-nine questionnaires were analyzed (26.7% of hospital workers); 30.7% of responders were vaccinated against influenza, 89.2% of responders were aware of influenza and vaccine. Vaccine coverage was lower in younger workers, non health-care workers, non physician health-care workers, and surgeons who responded. Motivation and reserve varied according to the status, position, and age, with some discrepancies.

CONCLUSION

These results suggest implementing a better targeted vaccination campaign, according to the various categories of personnel.

Influenza immunisation: attitudes and beliefs of UK healthcare workers

AIM

To explore attitudes to influenza immunisation and rates of uptake among staff working in acute hospitals in the UK.

METHOD

A cross-sectional survey of 11,670 healthcare workers in six UK hospitals was carried out using a postal questionnaire.

RESULTS

Among 6302 responders (54% of those mailed), 19% had taken up influenza immunisation during winter 2002/3. Vaccination was well tolerated, with a low prevalence of side effects (13%) and associated time off work (2%). The majority of subjects who accepted vaccination (66%) were most strongly influenced by the personal benefits of protection against influenza. Prevention of sickness absence and protection of patients were the prime motivation for only 10% and 7% of subjects, respectively. Among 3967 who declined vaccination, the most common primary demotivators were concern about safety (31%) and efficacy (29%). 22% were most strongly deterred by lack of time to attend for vaccination. Free text answers indicated that 37% declined because of a perceived low ratio of personal benefits to adverse effects. Subjects said they would be persuaded to take up vaccination in future by easier access (36%), more information about personal benefit and risk (34%) and more information about effects on staff absence (24%).

CONCLUSIONS

These findings indicate that the uptake of influenza immunisation among UK healthcare workers remains low. There is some scope for increasing uptake by improving accessibility and encouragement from professional peers. However, the results suggest that perception of small personal benefit in relation to risk mitigates, importantly, against higher uptake of routine annual influenza vaccination. Thus, resource might better be allocated to ensuring efficient management in epidemic years. The effect of publicity about pandemic influenza on risk perception and vaccine uptake among healthcare workers during winter 2005/6 warrants further study.

[Influenza vaccination in healthcare workers. Why are some vaccinated whereas others are not]

BACKGROUND AND OBJECTIVE

Influenza vaccination is indicated in health professionals. Nevertheless, vaccination coverage in healthcare workers tends to be low. This paper determines the reasons why some workers are vaccinated whereas others are not and investigates what type of intervention can modify the latter attitude.

METHOD

This was a cross-sectional descriptive study using a questionnaire survey.

SETTING

workers at Hospital General Universitario de Alicante (Alicante, Spain). Absolute frequencies and relative frequencies expressed in percentages were calculated for each of the variables studied. Results were analyzed considering the professional categories of the persons involved and the departments where they worked.

RESULTS

The reasons for influenza vaccination stated by hospital workers were to protect their health (65.6%), the belief that vaccination is beneficial (45.7%), and to avoid transmitting influenza to their patients (42.5%), and to their own families (39.8%). The main reasons for not undergoing vaccination were to avoid medication (17.9%), confidence in their own defenses (17%), or fear of the secondary effects of the vaccine (16.8%).

CONCLUSION

The main reason given by hospital personnel for undergoing vaccination was to protect their own health and that of their family and patients. The reasons most frequently given for not undergoing vaccination were based on possible side effects of the vaccine, the conviction of not being part of a high-risk group, and doubts about the effectiveness of the vaccine as a protective agent. Many of the reasons given for not undergoing vaccination were based on erroneous beliefs and should be taken into account when designing strategies to increase influenza vaccination coverage among health personnel.

Use of a mobile cart influenza program for vaccination of hospital employees

OBJECTIVE

Rates of annual influenza vaccination of healthcare workers (HCWs) remained low in our university hospital. This study was conducted to evaluate the impact of a mobile cart influenza vaccination program on HCW vaccination.

METHODS

From 2000 to 2002, the employee health service continued its annual influenza vaccination program and the mobile cart program was implemented throughout the institution. This program offered influenza vaccination to all employees directly on the units. Each employee completed a questionnaire. Vaccination rates were analyzed using the Mantel-Haenszel test.

RESULTS

The program proposed vaccination to 50% to 56% of the employees. Among the nonvaccinated employees, 52% to 53% agreed to be vaccinated. The compliance with vaccination varied from 61% to 77% among physicians and medical students and from 38% to 55% among nurses and other employees. Vaccination of the chief or associate professor of the unit was associated with a higher vaccination rate of the medical staff (P < .01). Altogether, the vaccination program led to an increase in influenza vaccination among employees from 6% in 1998 and 7% in 1999 before the mobile cart program to 32% in 2000, 35% in 2001, and 32% in 2002 (P < .001).

CONCLUSIONS

The mobile cart program was associated with a significantly increased vaccination acceptance. Our study was able to identify HCW groups for which the mobile cart was effective and highlight the role of the unit head in its success.