Poor health care worker vaccination coverage and knowledge of vaccination recommendations in a tertiary Australia hospital

Influenza vaccination rates among healthcare workers: a systematic review and meta-analysis investigating influencing factors

Introduction

Healthcare workers risk of exposure to the influenza virus in their work, is a high-risk group for flu infections. Thus WHO recommends prioritizing flu vaccination for them-an approach adopted by >40 countries and/or regions worldwide.

Methods

Cross-sectional studies on influenza vaccination rates among healthcare workers were collected from PubMed, EMBASE, CNKI, and CBM databases from inception to February 26, 2023. Influenza vaccination rates and relevant data for multiple logistic regression analysis, such as odds ratios (OR) and 95% confidence intervals (CI), were extracted.

Results

A total of 92 studies comprising 125 vaccination data points from 26 countries were included in the analysis. The meta-analysis revealed that the overall vaccination rate among healthcare workers was 41.7%. Further analysis indicated that the vaccination rate was 46.9% or 35.6% in low income or high income countries. Vaccination rates in the Americas, the Middle East, Oceania, Europe, Asia, and Africa were 67.1, 51.3, 48.7, 42.5, 28.5, and 6.5%, respectively. Influencing factors were age, length of service, education, department, occupation, awareness of the risk of influenza, and/or vaccines.

Conclusion

The global influenza vaccination rate among healthcare workers is low, and comprehensive measures are needed to promote influenza vaccination among this population.

Systematic review registration

www.inplysy.com, identifier: 202350051.

Analysis of Knowledge, Attitudes and Behaviours of Health Care Workers towards Vaccine-Preventable Diseases and Recommended Vaccinations: An Observational Study in a Teaching Hospital

Background: Recommended vaccinations are the cheapest and most effective measure to reduce the risk of transmission and related complications, especially in high-risk healthcare settings. This study aimed to evaluate the knowledge, attitudes and behaviours of HCWs in relation to national recommendations. Methods: A transversal study was conducted through administration of a questionnaire by personal interview. The following care units were involved: Paediatric, Neonatal, Cardiac Surgery and General Intensive Care Units and Infectious Diseases Unit. Results: The study sample comprised 308 HCWs. Half the sample were aware of the vaccination recommendations, with occupation and age found to be predictive factors (OR = 9.38, 95%CI: 2.07−42.41; OR = 0.36, 95%CI: 0.22−0.60). A higher percentage defined the diseases as a risk for their patients’ health, although this perception was lower in the over-40 age group. In several cases, there were statistically significant differences between the care units (p < 0.001). Around three-quarters of the sample agreed that vaccination should be mandatory; willingness to undergo a future booster vaccination was statistically correlated with the variables of age and care unit (p < 0.001, p = 0.03). Conclusion: The protection of health in the workplace can be achieved through some strategic actions, such as the implementation of educational strategies, and protocols for the monitoring of immunocompetence and the improvement of vaccination.

Hepatitis B Vaccination Uptake Rate and Predictors in Healthcare Professionals of Ethiopia

Introduction

Healthcare professionals continue to be at risk of acquiring occupation-related hepatitis B virus infection because of noncompliance for the 3-dose primary series of hepatitis B vaccine recommended. The objective of the study was to determine the rate of and to identify the predictors of hepatitis B vaccination uptake in healthcare professionals in Ethiopia.

Methods

A multicenter cross-sectional survey was conducted between May 19 2018 and June 15 2018. A stratified with systematic random sampling technique was used to select 260 healthcare professionals. A structured questionnaire was used to collect all the necessary primary data from samples. This survey analyzed hepatitis B vaccination uptake as the binary outcome variable ("noncomplete" vs "complete") with regard to the 30 potential predictor variables. Both descriptive and inferential statistical analysis techniques have been used to address the study objective.

Results

The rate of complete vs noncomplete hepatitis B vaccination uptake was 37.7% vs 62.3%. The significantly independent predictors of hepatitis B vaccination uptake were professional qualification (P=0.004), professional experience (P=0.013), household income (P=0.006), workload status (P=0.015), routine infant immunization program existence at the workplace (P=0.014), perceived susceptibility to infection (P=0.005), perceived safety of vaccine (P=0.001), prior occupational exposure to blood (P=0.006), training on universal precautions (P=0.015), and colleagues' suggestion (P=0.002).

Conclusion

The rate of hepatitis B vaccination uptake found was currently low. The significantly independent predictors of hepatitis B vaccination uptake included perceived safety, colleagues' suggestion, professional qualification, perceived susceptibility, household income, prior occupational exposure to blood, professional experience, existence of routine infant immunization program at the workplace facility, workload status, and universal precautions training.

Seasonal influenza vaccination in middle-income countries: Assessment of immunization practices in Belarus, Morocco, and Thailand

BACKGROUND

Vaccines for the control of seasonal influenza are recommended by the World Health Organization (WHO) for use in specific risk groups, but their use requires operational considerations that may challenge immunization programs. Several middle-income countries have recently implemented seasonal influenza vaccination. Early program evaluation following vaccine introduction can help ascertain positive lessons learned and areas for improvement.

METHODS

An influenza vaccine post-introduction evaluation (IPIE) tool was developed jointly by WHO and the U.S. Centers for Disease Control and Prevention to provide a systematic approach to assess influenza vaccine implementation processes. The tool was used in 2017 in three middle-income countries: Belarus, Morocco and Thailand.

RESULTS

Data from the three countries highlighted a number of critical factors: Health workers (HWs) are a key target group, given their roles as key influencers of acceptance by other groups, and for ensuring vaccine delivery and improved coverage. Despite WHO recommendations, pregnant women were not always prioritized and may present unique challenges for acceptance. Target group denominators need to be better defined, and vaccine coverage should be validated with vaccine distribution data, including from the private sector. There is a need for strengthening adverse events reporting and for addressing potential vaccine hesitancy through the establishment of risk communication plans. The assessments led to improvements in the countries' influenza vaccination programs, including a revision of policies, changes in vaccine management and coverage estimation, enhanced strategies for educating HWs and intensified collaboration between departments involved in implementing seasonal influenza vaccination.

CONCLUSION

The IPIE tool was found useful for delineating operational strengths and weaknesses of seasonal influenza vaccination programs. HWs emerged as a critical target group to be addressed in follow-up action. Findings from this study can help direct influenza vaccination programs in other countries, as well as contribute to pandemic preparedness efforts. The updated IPIE tool is available on the WHO website http://www.who.int/immunization/research/development/influenza/en/index1.html.

Immunisation Rates of Medical Students at a Tropical Queensland University

Although medical students are at risk of contracting and transmitting communicable diseases, previous studies have demonstrated sub-optimal medical student immunity. The objective of this research was to determine the documented immunity of medical students at James Cook University to important vaccine-preventable diseases. An anonymous online survey was administered thrice in 2014, using questions with categories of immunity to determine documented evidence of immunity, as well as closed-ended questions about attitudes towards the importance of vaccination. Of the 1158 medical students targeted via survey, 289 responses were included in the study (response rate 25%), of which 19 (6.6%) had documented evidence of immunity to all of the vaccine-preventable diseases surveyed. Proof of immunity was 38.4% for seasonal influenza, 47.1% for pertussis, 52.2% for measles, 38.8% for varicella, 43.7% for hepatitis A, and 95.1% for hepatitis B (the only mandatory vaccination for this population). The vast majority of students agreed on the importance of vaccination for personal protection (98.3%) and patient protection (95.9%). In conclusion, medical students have sub-optimal evidence of immunity to important vaccine-preventable diseases. Student attitudes regarding the importance of occupational vaccination are inconsistent with their level of immunity. The findings of this study were used to prompt health service and educational providers to consider their duty of care to manage the serious risks posed by occupational communicable diseases.

Knowledge, Current Status, and Barriers toward Healthcare Worker Vaccination among Family Medicine Resident Participants in a Web-Based Survey in Korea

Background

We investigated the knowledge, status, and barriers toward healthcare workers receiving vaccinations among Korean family medicine residents. To date, a systematic study has not been conducted among medical practitioners examining these variables.

Methods

A web-based, anonymous, self-administered questionnaire was distributed to all 942 family medicine residents working in 123 training hospitals in Korea. A multiple logistic regression analysis was performed to investigate factors affecting vaccination completion.

Results

Korean family medicine residents (N=242, 25.7%) from 54 training hospitals (43.9%) participated in the survey. Only 24 respondents (9.9%) had correct knowledge on all the recommended vaccinations by the Korean Society of Infectious Diseases. The complete vaccination rates against hepatitis B virus and influenza were relatively high (69.4% and 83.0%, respectively), whereas they were relatively low against other infections (e.g., 16.5%– 53.1%). The most common reason for not receiving a vaccination was the belief that there was little possibility of infection from the vaccine-preventable diseases.

Conclusion

Knowledge and vaccination coverage were poor among family medicine residents in Korea. Medical schools should provide vaccination information to healthcare workers as part of their mandatory curriculum. Further research should confirm these findings among primary care physicians and other healthcare workers.

Immunization of Health-Care Providers: Necessity and Public Health Policies

Health-care providers (HCPs) are at increased risk for exposure to vaccine-preventable diseases (VPDs) in the workplace. The rationale for immunization of HCPs relies on the need to protect them and, indirectly, their patients from health-care-associated VPDs. Published evidence indicates significant immunity gaps for VPDs of HCPs globally. Deficits in knowledge and false perceptions about VPDs and vaccines are the most common barriers for vaccine uptake and may also influence communication about vaccines between HCPs and their patients. Most countries have immunization recommendations for HCPs; however, there are no universal policies and significant heterogeneity exists between countries in terms of vaccines, schedules, frame of implementation (recommendation or mandatory), and target categories of HCPs. Mandatory influenza immunization policies for HCPs have been implemented with high vaccine uptake rates. Stronger recommendations for HCP immunization and commitment at the level of the health-care facility are critical in order to achieve high vaccine coverage rates. Given the importance to health, mandatory immunization policies for VPDs that can cause serious morbidity and mortality to vulnerable patients should be considered.

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.

Should professionals caring for children be vaccinated? Community perspectives on health care and child care worker immunisation

OBJECTIVE

Several immunisations including influenza and pertussis are specifically recommended for healthcare workers (HCW) and childcare workers (CCW). This study aimed to assess community attitudes to HCW and CCW immunisation recommendations for pertussis and seasonal influenza.

METHODS

A cross-sectional study was conducted by Computer Assisted Telephone Interviewing (CATI) from April to May 2011. Statistical analyses used data weighted to the South Australian population by probability of selection, age, gender and geographical location using benchmarks derived from the 2009 Census population figures.

RESULTS

Almost all respondents supported vaccination of HCWs and CCWs against pertussis and influenza. For pertussis, 95.3% agreed nurses, 94.9% agreed doctors and 94.7% agreed CCWs have an obligation to be vaccinated. For influenza, 91.4% agreed nurses, 90.7% agreed doctors and 89.9% agreed CCWs have an obligation to be vaccinated. We identified higher support for protection against pertussis compared to influenza for all three groups of workers (p<0.001). There were higher concerns if CCWs compared to HCWs were not vaccinated against pertussis (OR=2.78) and influenza (OR=1.99). Young (18-30 years) and older age (60+ years) and lower educational attainment were predictors of support for HCWs and CCWs to be vaccinated against influenza. For pertussis, lower educational attainment was a predictor of support for HCWs immunisation.

CONCLUSIONS

Community support for CCW and HCW immunisation is strong with CCW immunisation was considered a priority. Pertussis immunisation was considered a higher priority than influenza immunisation for HCWs and CCWs. CCW immunisation should be considered for inclusion in public health immunisation programmes.

Are they protected? Immunity to vaccine-preventable diseases in healthcare workers at an Australian hospital

OBJECTIVE

Australian guidelines for healthcare worker (HCW) vaccination were updated in 2010, and pre-employment assessment of new employees has previously been identified as a priority. We determined the vaccination status of a cohort of existing HCWs at a tertiary hospital in Melbourne, Victoria.

METHODS

Random sampling of HCWs employed prior to 2006 with unknown/incomplete immunisation status was conducted between April and August 2011. Immunity to vaccine-preventable diseases (VPDs) was determined serologically (hepatitis B, varicella, measles, mumps, rubella) and by questionnaire (diphtheria, tetanus and pertussis), with vaccination by a nurse immuniser.

RESULTS

Overall, 95 HCWs were evaluated. Mean age and duration of employment were 47.2 and 12.6 years, respectively. Forty-seven staff (49%) required vaccination to comply with Australian immunisation guidelines: 18% were non-immune to hepatitis B, 2% to varicella, 8% to measles, 19% to mumps and 13% to rubella. HCWs without serological hepatitis B immunity were all staff with clinical roles. Total costs were $7,527.34 (mean $222.79/HCW).

CONCLUSIONS

Immunity to VPDs among existing HCWs was inadequate. About half assessed HCWs were non-immune to at least one VPD, and non-immunity to hepatitis B was high. A comprehensive assessment strategy for existing employees is required to enhance vaccination coverage and compliance with national guidelines.

IMPLICATIONS

Adequately resourced 'look-back' immunisation assessment programs are required to reduce the risks of VPDs among existing staff and patients. Review of current approaches and national consensus regarding the need for mandatory strategies would assist this process.

Factors affecting uptake of recommended immunizations among health care workers in South Australia

Despite the benefits of vaccination for health care workers (HCWs), uptake of recommended vaccinations is low, particularly for seasonal influenza and pertussis. In addition, there is variation in uptake within hospitals. While all vaccinations recommended for HCWs are important, vaccination against influenza and pertussis are particularly imperative, given HCWs are at risk of occupationally acquired influenza and pertussis, and may be asymptomatic, acting as a reservoir to vulnerable patients in their care. This study aimed to determine predictors of uptake of these vaccinations and explore the reasons for variation in uptake by HCWs working in different hospital wards. HCWs from wards with high and low influenza vaccine uptake in a tertiary pediatric and obstetric hospital completed a questionnaire to assess knowledge of HCW recommended immunizations. Multiple logistic regression was used to determine predictors of influenza and pertussis vaccination uptake. Of 92 HCWs who responded, 9.8% were able to identify correctly the vaccines recommended for HCWs. Overall 80% of respondents reported they had previously received influenza vaccine and 50.5% had received pertussis vaccine. Independent predictors of pertussis vaccination included length of time employed in health sector (P < 0.001), previously receiving hepatitis B/MMR (measles, mumps, rubella) vaccine (P < 0.001), and a respondent being aware influenza infections could be severe in infants (p = 0.023). Independent predictors of seasonal influenza vaccination included younger age (P < 0.001), English as first language (P < 0.001), considering it important to be vaccinated to protect themselves (P < 0.001), protect patients (p = 0.012) or awareness influenza could be serious in immunocompromised patients (p = 0.030). Independent predictors for receiving both influenza and pertussis vaccinations included younger age (P < 0.001), time in area of work (P = 0.020), previously receiving hepatitis B vaccine (P = 0.006) and awareness influenza could be severe in infants (P < 0.001). A knowledge gap exists around HCW awareness of vaccination recommendations. Assessment of the risk/benefit value for HCWs and their patients, determines uptake of HCW immunization programs and should be considered in promotional HCW vaccination programs.

Sharps injuries in a teaching hospital: changes over a decade

BACKGROUND

Sharps injuries create a high volume of occupational health (OH) workload in the health care setting. The deadline for implementation of the European Sharps Directive was 11 May 2013.

AIMS

To compare the epidemiology of sharps injuries reported in a large Irish teaching hospital in 2008-10 with those reported between 1998 and 2000.

METHODS

We compared data from electronic and paper OH records of sharps injuries reported between 1 January 2008 and 31 December 2010 with those from a previous study of sharps injuries reported between 1 January 1998 and 31 December 2000.

RESULTS

A total of 325 sharps injuries were reported in 2008-10, compared with 332 in 1998-2000 (P = 0.568). Hepatitis B immunity in sharps injury recipients in 2008-10 was 87% compared to 86% in 1998-2000 (P = 0.32). Glove use was reported in 80% of reported injuries in 2008-10 compared with 74% in 1998-2000 (P = 0.32). In 2008-10, 49% of injuries occurred during disposal or following improper disposal of sharps, compared with 42% in 1998-2000.

CONCLUSIONS

There was no significant change in the epidemiology of sharps injuries reported between 2008 and 2010 compared with 1998-2000. Further education in standard precautions, safe disposal of sharps, the use of safety-engineered devices and the benefits of hepatitis B immunization is needed.

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.

Predictive factors associated with the acceptance of pandemic and seasonal influenza vaccination in health care workers and students in Tuscany, Central Italy

Assessing the beliefs and attitudes of Health Care Workers (HCW) to influenza and influenza vaccination can be useful in overcoming low compliance rates. The purpose of our study is to evaluate the opinion of HCW and students regarding influenza, influenza vaccine and the factors associated with vaccination compliance. A survey was conducted between October 2010 and April 2011 in the Florence metropolitan area. A questionnaire was administered to HCW in three local healthcare units and at Careggi University Teaching Hospital. Students matriculating in health degree programs at Florence University were also surveyed.

The coverage with vaccination against seasonal and pandemic influenza is generally low, and it is lower in students than in HCW (12.5% vs 15% for the seasonal vaccination, 8.5% vs 18% for the pandemic vaccination). Individuals comply with vaccination offer mainly to protect themselves and their contacts. Individuals not receiving vaccination did not consider themselves at risk, had never been vaccinated before or believed that pandemic influenza was not a public health concern. Physicians had the highest compliance to vaccination and women were less frequently vaccinated than men. HCW do not appear to perceive their possible influenza infections as a risk for patients: HCW receive vaccination mainly as a form of personal protection.

Low compliance to vaccination is determined by various factors and therefore requires a multi-faceted strategy of response. This should include short-term actions to overcome organizational barriers, in addition to long-term interventions to raise HCW’s level of knowledge about influenza and influenza vaccination.

A review of the evidence to support influenza vaccine introduction in countries and areas of WHO's Western Pacific Region

Background

Immunization against influenza is considered an essential public health intervention to control both seasonal epidemics and pandemic influenza. According to the World Health Organization (WHO), there are five key policy and three key programmatic issues that decision-makers should consider before introducing a vaccine. These are (a) public health priority, (b) disease burden, (c) efficacy, quality and safety of the vaccine, (d) other inventions, (e) economic and financial issues, (f) vaccine presentation, (g) supply availability and (h) programmatic strength. We analyzed the body of evidence currently available on these eight issues in the WHO Western Pacific Region.

Methodology/Principal Findings

Studies indexed in PubMed and published in English between 1 January 2000 and 31 December 2010 from the 37 countries and areas of the Western Pacific Region were screened for keywords pertaining to the five policy and three programmatic issues. Studies were grouped according to country income level and vaccine target group. There were 133 articles that met the selection criteria, with most (90%) coming from high-income countries. Disease burden (n = 34), vaccine efficacy, quality and safety (n = 27) and public health priority (n = 27) were most frequently addressed by studies conducted in the Region. Many studies assessed influenza vaccine policy and programmatic issues in the general population (42%), in the elderly (24%) and in children (17%). Few studies (2%) addressed the eight issues relating to pregnant women.

Conclusions/Significance

The evidence for vaccine introduction in countries and areas in this Region remains limited, particularly in low- and middle-income countries that do not currently have influenza vaccination programmes. Surveillance activities and specialized studies can be used to assess the eight issues including disease burden among vaccine target groups and the cost-effectiveness of influenza vaccine. Multi-country studies should be considered to maximize resource utilization for cross-cutting issues such as vaccine presentation and other inventions.

Attitudes toward mandatory occupational vaccinations and vaccination coverage against vaccine-preventable diseases of health care workers in primary health care centers

BACKGROUND

The aim of this study was to assess the attitudes regarding mandatory occupational vaccinations and the vaccination coverage against vaccine-preventable diseases among health care workers (HCWs) working in primary health care centers in Greece.

METHODS

A standardized questionnaire was distributed to HCWs working in all primary health care centers in Greece (n = 185).

RESULTS

A total of 2,055 of 5,639 HCWs (36.4% response rate) from 152 primary health care centers participated. The self-reported completed vaccination rates were 23.3% against measles, 23.3% against mumps, 29.8% against rubella, 3% against varicella, 5.8% against hepatitis A, 55.7% against hepatitis B, and 47.3% against tetanus-diphtheria; corresponding susceptibility rates were 17%, 25%, 18.6%, 16.7%, 87.5%, 35%, and 52.6%. Mandatory vaccinations were supported by 65.1% of 1,807 respondents, with wide differences by disease. Multiple logistic regression analysis revealed higher rates of acceptance of mandatory vaccination in physicians compared with other HCW categories.

CONCLUSIONS

Despite the fact that two-thirds of HCWs working in primary health care centers in Greece support mandatory vaccination for HCWs, completed vaccination rates against vaccine-preventable diseases are suboptimal.

Attitudes regarding occupational vaccines and vaccination coverage against vaccine-preventable diseases among healthcare workers working in pediatric departments in Greece

We studied the attitudes with regard to occupational vaccines and vaccination coverage among healthcare workers in pediatric departments. Completed vaccination rates were 33%, 33%, 41.7%, 3%, 5.8%, 69.2% and 36.3% against measles, mumps, rubella, varicella, hepatitis A, hepatitis B and tetanus-diphtheria, respectively. Susceptibility rates were 14.2%, 15.7%, 14.6%, 7.6%, 87.4%, 22.6% and 61.8% for measles, mumps, rubella, varicella, hepatitis A, hepatitis B and tetanus-diphtheria, respectively. Mandatory vaccinations were supported by 70.6% of healthcare workers, with considerable differences by target disease.

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%.

Attitudes towards mandatory vaccination and vaccination coverage against vaccine-preventable diseases among health-care workers in tertiary-care hospitals

OBJECTIVE

To assess the attitudes about mandatory vaccination and vaccination coverage against vaccine-preventable diseases among health-care workers (HCWs) working in tertiary-care hospitals in Greece.

METHODS

A questionnaire was distributed to HCWs working in four tertiary-care hospitals.

RESULTS

In total, 505 HCWs participated in the survey. Self-reported completed vaccination rates were 18.8% against measles, 18.8% against mumps, 22.2% against rubella, 1.9% against varicella, 3.6% against hepatitis A, 56.5% against hepatitis B, and 35.7% against tetanus-diphtheria. Younger age groups had higher completed vaccination rates against measles, mumps, rubella, varicella, and hepatitis B compared with older HCWs (p-value < 0.001). Self-reported susceptibility rates were 12.7% for measles, 18.9% for mumps, 15.8% for rubella, 15.2% for varicella, 89.9% for hepatitis A, 34.2% for hepatitis B, and 64.3% for tetanus-diphtheria. Sixty three percent of 451 HCWs who answered this question supported mandatory vaccinations for HCWs, with significant differences per target disease. Physicians more frequently supported a mandatory vaccination policy compared to nurses and other professions (72.1% versus 61.9% and 54.2%, respectively; p-value = 0.028).

CONCLUSIONS

Approximately two thirds of HCWs working in tertiary-care hospitals in Greece support mandatory vaccinations for HCWs, however suboptimal vaccination rates against vaccine-preventable diseases were recorded.

Seasonal influenza vaccination in Australian hospital health care workers: a review

OBJECTIVE

To review the uptake of seasonal influenza vaccination among hospital health care workers (HCWs) in Australia to date.

DATA SOURCES

We searched MEDLINE and EMBASE (up to September 2010) and bibliographies of relevant reports for studies examining seasonal influenza vaccination (uptake, attitudes and/or programs) among Australian hospital HCWs. Studies relating to pandemic (H1N1) 2009 influenza vaccination or other types of health care facilities were excluded.

STUDY SELECTION

15 articles were assessed, of which 10 met inclusion criteria.

DATA SYNTHESIS

The 10 studies were conducted between 1997 and 2008 and reported vaccination rates of hospital HCWs of 16.3%-58.7%. Two of three studies documenting uptake rates of > 50% were associated with active implementation of vaccination policies or interventions. Uptake rates by occupational group ranged from 29% to 58.3% for physicians, 19% to 56.4% for nurses, 23% to 57.7% for allied health professionals, and 18% to 66.7% for ancillary or support staff. Coverage rates in hospitals that provided the vaccine free of charge to staff (with or without an informational campaign) were no higher than in other hospitals.

CONCLUSION

While seasonal influenza vaccination uptake was higher in hospitals with documented intervention programs, coverage is still low and does not appear to be affected by the provision of free vaccine to staff. State or institutional policies or mandates are likely needed to increase HCW uptake of seasonal influenza vaccination.

The decision to receive influenza vaccination among nurses in North and South Dakota

OBJECTIVES

We examined the relationships between factors (intention, habit, facilitating conditions, and social, cognitive, and affective factors) and nurses' decisions about influenza vaccinations to understand why some get vaccinated while others do not.

DESIGN AND SAMPLE

In a descriptive correlational design, the Triandis model of interpersonal behavior was used to examine the decision of nurses to receive influenza vaccinations. Participants were a random sample (N=193) of registered nurses in North and South Dakota drawn from the respective state nursing licensing board lists.

MEASURES

Instrument construction and mail survey procedures followed Dillman's tailored design method.

RESULTS

The response rate exceeded 80%. The findings revealed significant, positive correlations among all model variables. Item analysis showed that false beliefs about influenza disease and vaccinations were prevalent and that there was a wide variation in employer support for nurses getting vaccinated.

CONCLUSIONS

Educational and social marketing strategies may improve nurse's knowledge about influenza disease and vaccine and increase vaccine uptake. Employers should be encouraged to promote and improve influenza vaccine accessibility in the workplace. Additional study is needed to understand how best to strengthen the influence of intention and habit on the decision of nurses to receive influenza vaccinations.

Seasonal influenza vaccine uptake in Germany 2007/2008 and 2008/2009: results from a national health update survey

In 2008/2009 a nationwide cross-sectional telephone survey was conducted to assess, among other health-relevant parameters, seasonal influenza vaccination coverage. Data from 21,262 household-interviews representative of the adult population in Germany were collected and analyzed. In seasons 2007/2008 and 2008/2009, vaccine uptake in individuals aged ≥60 years was 57% and 55% and in individuals with underlying chronic diseases 44% and 42%. Living in the eastern part of Germany, higher age, and medium household income level were independently associated with higher vaccine uptake in both target groups. Healthcare workers were significantly less frequently (21.9% in 2007/2008; 20.4% in 2008/2009) vaccinated than the general population (30.8% and 28.1%). Special effort must be undertaken to develop immunization strategies for improved vaccine uptake in target groups, especially in healthcare workers.

Making influenza vaccination mandatory for health care workers: the views of NSW Health administrators and clinical leaders

The challenges of maintaining high influenza vaccination rates in health care workers have focused worldwide attention on mandatory measures. In 2007, NSW Health issued a policy directive requiring health care workers to be screened/vaccinated for certain infectious diseases. Annual influenza vaccine continued to be recommended but not required. This paper describes the views of NSW Health administrators and clinical leaders about adding influenza vaccination to the requirements. Of 55 staff interviewed, 45 provided a direct response. Of these, 23 supported inclusion, 14 did not and eight were undecided. Analysis of interviews indicated that successfully adding influenza vaccination to the current policy directive would require four major issues to be addressed: (1) providing and communicating a solid evidence base supporting the policy directive; (2) addressing the concerns of staff about the vaccine; (3) ensuring staff understand the need to protect patients; and (4) addressing the logistical challenges of enforcing an annual vaccination.

Can we know the immunization status of healthcare workers? Results of a feasibility study in hospital trusts, England, 2008

In England, there is no surveillance system for vaccines offered to healthcare workers apart from that in place annually for the seasonal influenza vaccine. To inform the feasibility of a general vaccine uptake surveillance system and to understand which policies are currently in place, we conducted a survey in the 162 National Health Service Foundation and Acute Hospital trusts in England, by submitting a questionnaire to their occupational health departments on immunization policies and methods of storing vaccine uptake data. In total, 104 hospital trusts (64·2%) responded. All responders offer hepatitis B, tuberculosis, measles-mumps-rubella, and influenza vaccines to healthcare workers; 0·9% reported not offering varicella and 13·5% not offering tetanus-diphtheria-polio; 66·4% record staff eligible for immunizations and 68·2% record staff they have immunized. Our study suggests that setting up a surveillance system to monitor vaccine uptake in healthcare workers is possible but would be challenging, given the variation in current systems.

Influenza vaccination among healthcare workers in a multidisciplinary University hospital in Italy

BACKGROUND

Annual influenza vaccination is recommended for healthcare workers (HCWs) in order to reduce the morbidity associated with influenza in healthcare settings. The aim of this study was to evaluate the current vaccination status of the HCWs in one of Italy's largest multidisciplinary University Hospitals.

METHODS

Between February 1 and March 31, 2006, we carried out a cross-sectional study of influenza vaccination coverage among HCWs at the University Hospital Fondazione IRCCS "Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena", Milan, Italy. After receiving a brief description of the aim of the study, 2,143 (95%: 1,064 physicians; 855 nurses; 224 paramedics) of 2,240 HCWs self-completed an anonymous questionnaire.

RESULTS

Influenza vaccination coverage was very low in all specialties, varying from 17.6% in the Emergency Department to 24.3% in the Surgery Department, and knowledge of influenza epidemiology and prevention was poor. The factors positively associated with being vaccinated were an age of >or= 45 years, considering influenza a potentially severe disease, and being aware of the high-risk categories for which influenza vaccination is strongly recommended; those that negatively associated with being vaccinated were being female, working in the Medicine Department, and being a nurse or paramedic.

CONCLUSION

Despite strong recommendations, influenza vaccination coverage seemed to be very low among HCWs of all specialties, with differences between areas and types of employment. Specific continuous educational and vaccination programs for different targets should be urgently organized to reduce morbidity and mortality in high-risk patients, contain nosocomial outbreaks, and ensure an appropriate socioeconomic impact.

Healthcare workers and immunity to infectious diseases

OBJECTIVE

In 2002, New South Wales (NSW) Health introduced an updated policy for occupational screening and vaccination against infectious diseases. This study describes healthcare worker (HCW) immunity to hepatitis B, measles, mumps, rubella (MMR) and varicella based on serological screening, following introduction of this policy.

METHODS

HCW screening serology performed at two healthcare facilities in south western Sydney (Bankstown and Fairfield) was extracted for the period September 2003 to September 2005. Immunity to hepatitis B, MMR and varicella was quantitated and cross-tabulated against age, sex and staff risk category.

RESULTS

A total of 1,320 HCWs were screened. Almost two thirds were immune to hepatitis B while immunity to MMR and varicella ranged from 88% to 94%. Age stratification showed lower levels of measles immunity in those born after 1965.

CONCLUSIONS

Despite availability of vaccination for over two decades, a significant proportion of HCWs at these two facilities were non-immune to hepatitis B. This is of concern for those non-immune staff involved in direct clinical care, who are at risk of blood and body fluid exposures. The small group of HCWs non-immune to MMR and varicella pose a risk to themselves and others in the event of an outbreak.

IMPLICATIONS

There is a need for improved implementation of the occupational screening and vaccination policy, including better education of HCWs about the risks of non-immunity to vaccine preventable diseases. The revised 2007 NSW Health policy may assist this process and will need evaluation to determine whether HCW immunity improves in the coming years.

Update on immunizations in solid organ transplant recipients: what clinicians need to know

Vaccine-preventable diseases remain a major source of morbidity and mortality in transplant recipients. Since the publication of the American Society of Transplantation's guidelines for vaccination of solid organ transplant recipients in 2004 (1), several new vaccines have been licensed. Transplant clinicians have been inundated by questions from patients and colleagues regarding the utility and safety of these vaccines in transplant candidates and recipients. In addition, new data has appeared regarding utility of some established vaccines, lack of rejection after vaccination and newer adjuvant strategies. Literature published between 2004 and 2007 was reviewed in a Medline search. Guidelines from the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices are reviewed and summarized, with particular attention to vaccines for human papillomavirus, varicella and varicella-zoster, tetanus-reduced diphtheria-acellular pertussis (Tdap) and hepatitis B, as well as conjugated meningococcal and conjugated pneumococcal vaccines. Although randomized controlled trials in transplant recipients have not been performed for most new licensed vaccines, preliminary recommendations can be formulated based on current data and guidelines. Further studies will be important to determine the indications and optimal timing of newer immunizations and immunization strategies.

High Coverage of Influenza Vaccination Among Healthcare Workers Can Be Achieved During Heightened Awareness of Impending Threat

Introduction: As preparation against a possible avian flu pandemic, international and local health authorities have recommended seasonal influenza vaccination for all healthcare workers at geographical risk. This strategy not only reduces “background noise”, but also chance of genetic shifts in avian influenza viruses when co-infection occurs. We evaluate the response of healthcare workers, stratified by professional groups, to a non-compulsory annual vaccination call, and make international comparisons with countries not at geographical risk. Materials and Methods: A cross-sectional study was performed over the window period for vaccination for the 2004 to 2005 influenza season (northern hemisphere winter). The study population included all adult healthcare workers (aged ≤21 years) employed by a large acute care tertiary hospital. Results: The uptake rates among frontline caregivers – doctors >50%, nurses >65% and ancillary staff >70% – markedly exceeded many of our international counterparts’ results. Conclusion: Given its close proximity in time and space to the avian flu pandemic threat, Singapore healthcare workers responded seriously and positively to calls for preventive measures. Other factors, such as the removal of financial, physical and mental barriers, may have played important facilitative roles as well. Key words: Avian, Flu, Pandemic, Season

Whooping cough: are health-care workers putting children at risk?

AIM

To explore the attitudes and knowledge of health-care workers (HCW) towards whooping cough and an adult whooping cough booster for HCW.

METHODS

HCW at Fairfield Health Service, who had clinical contact with infants or children, were sent a self-administered questionnaire.

RESULTS

Questionnaires were completed by 135 staff, giving a response rate of 74%. Thirty-five per cent were not known to be immunised against whooping cough. Fifty-nine per cent of doctors were known to be immunised, 33% of allied health staff and 28% of nurses. The rates of immunisation between the professional groups were significantly different (chi2 = 8.2 with 2 degrees of freedom; P = 0.017). Thirty-nine per cent of HCW did not know that primary immunisation did not provide lifelong protection. Twenty-seven per cent did not agree that HCW should be offered an adult whooping cough booster. Staff who felt at risk of contracting whooping cough were more likely to recommend that a booster should be offered (OR 2.71; 95% CI 1.22-6.04; P = 0.019). Doctors were less likely to recommend that a booster should be offered (OR 0.36; 95% CI 0.15-0.87; P = 0.028).

CONCLUSIONS

HCW have low rates of immunity to whooping cough and misconceptions about whooping cough infection and immunisation. Over a quarter of HCW did not agree that a booster should be offered. An ongoing education programme addressing the attitudes and misconceptions identified in this study is a crucial component of the campaign to increase the uptake of adult whooping cough booster immunisation by HCW.

Gaps between knowing and doing: understanding and assessing the barriers to optimal health care

INTRODUCTION

A significant gap exists between science and clinical practice guidelines, on the one hand, and actual clinical practice, on the other. An in-depth understanding of the barriers and incentives contributing to the gap can lead to interventions that effect change toward optimal practice and thus to better care.

METHODS

A systematic review of English language studies involving human subjects and published from January 1998 to March 2007 yielded 256 articles that fulfilled established criteria. The analysis was guided by two research questions: How are barriers are assessed? and What types of barriers are identified? The studies abstracted were coded according to 33 emerging themes; placed into seven categories that typified the barriers; grouped as to whether they involved the health care professional, the guideline, the scientific evidence, the patient, or the health system; and organized according to relationship pattern between barriers.

RESULTS

The results expand our understanding of how multiple factors pose barriers to optimal clinical practice. The review reveals increasing numbers of behavioral and system barriers. Quantitative survey type assessments continue to dominate barrier research; however, an increasing number of qualitative and mixed-method study designs have emerged recently.

DISCUSSION

The findings establish the evolution of research methodologies and emerging barriers to the translation of knowing to doing. While many studies are methodologically weak, there are indications that designs are becoming more aligned with the complexity of the health care environment. The review provides support for the need to examine multiple factors within the knowledge-to-action process.

Factors that influence influenza vaccination among healthcare workers in a French geriatric hospital

In a geriatric hospital in France, only 80 (21%) of 390 healthcare workers (HCWs) were vaccinated against influenza. Predictive factors for accepting influenza vaccination were occupation as a physician (odds ratio [OR], 9.79), previous receipt of influenza vaccination (OR, 36), and desire to protect their own health (OR, 2.42) and residents' health (OR, 3.68). Predictive factors for refusing influenza vaccination were occupation as a nurse (OR, 6.41) or nursing assistant (OR, 4.04) and belief that homeopathic medication is more effective than the vaccine (OR, 5.75).

Prevalence and determinants of influenza vaccination in Australians aged 40 years and over--a national survey

OBJECTIVES

To determine influenza vaccination coverage in 2001 in Australian adults aged > or = 40 years, assess awareness of and attitudes to influenza vaccine, factors associated with vaccination, and estimate uptake of free vaccine provided to those aged > or = 65 years.

METHODS

National computer-assisted telephone interview (CATI) survey in October/November 2001.

RESULTS

Interviews were completed with 5,266 people aged > or = 65 and 2,415 aged 40-64 years. Thirty per cent of selected households participated. Overall, 67% of respondents believed that the vaccine was somewhat to very effective in preventing influenza. Seventy-eight per cent of those aged > or = 65 years reported influenza vaccination; 89% had received it free. Independent predictors of vaccination were: belief that influenza vaccine is effective in preventing influenza (OR=13.5, 95% CI 10.6-17.2); and the presence of chronic disease (OR=1.6, 95% CI 1.3-2.0). Overall, 24% of those aged 40-64 years were vaccinated; only 34% of those who met any of the criteria for vaccination (medical risk factor, at-risk occupation, or being Aboriginal or Torres Strait Islander) reported vaccination.

CONCLUSIONS

Influenza vaccine coverage was high in those aged > or = 65 years, but coverage of those at-risk aged 40-64 years remained suboptimal. Immunisation against influenza was influenced more by beliefs about the vaccine's effectiveness and existing medical risk factors, rather than socio-demographic factors such as gender and income.