Influenza Vaccination Of Healthcare Workers Research Articles

Influenza vaccine uptake, determinants, motivators, and barriers of the vaccine receipt among healthcare workers in a tertiary care hospital in Saudi Arabia

Influenza vaccination of healthcare workers (HCWs) is essential for patient safety, their own safety, and hospital operation. However, despite its strong recommendation, studies indicates a low rate of vaccine uptake. To assess rates of, and factors affecting, influenza vaccine uptake among HCWs. A cross-sectional survey was carried out during October 1st to 16th, 2015, among HCWs in King Abdullah Medical City in Makkah, Saudi Arabia. A self-administered, anonymous questionnaire was distributed to HCWs; this included questions on demographic characteristics, vaccine uptake, and knowledge, beliefs, attitude, and concern about influenza vaccine. Out of 500 HCWs approached, 447 returned valid self-reported questionnaires with response rate 89.4%. Overall, 88.3% of the participants reported receiving vaccination during the 2014/15 season, higher than during the 2013/14 (61.2%) and 2012/13 (54.5%) seasons. Self-protection (81.5%) was the main reason for vaccination, whereas 73.4% of HCWs reported vaccination to protect patients. The main reasons for vaccination avoidance were misconception that the vaccine causes influenza (38.5%) and concern about vaccine efficacy (32.7%). Logistic regression analysis revealed that the following were independently associated with vaccine receipt among HCWs: awareness of vaccine guidelines; intention to receive the vaccine next season; nurses and other HCWs compared to physicians; longer practice; and age >40 years. A good uptake of influenza vaccine was achieved during the 2014/15 season following adoption of mandatory vaccination policy. Awareness programmes are needed to correct HCWs' misconceptions about the vaccine. Efforts need to focus especially on physicians, younger staff and new recruits.

Nurses' attitudes towards enforced measures to increase influenza vaccination: A qualitative study.

BackgroundDespite studies demonstrating that the annual influenza vaccination of healthcare workers reduces morbidity and mortality among vulnerable patients, vaccination rates remain very low, particularly in nursing staff. Educational programmes have failed to improve rates, which has led to a diverse range of enforced approaches being advocated and implemented.ObjectivesTo examine the attitudes of non‐vaccinated nursing staff towards various enforced measures aimed at increasing rates of influenza vaccination.MethodsSemi‐structured qualitative interviews with a purposive sample of 18 non‐vaccinated nurses, working in units with high‐risk patients at two hospitals in Switzerland. Analysis of interviews was done using conventional content analysis.ResultsNurses were critical of enforced measures. However, measures that include an element of choice were perceived as more acceptable. Declination forms and mandatory vaccinations as part of the employment requirements were found to be the most accepted measures.ConclusionThe perception of choice is crucial to the acceptance of a measure. Respect for choice and autonomy has a positive effect on behavioural change.Mandatory influenza vaccination as a condition of new (and perhaps ongoing) employment could be a feasible, effective and ethical measure to increase vaccination rates among nurses who oppose vaccination.

Influenza Vaccination of Healthcare Workers: Critical Analysis of the Evidence for Patient Benefit Underpinning Policies of Enforcement.

BackgroundFour cluster randomized controlled trials (cRCTs) conducted in long-term care facilities (LTCFs) have reported reductions in patient risk through increased healthcare worker (HCW) influenza vaccination. This evidence has led to expansive policies of enforcement that include all staff of acute care hospitals and other healthcare settings beyond LTCFs. We critique and quantify the cRCT evidence for indirect patient benefit underpinning policies of mandatory HCW influenza vaccination.MethodsPlausibility of the four cRCT findings attributing indirect patient benefits to HCW influenza vaccination was assessed by comparing percentage reductions in patient risk reported by the cRCTs to predicted values. Plausibly predicted values were derived according to the basic mathematical principle of dilution, taking into account HCW influenza vaccine coverage and the specificity of patient outcomes for influenza. Accordingly, predicted values were calculated as a function of relevant compound probabilities including vaccine efficacy (ranging 40–60% in HCWs and favourably assuming the same indirect protection conferred through them to patients) × change in proportionate HCW influenza vaccine coverage (as reported by each cRCT) × percentage of a given patient outcome (e.g. influenza-like illness (ILI) or all-cause mortality) plausibly due to influenza virus. The number needed to vaccinate (NNV) for HCWs to indirectly prevent patient death was recalibrated based on real patient data of hospital-acquired influenza, with adjustment for potential under-detection (5.2-fold), and using favourable assumptions of HCW-attributable risk (ranging 60–80%).ResultsIn attributing patient benefit to increased HCW influenza vaccine coverage, each cRCT was found to violate the basic mathematical principle of dilution by reporting greater percentage reductions with less influenza-specific patient outcomes (i.e., all-cause mortality > ILI > laboratory-confirmed influenza) and/or patient mortality reductions exceeding even favourably-derived predicted values by at least 6- to 15-fold. If extrapolated to all LTCF and hospital staff in the United States, the prior cRCT-claimed NNV of 8 would implausibly mean >200,000 and >675,000 patient deaths, respectively, could be prevented annually by HCW influenza vaccination, inconceivably exceeding total US population mortality estimates due to seasonal influenza each year, or during the 1918 pandemic, respectively. More realistic recalibration based on actual patient data instead shows that at least 6000 to 32,000 hospital workers would need to be vaccinated before a single patient death could potentially be averted.ConclusionsThe four cRCTs underpinning policies of enforced HCW influenza vaccination attribute implausibly large reductions in patient risk to HCW vaccination, casting serious doubts on their validity. The impression that unvaccinated HCWs place their patients at great influenza peril is exaggerated. Instead, the HCW-attributable risk and vaccine-preventable fraction both remain unknown and the NNV to achieve patient benefit still requires better understanding. Although current scientific data are inadequate to support the ethical implementation of enforced HCW influenza vaccination, they do not refute approaches to support voluntary vaccination or other more broadly protective practices, such as staying home or masking when acutely ill.

Influenza Vaccination of Healthcare Workers Is an Important Approach for Reducing Transmission of Influenza from Staff to Vulnerable Patients.

Influenza Vaccination of Healthcare Workers Is an Important Approach for Reducing Transmission of Influenza from Staff to Vulnerable Patients.

Knowledge and attitudes towards influenza vaccination of health care workers in emergency services

Annual vaccination rates among French health care workers (HCWs) are in decline even in Emergency Services to which patients at highest risk of influenza complications are admitted, and in which HCWs have the greatest risk of exposure to influenza from patients. We aimed here to identify knowledge and attitudes towards influenza vaccination of HCWs in Emergency Services. We collected 344 self-administered questionnaires of 1060 HCWs. Only 18% of HCWs were vaccinated against influenza. Physicians were vaccinated more often (55%) than nurses (16%) or aid nurses (11%). The most important barriers to vaccination were reported as being a lack of time (33%), lack of safety of the vaccine (31%), fear of contracting influenza due to vaccination (29%), and lack of effectiveness (23%). Being vaccinated was significantly related to a higher knowledge score based on epidemiological influenza items (OR (95% CI)) (1.63 (1.08–2.46)) and vaccine features items (2.36 (1.36–4.10)).

Seasonal influenza vaccination in health-care workers: the influence of consultants on the uptake of vaccination by medical students and early career doctors

BackgroundThe Chief Medical Officer for England recommends that all health-care workers receive an influenza vaccination annually. Medical students are also encouraged to get vaccinated. High vaccination coverage is believed to be the best form of protection against the spread of influenza within hospital settings, protecting both staff and patients, and reducing virus transmission. However, uptake of seasonal influenza vaccination by health-care workers remains substantially lower than the target level of 75%. Our study aimed to provide a deeper insight into the influenza vaccination practices of health-care workers. MethodsAn opportunistic sampling strategy was used and participants recruited via compulsory teaching sessions. We conducted a series of semi-structured interviews with seven medical students and nine foundation doctors, to explore the factors informing their vaccination decisions. Interviews were transcribed and the data analysed thematically. Data collection and analysis took place as an iterative process, until theoretical saturation was achieved. FindingsOf the 16 participants, ten had been vaccinated during the 2015–16 season. A number of key themes emerged, and there were inconsistencies between an individual's opinion of the vaccine, their intentions, and their vaccination status. For example, someone reporting negative opinions of the vaccine could have been vaccinated. Moreover, individuals did not necessarily vaccinate year on year. Participants were influenced by senior staff as role models, demonstrating both positive and negative attitudes towards the vaccine. Participants often presented this observation in the context of their own conflicting ideals of medical professionalism. The decision making processes around influenza vaccination seem to be finely balanced, take place within a culture of relative ambivalence, and can easily be tipped one way or the other by factors such as convenience. InterpretationThe findings are drawn from a diverse sample, and are supported by the literature. This study suggests that senior staff have an important role in the vaccination practices of juniors. The influential role of consultants could be used as part of a future strategy to increase vaccination, since positive role models can facilitate a cultural shift in favour of vaccination uptake. Future research involving senior staff is necessary to understand the complexities behind their own vaccination practices. FundingColt Foundation.

Get the jab done

Introduction: A government funded healthcare worker influenza vaccination program has been implemented for many years in Victorian public hospitals and data has been collected since 2005. The Department of Health and Human Services (DHHS) increased the vaccination target rate to 75 percent in 2014. The Royal Children's Hospital aims to increase the uptake of the influenza vaccination to 90 percent with a nurse immuniser managed program. Method: Healthcare workers and other hospitals were consulted to identify improvements to facilitate vaccination. Strategies to enhance the campaign included increased access to the vaccine with streamlined sessions, local nurse immunisers, education and communication. Nurse immunisers were supported in their role with education and resources. An education campaign targeting myths was updated. Communication included lift screens, intranet messages and customised emails to managers and individuals. Results: The program commenced with daily sessions for four weeks. The percentage of staff vaccinated in the first four weeks exceeded the target of 75 percent. Drop in sessions continued with nurse immunisers roaming in offices hours and local nurse immunisers providing afterhours vaccination. The combination of education, individual reminders and providing access to the vaccine has resulted in a high vaccination rate early in the campaign. Final results will be available in August. Conclusion: Vaccine campaigns require time to succeed. Support from leaders, continuous education and communication to healthcare workers is essential in increasing uptake across staff categories. Acting on feedback from healthcare workers, increasing access and supporting the local nurse immunisers resulted in a high vaccination rate.

Developing healthcare worker influenza vaccination as a hospital performance indicator

Developing healthcare worker influenza vaccination as a hospital performance indicator

The Achoo Stops With You: How Several Strategies, Including Mandatory Healthcare Worker (HCW) Influenza (Flu) Vaccine Program, Led to Increases in Vaccine Compliance and Decreases in Healthcare-Acquired (HA) Flu

The Achoo Stops With You: How Several Strategies, Including Mandatory Healthcare Worker (HCW) Influenza (Flu) Vaccine Program, Led to Increases in Vaccine Compliance and Decreases in Healthcare-Acquired (HA) Flu

Student-centered interventions the key to student health care worker influenza vaccination

Abstract Objectives To investigate influenza vaccination uptake rates, attitudes and motivations towards influenza vaccination among student health care workers (HCWs). Material and methods Self-reported influenza vaccination uptake among student HCWs at The University of Notre Dame Australia, Fremantle, Western Australia (UNDAF) was surveyed before and after implementation of a peer-led, student-centered campaign to raise awareness of, and improve access to, influenza vaccination. Data were weighted and analysed using logistic regression. Results Pre-campaign influenza vaccination uptake was 36.3% (95% CI = 31.8%–40.8%), with students identifying lack of awareness of both the Australian Government's recommendations and university policy, cost, and inconvenience of vaccine access as key barriers. Post-campaign vaccination coverage increased significantly to 55.9% (95% CI = 52.2%–59.6%). Multivariate logistic regression, controlled for statistically insignificant confounders of age and gender, showed that being a student HCW in 2014 (campaign year) was significantly and independently associated with influenza vaccination (OR 2.2, 95% CI = 1.7–2.9, P Conclusions Student HCWs' influenza vaccination uptake improved significantly following a low-cost, peer-led promotional campaign. This approach can be adapted to other settings.

Mandating influenza vaccinations for health care workers: analysing opportunities for policy change using Kingdon's agenda setting framework.

BackgroundThe consequences of annual influenza outbreaks are often underestimated by the general public. Influenza poses a serious public health threat around the world, particularly for the most vulnerable populations. Fortunately, vaccination can mitigate the negative effects of this common infectious disease. Although inoculating frontline health care workers (HCWs) helps minimize disease transmission, some HCWs continue to resist participating in voluntary immunization programs. A potential solution to this problem is government-mandated vaccination for HCWs; however, in practice, there are substantial barriers to the adoption of such policies. The purpose of this paper is to identify the likelihood of adopting a policy for mandatory immunization of HCWs in Ontario based on a historical review of barriers to the agenda setting process.MethodsDocuments from secondary data sources were analysed using Kingdon’s agenda setting framework of three converging streams leading to windows of opportunity for possible policy adoption.ResultsThe problems, politics, and policies streams of Kingdon’s framework have converged and diverged repeatedly over an extended period (policy windows have opened and closed several times). In each instance, a technically feasible solution was available. However, despite the evidence supporting the value of HCW immunization, alignment of the three agenda setting streams occurred for very short periods of time, during which, opposition lobby groups reacted, making the proposed solution less politically acceptable.ConclusionsPrior to the adoption of any new policies, issues must reach a government’s decision agenda. Based on Kingdon’s agenda setting framework, this only occurs when there is alignment of the problems, politics, and policies streams. Understanding this process makes it easier to predict the likelihood of a policy being adopted, and ultimately implemented. Such learning may be applied to policy issues in other jurisdictions. In the case of mandatory influenza vaccinations for HCWs in Ontario, it seems highly unlikely that a new policy will be adopted until perception of the problem’s importance is sufficient to overcome the political opposition to implementing a solution and thus, create a window of opportunity that is open long enough to support change.

Seasonal influenza vaccination among Chinese health care workers.

We conducted a study to examine the knowledge, attitudes, and opinions of health care workers (HCWs) and the factors associated with receipt of influenza vaccination in HCWs during August 2015 in 3 hospitals in Jiangsu Province, China. Among the 173 doctors and 220 nurses included in this study, the proportions who received vaccination for the 2014-2015 season were 14% and 13%, respectively. Ninety-eight percent of doctors and 99% of nurses maintained their vaccination practice over 4 seasons.

Influenza vaccination for healthcare workers in the UK: appraisal of systematic reviews and policy options

BackgroundThe UK Department of Health recommends annual influenza vaccination for healthcare workers, but uptake remains low. For staff, there is uncertainty about the rationale for vaccination and evidence underpinning the...

Answers linked to: To KW, Lai A, Lee KCK, Koh D, Lee SS. Increasing the coverage of influenza vaccination in healthcare workers: review of challenges and solutions. J Hosp Infect 2016;94:133–142

Answers linked to: To KW, Lai A, Lee KCK, Koh D, Lee SS. Increasing the coverage of influenza vaccination in healthcare workers: review of challenges and solutions. J Hosp Infect 2016;94:133–142

Questions linked to: To KW, Lai A, Lee KCK, Koh D, Lee SS. Increasing the coverage of influenza vaccination in healthcare workers: review of challenges and solutions. J Hosp Infect 2016;94:133–142

Questions linked to: To KW, Lai A, Lee KCK, Koh D, Lee SS. Increasing the coverage of influenza vaccination in healthcare workers: review of challenges and solutions. J Hosp Infect 2016;94:133–142

Influenza vaccination for healthcare workers who care for people aged 60 or older living in long-term care institutions.

A systematic review found that 3% of working adults who had received influenza vaccine and 5% of those who were unvaccinated had laboratory-proven influenza per season; in healthcare workers (HCWs) these percentages were 5% and 8% respectively. Healthcare workers may transmit influenza to patients. To identify all randomised controlled trials (RCTs) and non-RCTs assessing the effects of vaccinating healthcare workers on the incidence of laboratory-proven influenza, pneumonia, death from pneumonia and admission to hospital for respiratory illness in those aged 60 years or older resident in long-term care institutions (LTCIs). We searched CENTRAL (2015, Issue 9), MEDLINE (1966 to October week 3, 2015), EMBASE (1974 to October 2015) and Web of Science (2006 to October 2015), but Biological Abstracts only from 1969 to March 2013 and Science Citation Index-Expanded from 1974 to March 2013 due to lack of institutional access in 2015. Randomised controlled trials (RCTs) and non-RCTs ofinfluenza vaccination of healthcare workers caring for individuals aged 60 years or older in LTCIs and the incidence of laboratory-proven influenza and its complications (lower respiratory tract infection, or hospitalisation or death due to lower respiratory tract infection) in individuals aged 60 years or older in LTCIs. Two authors independently extracted data and assessed risk of bias. Effects on dichotomous outcomes were measured as risk differences (RDs) with 95% confidence intervals (CIs). We assessed the quality of evidence with GRADE. We identified four cluster-RCTs and one cohort study (n = 12,742) of influenza vaccination for HCWs caring for individuals ≥ 60 years in LTCIs. Four cluster RCTs (5896 residents) provided outcome data that addressed the objectives of our review. The studies were comparable in their study populations, intervention and outcome measures. The studies did not report adverse events. The principal sources of bias in the studies related to attrition, lack of blinding, contamination in the control groups and low rates of vaccination coverage in the intervention arms, leading us to downgrade the quality of evidence for all outcomes due to serious risk of bias.Offering influenza vaccination to HCWs based in long term care homes may have little or no effect on the number of residents who develop laboratory-proven influenza compared with those living in care homes where no vaccination is offered (RD 0 (95% CI -0.03 to 0.03), two studies with samples taken from 752 participants; low quality evidence). HCW vaccination probably leads to a reduction in lower respiratory tract infection in residents from 6% to 4% (RD -0.02 (95% CI -0.04 to 0.01), one study of 3400 people; moderate quality evidence). HCW vaccination programmes may have little or no effect on the number of residents admitted to hospital for respiratory illness (RD 0 (95% CI -0.02 to 0.02, one study of 1059 people; low quality evidence). We decided not to combine data on deaths from lower respiratory tract infection (two studies of 4459 people) or all cause deaths (four studies of 8468 people). The direction and size of difference in risk varied between the studies. We are uncertain as to the effect of vaccination on these outcomes due to the very low quality of evidence. Adjusted analyses, which took into account the cluster design, did not differ substantively from the pooled analysis with unadjusted data. Our review findings have not identified conclusive evidence of benefit of HCW vaccination programmes on specific outcomes of laboratory-proven influenza, its complications (lower respiratory tract infection, hospitalisation or death due to lower respiratory tract illness), or all cause mortality in people over the age of 60 who live in care institutions. This review did not find information on co-interventions with healthcare worker vaccination: hand-washing, face masks, early detection of laboratory-proven influenza, quarantine, avoiding admissions, antivirals and asking healthcare workers with influenza or influenza-like illness (ILI) not to work. This review does not provide reasonable evidence to support the vaccination of healthcare workers to prevent influenza in those aged 60 years or older resident in LTCIs. High quality RCTs are required to avoid the risks of bias in methodology and conduct identified by this review and to test further these interventions in combination.

Understanding motivators and barriers of hospital-based obstetric and pediatric health care worker influenza vaccination programs in Australia

ABSTRACTUnderstanding motivators and barriers of health care worker (HCW) vaccination programs is important for determining strategies to improve uptake. The aim of this study was to explore key drivers and HCW decision making related to recommended vaccines and seasonal influenza vaccination programs. We used a qualitative approach with semi-structured one-to-one interviews with 22 HCWs working at a tertiary pediatric and obstetric hospital in South Australia. A thematic analysis and coding were used to examine data. Key motivators that emerged included: sense of responsibility, convenience and ease of access, rotating trolleys, the influenza vaccine being free, basic knowledge about influenza and influenza vaccination, peer pressure, personal values and family culture, as well as the culture of support for the program. Personal decisions were the major barrier to HCWs receiving the influenza vaccine which were predominantly self-protection related or due to previous experience or fear of adverse reactions. Other barriers that emerged were misconceptions about the influenza vaccine, needle phobia and privacy concerns. This study identified both attitudinal and structural barriers that could be addressed to improve uptake of the seasonal influenza vaccine.

Potential Ceiling Effect of Healthcare Worker Influenza Vaccination on the Incidence of Nosocomial Influenza Infection.

OBJECTIVE To evaluate the effect of healthcare worker (HCW) influenza vaccination on the incidence of nosocomial influenza DESIGN Retrospective cross-sectional study SETTING A 550-bed tertiary-care academic medical center METHODS All admitted patients with a direct fluorescent antibody (DFA) or polymerase chain reaction (PCR) assay positive for influenza ordered between October 1 and May 31 from 2010 to 2015 were eligible for inclusion. Nosocomial influenza was defined as a positive influenza test collected ≥48 hours after admission in patients without influenza-like illness present within 24 hours of admission. Relative nosocomial influenza frequency was calculated by dividing the number of nosocomial cases by the total number of admitted patients with influenza for each season. A univariate logistic regression was used to determine the association between HCW influenza vaccination coverage and nosocomial influenza. RESULTS Over 5 seasons, 533 patients had positive influenza tests during their hospitalization; 29 of these patients (5.4%) acquired influenza during their hospitalization. HCW vaccination coverage increased over the 5 seasons from 47% to 90% (P<.001). Despite an initial decrease in relative nosocomial influenza frequency during the first year (9% to 4.9%), subsequent seasons failed to show an additional decrease in nosocomial infections (4.3%, 5.2%, and 4.8%, respectively); the overall decrease in nosocomial influenza from the first season to the final season was not significant (P=.282). No association was detected between HCW vaccination coverage and nosocomial influenza (odds ratio [OR], 0.990; 95% confidence interval [CI], 0.970-1.011). CONCLUSION HCW vaccination >50% may not have a significant effect on nosocomial influenza. Infect Control Hosp Epidemiol 2016;37:840-844.

Association of State Laws and Healthcare Workers’ Influenza Vaccination Rates

State laws are being used to increase healthcare worker (HCW) influenza vaccine uptake. Approximately 40% of states have enacted such laws but their effectiveness has been infrequently studied. Data sources for this study were the 2000-2011 U.S. National Health Interview Survey Adult Sample File and a summary of U.S. state HCW influenza vaccination laws. Hierarchical linear modeling was used for two time periods: 1) 2000-2005 (before enactment of many state laws) and 2) 2006-2011 (a time of increased enactment of state HCW influenza vaccination legislation). During 2000-2005, two states had HCW influenza vaccination laws and HCW influenza vaccination rates averaged 22.5%. In 2006-2011, 19 states had such laws and vaccination rates averaged 50.9% (p < 0.001). The likelihood of HCW vaccination increased with the scope and breadth, measured by a law score. Although laws varied widely in scope and applicability, states with HCW influenza vaccination laws reported higher HCW vaccination rates.

Immunogenicity and Reactogenicity of High Versus Standard Dose Trivalent Inactivated Influenza Vaccine in Healthcare Workers (HCWs)

revised) Background: Significant influenza morbidity and mortality persists despite use of current vaccines. The most effective existing vaccine for healthy adults is standard dose split virus vaccine (SDTIV), which prevents only 60% of influenza infection. A high dose trivalent inactivated influenza vaccine (HDTIV) has shown greater immunogenicity and efficacy in older subjects. This trial was designed to assess immunogenicity and reactogenicity of HDTIV versus SDTIV in HCWs. Methods: We conducted a prospective, randomized controlled, observer blind trial of HDTIV (60μg antigen/strain) versus SDTIV (15μg antigen/strain) in healthy HCWs 18-64yrs of age in November, 2014. The primary outcome was seroconversion to vaccine strains measured by change in HAI GMT from day 0 (pre-vaccine) to day 21 post-vaccination. Results: 47 HCWs were enrolled; 37 were female; the median age was 40yrs (range 22-64yrs). 25 received HDTIV (24 with HAI results) and 22 SDTIV. There was no significant difference in pre-vaccination HAI GMTs. Post-vaccination HAI GMTs for vaccine strains were: for A(H3N2) 1092 HD v 405 SD, A(H1N1) 1337 HD V 601 SD, and B 2061 HD v 1165 SD (all p /=65 years of age: a randomized, controlled, phase II trial. Vaccine, 32(21), 2507-2517.