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Strategies to Increase Flu Vaccination Coverage among Healthcare Workers: A 4 Years Study in a Large Italian Teaching Hospital. Vaccines (Basel) 2020; 8:vaccines8010085. [PMID: 32069869 PMCID: PMC7157643 DOI: 10.3390/vaccines8010085] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/09/2020] [Accepted: 02/10/2020] [Indexed: 11/16/2022] Open
Abstract
Flu vaccination is recommended among healthcare workers (HCWs). The low vaccination coverage registered in our hospital among HCWs called for new engaging approaches to improve flu vaccination coverage. The aim of this study was to evaluate the efficacy of different strategies implemented during the last four years (2015-2019). A quasi-experimental study was conducted, involving almost 4000 HCWs each year. Starting from the 2015-2016 campaign, new evidence-based strategies were progressively implemented. At the end of each campaign, an evaluation of the vaccination coverage rate reached was performed. Moreover, during the last three campaigns, differences in coverage among job category, wards involved or not in on-site vaccination (OSV) intervention, age classes and gender were analyzed. An increasing flu vaccination coverage rate was registered, from 6% in 2015-2016 to almost 22% at the end of 2018-2019. The overall number of vaccinated HCWs increased, especially at younger ages. OSV strategy always leads to better results, and physicians always show a higher vaccination coverage than nurses and other HCWs. The implemented strategies were effective in achieving higher flu vaccination coverage among HCWs in our hospital and therefore can be considered valuable examples of good prevention practices in hospital settings.
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Cherian T, Morales KF, Mantel C, Lambach P. Factors and considerations for establishing and improving seasonal influenza vaccination of health workers: Report from a WHO meeting, January 16-17, Berlin, Germany. Vaccine 2019; 37:6255-6261. [PMID: 31500965 PMCID: PMC6868506 DOI: 10.1016/j.vaccine.2019.07.079] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 07/19/2019] [Indexed: 12/13/2022]
Abstract
Health workers represent an important target group for seasonal influenza vaccination because of their increased risk of infection as well as the risk of transmitting infection to vulnerable patients in the health care setting. Moreover, seasonal vaccination of health workers contributes to pandemic preparedness. However, many countries, especially in Africa and Asia, do not have policies for health worker influenza vaccination. In countries where such policies exist, vaccination coverage is often low. The World Health Organization (WHO) is developing a manual to guide the introduction of seasonal influenza vaccination of health workers. An Independent External Advisory Group (IEAG) that is advising WHO on the content of the manual met to discuss issues that are relevant and often unique to health worker vaccination. This meeting report summarizes the main issues that were discussed and the outcomes of the discussion. The issues include policy considerations, including the evidence in support of health worker vaccination; categorization and prioritization of health workers; the choice of vaccination strategy; its integration into broader health worker vaccination and occupational health policies; planning and management of vaccination, particularly the approaches for communication and demand generation; and the challenges with monitoring and evaluation of health worker vaccination, especially in low and middle-income countries.
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Affiliation(s)
| | | | - Carsten Mantel
- MMGH Consulting, Zurich, Switzerland; Immunization Unit, Robert Koch Institute, Berlin, Germany
| | - Philipp Lambach
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland.
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Protecting Healthcare Personnel in Outpatient Settings: The Influence of Mandatory Versus Nonmandatory Influenza Vaccination Policies on Workplace Absenteeism During Multiple Respiratory Virus Seasons. Infect Control Hosp Epidemiol 2018. [PMID: 29514719 DOI: 10.1017/ice.2018.9] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine the effect of mandatory and nonmandatory influenza vaccination policies on vaccination rates and symptomatic absenteeism among healthcare personnel (HCP). DESIGN Retrospective observational cohort study. SETTING This study took place at 3 university medical centers with mandatory influenza vaccination policies and 4 Veterans Affairs (VA) healthcare systems with nonmandatory influenza vaccination policies. PARTICIPANTS The study included 2,304 outpatient HCP at mandatory vaccination sites and 1,759 outpatient HCP at nonmandatory vaccination sites. METHODS To determine the incidence and duration of absenteeism in outpatient settings, HCP participating in the Respiratory Protection Effectiveness Clinical Trial at both mandatory and nonmandatory vaccination sites over 3 viral respiratory illness (VRI) seasons (2012-2015) reported their influenza vaccination status and symptomatic days absent from work weekly throughout a 12-week period during the peak VRI season each year. The adjusted effects of vaccination and other modulating factors on absenteeism rates were estimated using multivariable regression models. RESULTS The proportion of participants who received influenza vaccination was lower each year at nonmandatory than at mandatory vaccination sites (odds ratio [OR], 0.09; 95% confidence interval [CI], 0.07-0.11). Among HCP who reported at least 1 sick day, vaccinated HCP had lower symptomatic days absent compared to unvaccinated HCP (OR for 2012-2013 and 2013-2014, 0.82; 95% CI, 0.72-0.93; OR for 2014-2015, 0.81; 95% CI, 0.69-0.95). CONCLUSIONS These data suggest that mandatory HCP influenza vaccination policies increase influenza vaccination rates and that HCP symptomatic absenteeism diminishes as rates of influenza vaccination increase. These findings should be considered in formulating HCP influenza vaccination policies. Infect Control Hosp Epidemiol 2018;39:452-461.
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Luthy KE, Kohler LR, Macintosh JLB, Eden LM, Beckstrand RL, Wright EL, E Hill K. Vaccination policies of Utah family practice clinics. J Am Assoc Nurse Pract 2016; 29:77-84. [PMID: 27459709 DOI: 10.1002/2327-6924.12395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 06/02/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to collect information regarding healthcare worker (HCW) vaccination policies in Utah family practice clinics. METHODS The study was conducted in Utah family practice clinics in the most densely populated counties in the state and was a cross-sectional descriptive design. Data were collected from 91 family practice clinic managers. Descriptive statistics were performed, as well as a content analysis for open-ended items. CONCLUSIONS HCWs are employed in environments where infectious diseases can be easily spread from person to person, thus, vaccinations can be instrumental in protecting the health of HCWs and patients alike. In Utah, 56.8% of family practice clinics had either no vaccination policy for HCWs or had a policy with no consequences for noncompliance. Utah family practice clinics need to implement changes to create and maintain HCW vaccination policies. IMPLICATIONS FOR PRACTICE Nurse practitioners can be leaders and change agents by working with their county and state health departments to create state-wide policies that mirror the position statements from the American Nurses Association and the American Association of Nurse Practitioners.
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Affiliation(s)
- Karlen E Luthy
- College of Nursing, Brigham Young University, Provo, Utah
| | - Levi R Kohler
- College of Nursing, Brigham Young University, Provo, Utah
| | | | - Lacey M Eden
- College of Nursing, Brigham Young University, Provo, Utah
| | | | - Emily L Wright
- College of Nursing, Brigham Young University, Provo, Utah
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Wicker S, Marckmann G, Poland GA, Rabenau HF. Healthcare Workers' Perceptions of Mandatory Vaccination: Results of an Anonymous Survey in a German University Hospital. Infect Control Hosp Epidemiol 2015; 31:1066-9. [DOI: 10.1086/656242] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Despite decades of effort to encourage healthcare workers (HCWs) to be immunized, vaccination rates remain insufficient. Among German HCWs, 831 (68.4%) of 1,215 respondents supported mandatory vaccinations for HCWs in general. However, acceptance of mandatory vaccination varied significantly between physicians and nurses and also depended on the targeted disease.
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Winston L, Wagner S, Chan S. Healthcare workers under a mandated H1N1 vaccination policy with employment termination penalty: a survey to assess employee perception. Vaccine 2014; 32:4786-90. [PMID: 24996124 DOI: 10.1016/j.vaccine.2014.06.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Revised: 04/21/2014] [Accepted: 06/02/2014] [Indexed: 11/26/2022]
Abstract
The ethical debate over mandatory healthcare worker (HCW) influenza vaccination is a heated one. Our study hospital instituted a mandatory employee influenza vaccination policy for the 2009-2010 influenza season during the highly publicized pandemic of the H1N1 "Swine Flu." Under this mandate there was no informed declination option, and termination of employment was the consequence for noncompliance. Our objective was to examine HCW perceptions of the H1N1 influenza virus, the vaccine, and the strict mandated vaccination policy. A survey was designed, distributed, and anonymously collected. In total, 202 completed questionnaires were obtained via accidental sampling by the investigators achieving a 100% response rate. Data analysis showed that 31.7% of surveyed HCWs felt the mandate was an infringement on their rights and 3.5% of HCWs would electively seek employment elsewhere. Significantly more nurses and clerks/technicians were opposed to the mandate compared to other types of employees. 96% felt that the mandating hospital should be liable should a significant adverse effect occur from receiving the vaccine. While the mandate helped to increase HCW influenza vaccination rates dramatically, the strict consequence of employment termination created negative feelings of coercion. Adopting a policy that includes a declination option with mandatory masking during influenza season might be a more widely acceptable and still adequate approach.
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Affiliation(s)
- Lori Winston
- CEP America, Kaweah Delta Health Care District, Visalia, CA, United States; University of California at Irvine and American University of Antigua, United States.
| | - Stephanie Wagner
- Infinity Healthcare, Sacred Heart Hospital Eau Claire, WI, United States
| | - Shu Chan
- Presence Resurrection Medical Center, Chicago, IL, United States; University of Illinois at Chicago, United States
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Zimmerman RK. Ethical analyses of institutional measures to increase health care worker influenza vaccination rates. Vaccine 2013; 31:6172-6. [PMID: 24188752 DOI: 10.1016/j.vaccine.2013.10.066] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 10/18/2013] [Accepted: 10/22/2013] [Indexed: 10/26/2022]
Abstract
Health care worker (HCW) influenza vaccination rates are modest. This paper provides a detailed ethical analysis of the major options to increase HCW vaccination rates, comparing how major ethical theories would address the options. The main categories of interventions to raise rates include education, incentives, easy access, competition with rewards, assessment and feedback, declination, mandates with alternative infection control measures, and mandates with administrative action as consequences. The aforementioned interventions, except mandates, arouse little ethical controversy. However, these efforts are time and work intensive and rarely achieve vaccination rates higher than about 70%. The primary concerns voiced about mandates are loss of autonomy, injustice, lack of due process, and subsuming the individual for institutional ends. Proponents of mandates argue that they are ethical based on beneficence, non-maleficence, and duty. A number of professional associations support mandates. Arguments by analogy can be made by mandates for HCW vaccination against other diseases. The ethical systems used in the analyses include evolutionary ethics, utilitarianism, principalism (autonomy, beneficence, non-maleficence, and justice), Kantism, and altruism. Across these systems, the most commonly preferred options are easy access, assessment and feedback, declinations, and mandates with infection control measures as consequences for non-compliance. Given the ethical imperatives of non-maleficence and beneficence, the limited success of lower intensive interventions, and the need for putting patient safety ahead of HCW convenience, mandates with additional infection control measures as consequences for non-compliance are preferred. For those who opt out of vaccination due to conscience concerns, such mandates provide a means to remain employed but not put patient safety at risk.
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Affiliation(s)
- Richard K Zimmerman
- Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh, 3518 Fifth Avenue, Pittsburgh, PA 15261, United States.
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Hollmeyer H, Hayden F, Mounts A, Buchholz U. Review: interventions to increase influenza vaccination among healthcare workers in hospitals. Influenza Other Respir Viruses 2012; 7:604-21. [PMID: 22984794 PMCID: PMC5781006 DOI: 10.1111/irv.12002] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Please cite this paper as: Hollmeyer et al. (2012) Review: interventions to increase influenza vaccination among healthcare workers in hospitals. Influenza and Other Respiratory Viruses 7(4), 604–621. Annual influenza vaccination rates among hospital healthcare workers (HCW) are almost universally low despite recommendations from WHO and public health authorities in many countries. To assist in the development of successful vaccination programmes, we reviewed studies where interventions aimed to increase the uptake of influenza vaccination among hospital HCW. We searched PUBMED from 1990 up to December 2011 for publications with predetermined search strategies and of pre‐defined criteria for inclusion or exclusion. We evaluated a large number of ‘intervention programmes’ each employing one or more ‘intervention components’ or strategies, such as easy access to vaccine or educational activities, with the goal to raise influenza vaccine uptake rates in hospital HCW during one influenza season. Included studies reported results of intervention programmes and compared the uptake with the season prior to the intervention (historical control) or to another intervention programme within the same season that started from the same set of baseline activities. Twenty‐five studies performed in eight countries met our selection criteria and described 45 distinct intervention programmes. Most studies used their own facility as historical control and evaluated only one season. The following elements were used in intervention programmes that increased vaccine uptake: provision of free vaccine, easy access to the vaccine (e.g. through mobile carts or on‐site vaccination), knowledge and behaviour modification through educational activities and/or reminders and/or incentives, management or organizational changes, such as the assignment of personnel dedicated to the intervention programme, long‐term implementation of the strategy, requiring active declination and mandatory immunization policies. The number of these components applied appeared to be proportional to the increase in uptake. If influenza uptake in hospital HCW is to be increased on sustained basis, hospital managers need to be committed to conduct a well‐designed long‐term intervention programme that includes a variety of co‐ordinated managerial and organizational elements.
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Affiliation(s)
- Helge Hollmeyer
- International Health Regulations Coordination Department, World Health Organization, Geneva, Switzerland.
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Ottenberg AL, Wu JT, Poland GA, Jacobson RM, Koenig BA, Tilburt JC. Vaccinating health care workers against influenza: the ethical and legal rationale for a mandate. Am J Public Health 2011; 101:212-6. [PMID: 21228284 DOI: 10.2105/ajph.2009.190751] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Despite improvements in clinician education, symptom awareness, and respiratory precautions, influenza vaccination rates for health care workers have remained unacceptably low for more than three decades, adversely affecting patient safety. When public health is jeopardized, and a safe, low-cost, and effective method to achieve patient safety exists, health care organizations and public health authorities have a responsibility to take action and change the status quo. Mandatory influenza vaccination for health care workers is supported not only by scientific data but also by ethical principles and legal precedent. The recent influenza pandemic provides an opportunity for policymakers to reconsider the benefits of mandating influenza vaccination for health care workers, including building public trust, enhancing patient safety, and strengthening the health care workforce.
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Niedrige Influenzaimpfquoten bei Mitarbeitern im Gesundheitswesen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2010; 53:1298-303. [DOI: 10.1007/s00103-010-1176-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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McLennan S, Wicker S. Reflections on the influenza vaccination of healthcare workers. Vaccine 2010; 28:8061-4. [PMID: 20971112 DOI: 10.1016/j.vaccine.2010.10.019] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 09/28/2010] [Accepted: 10/07/2010] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Stuart McLennan
- Institute of Medical Ethics and History of Medicine, Faculty of Medicine, Ruhr-Universität Bochum, Bochum, Germany.
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