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Gianino MM, Kakaa O, Politano G, Scarmozzino A, Benso A, Zotti CM. Severe and moderate seasonal influenza epidemics among Italian healthcare workers: A comparison of the excess of absenteeism. Influenza Other Respir Viruses 2020; 15:81-90. [PMID: 32666696 PMCID: PMC7767959 DOI: 10.1111/irv.12777] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 06/05/2020] [Accepted: 06/06/2020] [Indexed: 12/03/2022] Open
Abstract
Background This study aims to quantify the excess of sickness absenteeism among healthcare workers (HCWs), to estimate the impact of a severe versus moderate influenza season and to determine whether the vaccination rates are associated with reduced sickness absence. Methods We investigated the excess absenteeism that occurred in a large Italian hospital, 5300 HCWs, during the severe influenza season of 2017/2018 and compared it with three moderate flu seasons (2010/2013). Data on influenza vaccinations and absenteeism were obtained from the hospital's databases. The data were split into two periods: the epidemic, from 42 to 17 weeks, and non‐epidemic, defined as 18 to 41 weeks, which was used as the baseline. We stratified the absenteeism among HCWs in multiple variables. Results Our study showed an increased absenteeism among HCWs during the epidemic period of severe season in comparison with non‐epidemic periods, the absolute increase correlated with a relative increase of 70% (from 4.05 to 6.68 days/person). Vaccinated HCWs had less excess of absenteeism in comparison with non‐vaccinated HCWs (1.74 vs 2.71 days/person). The comparison with the moderate seasons showed a stronger impact on HCW sick absenteeism in the severe season (+0.747days/person, P = .03), especially among nurses and HCWs in contact with patients (+1.53 P < .01; +1.19 P < .01). Conclusions In conclusion, a severe influenza epidemic has greater impacts on the absenteeism among HCWs than a moderate one. Although at a low rate, a positive effect of vaccination on absenteeism is present, it may support healthcare facilities to recommend vaccinations for their workers.
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Affiliation(s)
- Maria Michela Gianino
- Department of Sciences of Public Health and Pediatrics, University of Torino, Torino, Italy
| | - Omar Kakaa
- Department of Sciences of Public Health and Pediatrics, University of Torino, Torino, Italy
| | - Gianfranco Politano
- Department of Control and Computer Engineering, Politecnico di Torino, Torino, Italy
| | | | - Alfredo Benso
- Department of Control and Computer Engineering, Politecnico di Torino, Torino, Italy
| | - Carla Maria Zotti
- Department of Sciences of Public Health and Pediatrics, University of Torino, Torino, Italy
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2
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Di Castri AM, Halperin DM, McPherson CM, Nunn A, Farrar-Muir H, Kwong JC, Henry B. Narrowing the policy gap: lessons from years 2 and 3 of the British Columbia influenza prevention policy. Hum Vaccin Immunother 2020; 16:1354-1363. [PMID: 31922460 DOI: 10.1080/21645515.2019.1692561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Influenza can be potentially fatal to vulnerable populations, particularly those in the hospital. Canada's National Advisory Committee on Immunization recommends that health-care workers (HCW) be immunized against influenza partly to avoid infecting high-risk populations. However, influenza immunization rates among HCW remain suboptimal. In 2012, health authorities across British Columbia (B.C.) implemented a province-wide influenza prevention policy requiring HCW to either be immunized or wear a mask when in patient-care areas during the influenza season. This paper describes the second of two studies focused on what was learned from years 2 and 3 of the policy. A case study approach was used to examine this policy implementation event. Qualitative data were collected through key documents and key informant interviews with members of leadership teams responsible for policy implementation. Framework analysis and Prior's approach were used to analyze data from interviews and documents, respectively. Policy implementation varied by geographic region and gaps persist in immunization tracking and discipline for noncompliance. Debate regarding the scientific evidence used to support the policy fuels resistance from particular groups. Despite these challenges, findings suggest that the policy has been habituated, largely due to consistent policy objectives. This study emphasizes the importance of ongoing inter-professional and cross-sectoral program evaluation. While adherence may be routine for many, implementation processes must continue to respond to contextual issues to narrow the gap in policy implementation and to continue to engage stakeholders to ensure compliance.
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Affiliation(s)
- Antonia M Di Castri
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and The Nova Scotia Health Authority , Halifax, NS, Canada.,Department of Community Health and Epidemiology, Dalhousie University , Halifax, NS, Canada
| | - Donna M Halperin
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and The Nova Scotia Health Authority , Halifax, NS, Canada.,Rankin School of Nursing, St. Francis Xavier University , Antigonish, NS, Canada
| | - Charmaine M McPherson
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and The Nova Scotia Health Authority , Halifax, NS, Canada.,Rankin School of Nursing, St. Francis Xavier University , Antigonish, NS, Canada
| | - Alexandra Nunn
- British Columbia Centre for Disease Control , Vancouver, B.C., Canada
| | - Haley Farrar-Muir
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and The Nova Scotia Health Authority , Halifax, NS, Canada.,Department of Sociology and Social Anthropology, Dalhousie University , Halifax, NS, Canada
| | - Jeffrey C Kwong
- Institute for Clinical Evaluative Sciences (ICES) , Toronto, ON, Canada.,Public Health Ontario , Toronto, ON, Canada.,Centre for Vaccine Preventable Diseases, University of Toronto , Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto , Toronto, ON, Canada.,Department of Family & Community Medicine, University of Toronto , Toronto, ON, Canada.,University Health Network , Toronto, ON, Canada
| | - Bonnie Henry
- School of Population and Public Health, University of British Columbia , Vancouver, B.C., Canada.,Provincial Health Officer, Ministry of Health , Vancouver, B.C., Canada
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Murti M, Otterstatter M, Orth A, Balshaw R, Halani K, Brown PD, Hejazi S, Thompson D, Allison S, Bharmal A, Dawar M, Hoyano D, Lee V, Naus M, Pollock S, Bevanda J, Coughlin S, Fitzgerald J, Keen D, Maracle M, Sprague S, Henry B. Measuring the impact of a mandatory province-wide vaccinate-or-mask policy on healthcare worker absenteeism in British Columbia, Canada. Vaccine 2019; 37:4008-4014. [PMID: 31204158 DOI: 10.1016/j.vaccine.2019.06.007] [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: 03/31/2019] [Revised: 05/31/2019] [Accepted: 06/02/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Vaccinate-or-mask (VOM) policies aim to improve influenza vaccine coverage among healthcare workers (HCW) and reduce influenza-related illness among patients and staff. In 2012, British Columbia (BC) implemented a province-wide VOM influenza prevention policy. This study describes an evaluation of policy impacts on HCW absenteeism rates from before to after policy implementation. METHODS Using payroll data from regional and provincial Health Authorities (HA), we assessed all-cause sick rates (sick time as a proportion of sick time and productive time) before (2007-2011, excluding 2009-2010) and after (2012-2017) policy implementation, and during influenza season (December 1-March 31) and non-influenza season (April 1-November 30). We used a two-part negative binomial hurdle model to calculate odds ratios (OR) of taking any sick time, relative rates (RR) of sick time taken, and predicted mean sick rates, adjusting for age group, sex, job type, job classification, HA, year and vaccine effectiveness. RESULTS During influenza season, HCWs in the post-policy period were less likely to take any sick time (OR 0.989, 95%CI: 0.979-0.999) but had higher rates of sick time (RR 1.038, 95%CI: 1.030-1.045). However, during non-influenza season, HCWs in the post-policy period were more likely to take any sick time (OR 1.015, 95%CI: 1.008-1.022) but had lower rates of sick time (RR 0.971, 95%CI: 0.966-0.976). There was an overall increase in predicted mean sick rate from pre to post-policy in influenza season (4.392% to 4.508%) and non-influenza season (3.815% to 3.901%). CONCLUSIONS The observed year-round increase in sick rates from pre-to-post policy was likely influenced by other factors; however, opposite trends in how HCWs took sick time in the influenza and non-influenza seasons may reflect policy influences and need further research to explore reasons for these differences.
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Affiliation(s)
- Michelle Murti
- Fraser Health Authority, 13450 102nd Ave., Suite 400, Surrey, BC V3T0H1, Canada; University of British Columbia, 2206 East Mall, Vancouver, BC V6T1Z3, Canada; Public Health Ontario, 480 University Ave., Suite 300, Toronto, ON M5G1V2, Canada.
| | - Michael Otterstatter
- BC Centre for Disease Control, 655 W 12th Ave, Vancouver, BC V5Z4R4, Canada; University of British Columbia, 2206 East Mall, Vancouver, BC V6T1Z3, Canada.
| | - Alison Orth
- Fraser Health Authority, 13450 102nd Ave., Suite 400, Surrey, BC V3T0H1, Canada.
| | - Robert Balshaw
- BC Centre for Disease Control, 655 W 12th Ave, Vancouver, BC V5Z4R4, Canada; University of Manitoba, 753 McDermot Ave., Third Floor, Winnipeg, MB R3E0T6, Canada.
| | - Khalif Halani
- Emmes Canada, 4664 Lougheed Hwy., Suite 200, Burnaby, BC V5C3Y2, Canada.
| | - Paul D Brown
- Fraser Health Authority, 13450 102nd Ave., Suite 400, Surrey, BC V3T0H1, Canada.
| | - Samar Hejazi
- Fraser Health Authority, 13450 102nd Ave., Suite 400, Surrey, BC V3T0H1, Canada.
| | - Darby Thompson
- Emmes Canada, 4664 Lougheed Hwy., Suite 200, Burnaby, BC V5C3Y2, Canada.
| | - Sandra Allison
- Northern Health Authority, 299 Victoria St. Suite 600, Prince George, BC, V2L5B8, Canada; University of British Columbia, 2206 East Mall, Vancouver, BC V6T1Z3, Canada.
| | - Aamir Bharmal
- Fraser Health Authority, 13450 102nd Ave., Suite 400, Surrey, BC V3T0H1, Canada; University of British Columbia, 2206 East Mall, Vancouver, BC V6T1Z3, Canada.
| | - Meena Dawar
- Vancouver Coastal Health Authority, 601 West Broadway, 11th Floor, Vancouver, BC V5Z4C2, Canada; University of British Columbia, 2206 East Mall, Vancouver, BC V6T1Z3, Canada.
| | - Dee Hoyano
- Island Health Authority, 1952 Bay St., Victoria, BC V8R1J8, Canada; University of British Columbia, 2206 East Mall, Vancouver, BC V6T1Z3, Canada.
| | - Victoria Lee
- Fraser Health Authority, 13450 102nd Ave., Suite 400, Surrey, BC V3T0H1, Canada; University of British Columbia, 2206 East Mall, Vancouver, BC V6T1Z3, Canada.
| | - Monika Naus
- BC Centre for Disease Control, 655 W 12th Ave, Vancouver, BC V5Z4R4, Canada; University of British Columbia, 2206 East Mall, Vancouver, BC V6T1Z3, Canada.
| | - Sue Pollock
- Interior Health Authority, 505 Doyle Ave., Kelowna, BC V1Y0C5, Canada; University of British Columbia, 2206 East Mall, Vancouver, BC V6T1Z3, Canada.
| | - John Bevanda
- Interior Health Authority, 505 Doyle Ave., Kelowna, BC V1Y0C5, Canada.
| | - Sandy Coughlin
- Providence Health Care, 1081 Burrard St., Vancouver, BC V6Z1Y6, Canada.
| | - John Fitzgerald
- Island Health Authority, 1952 Bay St., Victoria, BC V8R1J8, Canada.
| | - Dave Keen
- Fraser Health Authority, 13450 102nd Ave., Suite 400, Surrey, BC V3T0H1, Canada.
| | - Melanie Maracle
- Northern Health Authority, 299 Victoria St. Suite 600, Prince George, BC, V2L5B8, Canada.
| | - Stacy Sprague
- Vancouver Coastal Health Authority, 601 West Broadway, 11th Floor, Vancouver, BC V5Z4C2, Canada.
| | - Bonnie Henry
- Office of the Provincial Health Officer, PO Box 9648 STN PROV GOVT, Victoria, BC V8W9P4, Canada; University of British Columbia, 2206 East Mall, Vancouver, BC V6T1Z3, Canada.
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Tai X, Smith AM, McGeer AJ, Dubé E, Holness DL, Katz K, McGillis Hall L, McNeil SA, Powis J, Coleman BL. Comparison of response rates on invitation mode of a web-based survey on influenza vaccine adverse events among healthcare workers: a pilot study. BMC Med Res Methodol 2018; 18:59. [PMID: 29925324 PMCID: PMC6011252 DOI: 10.1186/s12874-018-0524-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 06/13/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Web-based surveys have become increasingly popular but response rates are low and may be prone to selection bias. How people are invited to participate may impact response rates and needs further study as previous evidence is contradictory. The purpose of this study was to determine whether response to a web-based survey of healthcare workers would be higher with a posted or an emailed invitation. We also report results of the pilot study, which aims to estimate the percentage of adults vaccinated against influenza who report recurrent systemic adverse events (the same systemic adverse event occurring successively following receipt of influenza vaccines). METHODS The pilot study was conducted in November 2016 in Toronto, Canada. Members of a registry of adults (18 years and older and predominantly healthcare workers) who volunteered to receive information regarding future studies about influenza were randomly assigned to receive either an email or postal invitation to complete a web-based survey regarding influenza vaccinations. Non-respondents received one reminder using the same mode of contact as their original invitation. RESULTS The overall response rate was higher for those sent the invitation by email (34.8%) than by post (25.8%; p < 0.001) and for older versus younger participants (ptrend < 0.001). Of those who responded, 387/401 had been vaccinated against influenza at least once since adulthood. Of those responding to the question, 70/386 (18.1%) reported a systemic adverse event after their most recent influenza vaccine including 22 (5.7%) who reported a recurring systemic event. Systemic adverse events were reported more often by males 18-49 years old than by other groups (p = 0.01). Recurrent systemic adverse events were similar by age and sex with muscle ache being the most commonly reported recurrent reaction. More respondents who reported only a local adverse event (93.1%) planned to be vaccinated again next year than those with a systemic adverse event (69.7%; p = 0.04). CONCLUSIONS In this convenience sample of registry volunteers, response rates were generally low, but were higher for the emailed than posted invitations and for older than younger adults.
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Affiliation(s)
- Xiaochen Tai
- Sinai Health System, Mount Sinai Hospital, Toronto, ON Canada
| | - Alanna M. Smith
- Sinai Health System, Mount Sinai Hospital, Toronto, ON Canada
| | - Allison J. McGeer
- Sinai Health System, Mount Sinai Hospital, Toronto, ON Canada
- University of Toronto, Toronto, ON Canada
| | - Eve Dubé
- National Public Health Institute of Quebec, Quebec City, QC Canada
- Laval University, Quebec City, QC Canada
| | - Dorothy Linn Holness
- University of Toronto, Toronto, ON Canada
- St. Michael’s Hospital, Toronto, ON Canada
| | - Kevin Katz
- University of Toronto, Toronto, ON Canada
- North York General Hospital, Toronto, ON Canada
| | | | - Shelly A. McNeil
- Dalhousie University, Halifax, NS Canada
- Nova Scotia Health Authority, Halifax, NS Canada
- IWK Health Centre, Halifax, NS Canada
- Canadian Center for Vaccinology, Halifax, NS Canada
| | - Jeff Powis
- Michael Garron Hospital, Toronto, ON Canada
| | - Brenda L. Coleman
- Sinai Health System, Mount Sinai Hospital, Toronto, ON Canada
- University of Toronto, Toronto, ON Canada
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6
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Cheung EKH, Lee S, Lee SS. Pattern of exposure to information and its impact on seasonal influenza vaccination uptake in nurses. J Hosp Infect 2017; 97:376-383. [PMID: 28807832 DOI: 10.1016/j.jhin.2017.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 08/06/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Uptake of annual influenza vaccination of healthcare workers (HCWs) varies, and remains at a suboptimal level in many countries. As HCWs are often exposed to a variety of information about vaccination, the pattern of exposure may impact their decision; this deserves further investigation. METHODS Practising nurses in Hong Kong were invited to participate in an anonymous online survey in February 2016, after the winter seasonal peak. The questionnaire covered demographics, work nature and experiences, vaccination uptake history and reasons for vaccination decisions. Two behavioural categories for access to information were defined - passive exposure to information and active information-seeking - differentiated by the source, type and nature of information accessed. Chi-squared test, Mann-Whitney U-test and logistic regression were performed to compare vaccinated and unvaccinated nurses. RESULTS In total, 1177 valid returns were received from nurses. The median age of respondents was 32 years and 86% were female. The overall vaccination rate was 33%. Passive exposure to information from the workplace, professional body and social network was not predictive of vaccination decision, but passive exposure to information from mass media was predictive [odds ratio (OR) 1.78]. Active information-seeking, such as consulting a senior (OR 2.46), organizing promotional activities (OR 2.85) and undertaking an information search (OR 2.43), was significantly associated with increased vaccination uptake. A cumulative effect could be demonstrated for active information-seeking (OR 1.86), but not for passive exposure to information. CONCLUSION The current strategy of promotions and campaigns for seasonal influenza vaccination in HCWs may not be effective in increasing vaccination coverage. Measures targeting information-seeking behaviours may serve as an alternative approach.
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Affiliation(s)
- E K H Cheung
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, 2/F Postgraduate Education Centre, Prince of Wales Hospital, Shatin, Hong Kong
| | - S Lee
- Department of Psychiatry, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - S S Lee
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, 2/F Postgraduate Education Centre, Prince of Wales Hospital, Shatin, Hong Kong.
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