Influenza Vaccination Of Healthcare Workers Research Articles

Paediatric respiratory viral epidemics need not cost the earth

Each winter paediatric hospitals worldwide experience increased admissions as a result of respiratory viral epidemics occurring in babies and children who are infected with one or more of eight different viruses. With an escalated number of infected inpatients the risk of healthcare-associated infection (HAI) is increased. Over the past 15 years the number of patients with paediatric viral respiratory infections admitted to a 220-bed Western Australian paediatric hospital has varied between 379 and 870 over a 5-month period. Rates of HAI over this period have ranged from 0.2% to 3.3%.Successful management of infected patients is dependent upon rapid identification of the causative virus. This enables effective placement of infected patients by single room isolation or cohorting the same infections utilising additional respiratory droplet precautions.This paper will describe a successful program that is dependent upon: availability of single rooms; an extensive specimen collection service by the virology laboratory; rapid virus detection; testing patients in the emergency department prior to admission; scrupulous attention to hand hygiene by health care workers and visitors; strict attention to decontamination of shared medical equipment; adequate environmental cleaning; effective cough etiquette by health care workers and visitors; and an extensive health care worker influenza vaccination program.The effectiveness of this management program has been measured by the overall HAI rate of these respiratory viruses. Benchmarking with another larger paediatric hospital has demonstrated a significantly lower HAI and subsequent cost saving with the implementation of this program.

A System Wide Approach to Improving Healthcare Workers Influenza Vaccination Compliance

A System Wide Approach to Improving Healthcare Workers Influenza Vaccination Compliance

Needling Employees into Compliance: Improving Healthcare Worker Influenza Vaccination Rates Through the Use of Time Off Awards

Needling Employees into Compliance: Improving Healthcare Worker Influenza Vaccination Rates Through the Use of Time Off Awards

Partnering with nursing service improves health care worker influenza vaccination rates

Increasing the influenza vaccination rate in health care workers (HCWs) promotes patient safety as well as employee health. The average HCW influenza vaccination rate is approximately 35%. Various studies have analyzed the reasons for the low vaccination rate in HCWs and developed strategies aimed at increasing this rate. At the study hospital, the Nursing Department was contacted to recruit influenza (flu) coordinators from the various hospital departments to coordinate administration of influenza vaccinations in their respective departments, with the aim of increasing HCW vaccination rates. The flu coordinators received education about the influenza vaccine along with lists of employees, vaccination supplies, and consent/declination forms. Each flu coordinator was responsible for contacting the employees in his or her department/unit. Both consent and declination responses were documented. Of the hospital's 3238 employees (including physicians), a total of 2534 were contacted (78%). Of these, 2008 consented to receive the influenza vaccine and 526 declined. This represented a 37% increase in the total number of HCWs contacted and a 20% increase in vaccine recipients over the previous influenza season. Partnering with the Nursing Department increased the accessibility to and acceptance of influenza vaccination among HCWs. The HCWs reported positive experiences about receiving the vaccine in the work environment.

Influenza vaccination in healthcare workers

This study aims to determine side effects in healthcare workers receiving influenza vaccination, and to scrutinize the opinion of and attitude toward vaccination of healthcare workers. Five hundred forty-seven hospital personnel employed by the Eskişehir Yunus Emre State Hospital were included in the study which was conducted in November 2006,. Hospital personnel were administered 0.5 ml inactivated influenza vaccine consisting of 2006/2007 strains. Inoculations were given intramuscularly into the deltoid muscle. A specially designated area in the emergency unit was used for the procedure. An evaluation on Day 10 following influenza vaccination demonstrated at least one adverse effect in 197 (36%) hospital personnel. There was no statistical relationship between side effects and age or gender (p=0.860, p=0.929), while side effects were significantly more frequent among subjects receiving their first vaccination (p=0.008) and nurses (p=0.021). The reasons for the lack of prior immunization in 420 (76.8%) HCWs included not considering influenza a serious disease in 124 (29.5%), disbelief in the efficacy of vaccination in 109 (26%), the lack of reimbursement of vaccination in 105 (25%), fear of the side effects of vaccination in 45 (10.7%), preference for other methods of protection in 75 (17.9%), and fear of injection in 29 (6.9%). The increase in the rate of influenza immunization among healthcare personnel is possible through education, contestation of fear, amelioration of misconceptions, solution of financial issues, constitution of a registry system, and tracking of vaccination.

Influenza vaccination of healthcare workers, oseltamivir resistance and prepandemic vaccination

Since the Second European Influenza Conference in 2005, the field of influenza research has advanced immensely. The main topics discussed were the possible mandatory vaccination of healthcare workers against seasonal influenza, the oseltamivir resistance, the pandemic and prepandemic vaccination strategies and the mathematical modeling of a pandemic. A key discussion was on the efficacy of seasonal vaccination of the elderly. Young scientists presented promising work on influenza transmission in the guinea pig model, the pathogenicity of the re-engineered 1918 Spanish Flu influenza virus and the global migration routes of influenza viruses.

Nosocomial influenza: new concepts and practice

Nosocomial influenza constitutes a serious risk among patients with underlying diseases and those of extreme age, and is associated with excess health-care costs. This article will review recent literature on this area. Despite longstanding recommendations and the fact that influenza vaccination of health-care workers improves patient and employee safety, vaccine coverage among health-care workers remains low worldwide. The Centers for Disease Prevention and Control recommends the use of signed declination forms for those health-care workers who refuse vaccination. Rapid antigen detection tests may accurately diagnose influenza at the point of care, and their use has been associated with reduced antibiotic use, diagnostic tests, and costs. Multiplex molecular methods may simultaneously detect several respiratory viruses and might prove advantageous for surveillance within hospitals. The beginning of the 2007-2008 influenza season was marked by the detection of a significant proportion of influenza A/H1N1 viruses resistant to oseltamivir in Europe. Given the prohibiting rates of resistance to adamantanes worldwide, our means for containing outbreaks within health-care facilities may narrow. Provision of influenza vaccine at no cost and at the work site, education to promote vaccination, and switch to a mandatory influenza vaccination policy should be implemented in order to achieve high and sustained vaccine coverage among health-care workers. Surveillance to monitor antiviral resistance in influenza viruses should be enhanced. Development of new antivirals is needed.

Outbreaks of Influenza A Among Nonvaccinated Healthcare Workers: Implications for Resource-Limited Settings

We identified 3 outbreaks of influenza A (attack rates, 18%-24%) among Thai healthcare workers in intensive care units. All outbreaks were epidemiologically linked to an index patient with pneumonia due to influenza A virus (subtype H3N2). The investigations of these outbreaks incurred costs that exceeded the estimated costs of healthcare worker influenza vaccination by more than 10-fold.

The Efficacy of Influenza Vaccination in Healthcare Workers in a Tropical Setting: A Prospective Investigator Blinded Observational Study

Influenza vaccine has been shown to be highly effective in temperate regions with well-defined seasonal influenza. Healthcare workers (HCWs) are advised to receive regular influenza vaccination to protect themselves and their patients. However, there are limited data on the efficacy of influenza vaccine in HCWs in the tropics. In this observational, investigator blinded cohort study, bi-monthly questionnaires recording influenza-like illness (ILI) episodes and medical leave were administered to 541 HCWs at the Singapore National University Hospital and KK Women's and Children's Hospital from 2004 to 2005. ILI was defined according to a standard symptom score. Baseline characteristics were comparable in both the vaccinated and non-vaccinated groups. Overall, the relative risk of self-reported ILI in vaccinated HCWs was 1.13 [95% confidence interval (CI), 0.98-1.13; P=0.107]; medical leave taken was lower in the vaccinated group [mean 0.26+/-0.6 days per visit, compared with 0.30+/-0.5 days in the non-vaccinated group (P=0.40)]. Because of the reported Northern Hemisphere 2003/04 vaccine mismatch, we stratified the cohort and determined that the group which received a matched vaccine had a relative risk of ILI of 0.49 (95% CI, 0.37-0.66; P<0.001), achieving a vaccine efficacy of 51%. Mean medical leave decreased significantly in HCWs who received the matched vaccine, compared with those who did not receive vaccination (0.13+/-0.3 vs 0.30+/-0.5; P<0.001) and with HCWs vaccinated with mismatched strains (0.13+/-0.3 vs 0.39+/-0.9; P=0.01). A well-matched influenza vaccine is effective in preventing ILI and reducing sickness absence in healthcare workers in tropical settings. Efforts need to be made to increase influenza vaccination rates and to improve the currently available vaccines.

Improving influenza vaccination rates in a large health service

Influenza vaccination of healthcare workers (HCWs) is an important consideration for all health services. In 2007, Southern Health set a target vaccination rate of 75% for all staff within the health service. To achieve this, an extended vaccination service was implemented that included the use of additional mobile rounds and extra staffing for night and weekend duty. The target of 75% was not achieved, however the overall uptake increased by 14%. To prepare for the 2008 program, a quality activity was undertaken to gain an understanding of why more than 40% of HCWs were still not vaccinated. Anin-depth interview was conducted of 20 HCWs to identify common themes of vaccine refusal. Twenty HCWs who were known to have openly refused influenza vaccination, were approached by an experienced infection control nurse consultant and an interview time was arranged. An in-depth interview comprising of six open-ended questions was used in a standardised interview model. Common themes emerged from the in-depth interview, including limited understanding of the importance of influenza vaccination, disbelief of herd immunity, doubt about the protection of influenza vaccine, fear of needles and concern about becoming unwell from the vaccine. The results of the interviews were used to develop strategies for the 2008 program. Education about the importance of influenza vaccination for HCWs was commenced well in advance of the arrival of vaccines for the 2008 program. Information disseminated to HCWs focussed on vaccine effectiveness, risk of illness in HCWs and patients, and the duty of care HCWs provide to patients through vaccination. A declination form was introduced to improve vaccine knowledge and reinforce the importance of duty of care.

Improving Healthcare Workers Influenza Vaccination Compliance in Acute Care Settings

Improving Healthcare Workers Influenza Vaccination Compliance in Acute Care Settings

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

To evaluate the utility and impact of using a declination form in the context of an influenza immunization program for healthcare workers. A combined form for documentation of vaccination consent, medical contraindication(s) for vaccination, or vaccination declination was used during the 2006-2007 influenza season in a healthcare system employing approximately 9,200 nonphysician employees in 3 hospitals; a skilled nursing care facility; a large, multisite, faculty-practice plan; and an administrative building. Responses were entered into a database that contained files from human resources departments, which allowed correlation with job category and work location. The overall levels of influenza vaccination coverage of employees increased from 43% (3,892 of 9,050) during the 2005-2006 season to 66.5% (6,123 of 9,214) during the 2006-2007 season. Of 9,214 employees, 1,898 (20.6%) signed the declination statement. Among the occupation groups, nurses had the lowest rate of declining vaccination (13.2% [393 of 2,970]; P < .0001), followed by pharmacy personnel (18.1% [40 of 221]), ancillary personnel with frequent patient contact (21.9% [169 of 771), and all others (24.7% [1,296 of 5,252]). Among the employees who declined vaccination, nurses were the least likely to select the reasons "afraid of needles" (3.8% [15 of 393], vs. 9.1% [137 of 1,505] for all other groups; P < .001) and "fear of getting influenza from the vaccine" (13.5% [53 of 393], vs. 20.5% [309 of 1,505]; P = .002). Seven pregnant nurses had been advised by their obstetricians to avoid vaccination. When declination of influenza vaccination was analyzed by age, 16% of personnel (797 of 4,980) 50 years of age and older declined to be vaccinated, compared with 26% of personnel (1,101 of 4,234) younger than 50 years of age (P < .0001). Implementing use of the declination form during the 2006-2007 influenza season was one of several measures that led to a 55% increase in the acceptance of influenza vaccination by healthcare workers in our healthcare system. Although we cannot determine to what degree use of the declination form contributed to the increased rate of vaccination, use of this form helped the vaccination program assess the reasons for declination and will help to focus future vaccination campaigns.

Effectiveness of influenza vaccine in preventing influenza-like illness among Faculty of Dentistry staff and students in Universiti Kebangsaan Malaysia

Influenza is a highly contagious respiratory disease and potentially hazardous for patients and dental personnel in dental clinics. The objective of this study was to evaluate the effectiveness and safety of influenza vaccine among the staff and students of the Faculty of Dentistry, Universiti Kebangsaan Malaysia. The project was conducted from Mayto September 2005. Atotal of 346 participants volunteered for the study and were assigned randomly to a vaccination (170) and control group (176). Participants in the vaccination group were given influenza vaccine for the southern hemisphere season 2005. Demographic data of the participants, data on adverse effects after vaccination and occurrence of influenza-like illness (ILI) were obtained through questionnaires. Results showed that vaccination significantly reduced ILI prevalence by 52.6% (P=0.002). Frequency of recurrence of the ILI episode, absenteeism and visits to doctors among the vaccinated group were 77.0% (P=0.031), 76.1% (P=0.001) and 52.7% (P=0.004), respectively. Vaccination also provided indirect protection to family members or housemates of the vaccinated participants, with 71.6% effectiveness (P=0.026). The most common adverse event reported by vaccinated individuals was pain at the site of injection. In conclusion, influenza vaccine is safe and beneficial for dental staff and students. Annual influenza vaccination of dental staff, students and other healthcare workers who have direct contact with patients should be encouraged.

Receptivity to Mandatory Influenza Vaccination Policies for Healthcare Workers Among Registered Nurses Working on Inpatient Units

A survey that included questions about preferred methods of influenza prevention was completed by 513 registered nurses working on inpatient units. Vaccination was the preferred influenza prevention method among 83.0% of respondents. Of 506 respondents, 283 (56.0%) stated that mandatory influenza vaccination was appropriate for healthcare workers, and 394 (59.4%) of 512 RNs reported that they would support a policy requiring annual influenza vaccination for healthcare workers that allowed for informed declination.

Attitude of Dutch hospital personnel towards influenza vaccination

In 2007, the Dutch Health Council recommended influenza vaccination of all institutional healthcare workers (HCWs). In this questionnaire study largely based on the health belief model we assessed the attitude and intentions of hospital personnel towards such vaccination. We sent out 220 questionnaires to medical personnel and nurses of departments of the University Medical Center Utrecht, The Netherlands. Only one-third of the 112 responders (response rate of 51%) reported a positive intention to comply with the national recommendation. Factors associated with a positive intention were the awareness of a HCW's responsibility not to harm patients, the belief to have a high risk of influenza infection and confidence in vaccine efficacy. Physicians were more likely than nurses and other staff to have a positive intention. Education is needed to convince hospital personnel about influenza vaccination.

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

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

The evaluation of free influenza vaccination in health care workers in a medical center in Taiwan

ObjectiveTo evaluate the outcome of free influenza vaccination for healthcare workers in Taiwan.MethodA retrospective observational study was conducted in a partially vaccinated sample of healthcare workers in a medical centre in the southern part of Taiwan. A convenience sample of 500 employees received a questionnaire.Main outcome measureIncidence of influenza like- illness (ILI), rates of absenteeism and costs savings.ResultsA final number of 407 returned questionnaires could be evaluated. Forty respondents were not vaccinated. The incidence of ILI was lower in the vaccinated group than the nonvaccinated group (13.6 vs. 15%). Fever was the most frequently occurring ILI. Rate of absenteeism because of ILI in the non-vaccinated employees was higher than in the group of vaccinated employees. The costs per saved lost working day was US $ 36.ConclusionFree influenza vaccination may cause reductions in incidence, absenteeism, and costs associated with ILI in healthcare workers in Taiwan.

Protecting Patients from Harm: Legislating Vaccinations for Healthcare Workers

In this issue of the Journal, Lindley et al. 1 Lindley M.C. Horlick G.A. Shefer A.M. Shaw F.E. Clemens M. Assessing state immunization requirements for healthcare workers and patients. Am J Prev Med. 2007; 32 (XX–XX) Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar review state immunization requirements for healthcare workers (HCWs). The results are both revealing and worrisome. While 32 states have some type of law concerning HCW immunization, these laws are rarely enforced and are outdated—only three of them include influenza vaccination, for example. Some states have laws requiring assessment (n=3) (e.g., does this HCW need vaccine?), while others had laws regarding vaccine administration (n=36)—which were further divided into those requiring vaccine administration (n=15) (e.g., if needed, ensure that the HCW received vaccine), versus offer laws (n=21) (e.g., if a vaccine is needed, it must be offered). For influenza in particular, only three states had offer laws for influenza vaccination of HCWs, and three states had ensure laws. ErratumAmerican Journal of Preventive MedicineVol. 34Issue 1PreviewPoland GA, Jacobson RM. Protecting patients from harm: Legislating vaccinations for healthcare workers. Am J Prev Med 2007;32:544–545. Full-Text PDF

Factors influencing influenza vaccination rates among healthcare workers in Greek hospitals

Influenza vaccination rates are generally low among healthcare workers (HCWs) worldwide. In September 2005, the Hellenic Center for Disease Control and Prevention conducted a nationwide campaign to promote influenza vaccination in hospital HCWs. During the 2005-2006 influenza season, the overall vaccination rate among HCWs was 16.36% (range: 0-85.96%). The self-reported vaccination rate during the previous season was 1.72%, indicating a 9.5-fold increase. Compared with physicians, significantly fewer technical personnel were vaccinated, whereas administrative personnel were more likely to receive the vaccine. Among clinicians, rates for internal medicine departments exceeded those of surgical departments by a factor of 2.71 and laboratory medicine departments by a factor of 2.36. Multivariate analysis showed lower vaccination rates in large hospitals (>200 beds) than in smaller hospitals and lower rates in hospitals with specialist services (intensive care unit, psychiatry or dermatology) than in general hospitals. Factors associated with higher rates included working in northern Greece, in a paediatric or an oncology hospital, or in a prefecture with avian influenza H5N1 activity. In conclusion, in Greece influenza vaccination rates among HCWs remain low, but the implementation of a nationwide campaign had a considerable impact. Efforts should focus on hospital- and HCW-associated factors to increase vaccination uptake.

Influenza vaccination in healthcare workers: A survey of coverage in French cystic fibrosis treatment centres

Influenza vaccination in healthcare workers: A survey of coverage in French cystic fibrosis treatment centres