Vaccination Policies For Healthcare Workers Research Articles

Support among healthcare workers for the new mandatory seasonal influenza vaccination policy and its effects on vaccination coverage

Introduction Finland was the first European country to introduce a nation-wide mandatory seasonal influenza vaccination policy for healthcare workers (HCWs) by mandating that administrators of health care institutions only employ vaccinated HCWs. In this study, we examine the effects of the new policy and the view of HCWs on the new policy. Methods A cross-sectional observational study was conducted in Kuopio University Hospital among HCWs working in close patient contact. The statistics on vaccination coverage were obtained from the hospital’s own databases, where employees were asked to self-report their suitability for work. An anonymous survey was sent to HCWs in 2015–2016 (n = 987) and 2018–2019 (n = 821). Results Vaccination coverage increased from 59.5 to 99.6%, according to the hospital’s own records. Among the survey respondents, the seasonal influenza vaccination coverage of HCWs increased from 68.2 to 95.4%. 83.8% of doctors and 49.4% of nurses supported the new policy. 12.7% of doctors and 41.5% of nurses found the new mandate coercive or that it restricted their self-determination. Conclusions Our study confirms the positive effects of mandating the administrators of health care institutions to only employ vaccinated HCWs. The majority (57.9%) of all HCWs supported the new policy, with doctors being more compliant than nurses. Key messages Finland became the first European country to mandate influenza vaccination for HCWs by mandating that administrators of health care institutions only employ vaccinated HCWs. After the new act, the vaccination coverage of HCWs increased close to 100%. Most of the HCWs supported the new act and did not find it coercive.

Barriers associated with mandatory influenza vaccination policies for healthcare workers: an integrative review.

Uptake of influenza vaccination reduces staff absenteeism as well as mortality of patients and healthcare workers (HCWs); however, adherence of HCWs to annual influenza vaccination is poor and some healthcare facilities are now considering mandatory influenza vaccination policies. The purpose of this study was to identify the perceived and reported barriers to the implementation of a mandatory influenza vaccination policy for HCWs. An integrative review of the literature was conducted. Databases including CINAHL, Cochrane Library, Medline and PubMed were searched using key terms. The quality of papers was assessed utilising the Standard Quality Assessment Criteria for Evaluating Primary Research papers for a Variety of Fields which consisted of 10 questions with a possible total score of 20. PRISMA guidelines were used to report the search outcomes. A total of 68 papers were identified from the database search. Seven papers were relevant, following screening. The quality scores of these were in the range of 15-20. A number of barriers are reported to prevent the effective implementation of mandatory influenza vaccination policies including ethical and legal considerations, logistics, healthcare burden, leadership and management, and human factors such as HCWs' perspectives. By comprehensively identifying these, barriers can be addressed to allow effective implementation of such policies in healthcare facilities to ensure improved outcomes. The results of the review indicated the need for further research to ensure that barriers are addressed cohesively.

European survey of hepatitis B vaccination policies for healthcare workers: An updated overview

BackgroundThe risk of transmission of bloodborne pathogens, including hepatitis B virus (HBV) to healthcare workers (HCWs) is well known. In 2005 we performed a survey on HBV prevention in HCWs in the European Union (EU). An update of the 2005 survey deemed necessary as an EU Council Directive (2010/32/EU) on sharps injuries was to be implemented into national legislation by 11 May 2013 and more countries were starting universal HBV vaccination. MethodsWe performed an electronic survey in 2016, among national representatives from the Occupational Medicine section of the European Union of Medical Specialists (UEMS), to find out how policies have been put into practice in the European Union countries (plus Norway and Switzerland). The data were updated in 2019. ResultsAnswers were received from 21 countries (among them 19 EU Member States), representing 78% of the population and 60% of HCWs in the EU-28. HBV vaccination was mandatory for medical and nursing staff in 10 countries; for other paramedical staff, medical and nursing students in 9 countries; for paramedical students in 8 countries; for cleaning staff in 7 countries; and for technical staff in 5 countries; it was recommended in all but one of other countries. Serotesting before vaccination was done in 7 countries. The vaccination schedule most often used was 0, 1, 6 months (18countries), monovalent HBV vaccine was used in 14 countries, and combined (HAV + HBV) vaccine in 11 countries. Serotesting after vaccination was done in 18 countries and boosters were recommended in 14 countries. A non-responder policy was present in 18 countries. HBV vaccination coverage (5 countries) was 70–95%. Sharps injuries were reported in 13 countries, nationwide in 7 of them; European-wide reporting was not mentioned by respondents. DiscussionThese results show the variation in the implementation of EU legislation in the participating countries. More consultation between actors at EU level, including enhancing medical surveillance in occupational medicine could help to optimise policies in European countries in order to further reduce HBV transmission to HCWs.

Discordance of hepatitis B vaccination policies for healthcare workers between the USA, the UK, and Germany.

The hepatitisB (HB) vaccine is effective for the prevention of HB virus infection. It has been widely accepted that an anti-HB surface antibody (HBs) level ≥10mIU/mL is protective against HB virus infection. Although transient infection can occur in individuals who attain a peak level of anti-HBs ≥10mIU/mL after primary vaccination, long-term follow-up studies show that successful primary vaccination can prevent individuals from acute clinical hepatitis and chronic infection. Healthcare workers (HCWs) are at-risk individuals. Based on the accumulated data, the USA considers an anti-HBs level ≥10mIU/mL to constitute successful vaccination for HCWs. In contrast, because some anti-HBs assays cannot accurately measure in the low anti-HBs range, including 10mIU/mL, the UK and Germany consider an anti-HBs level ≥100mIU/mL to constitute successful vaccination for HCWs. In the USA and UK, a booster dose is unnecessary for HCWs after successful vaccination. In Germany, anti-HBs testing is recommended for HCWs who are at particularly high individual exposure risk 10years after successful primary immunization, and a booster dose is offered if the anti-HBs level has declined to ˂100mIU/mL. The differences in the goal of HB vaccination, reliability of anti-HBs assays, and use of booster vaccination cause discordance in HB vaccination policies for HCWs.

Vaccination of healthcare workers in Nigeria: A review of barriers, policies and level of implementation

Health-care workers (HCWs) constitute a high-risk group frequently exposed to workplace hazards from contacts with infected body fluids. The World Health Organization recommends that high-risk groups, which include HCWs, be vaccinated against vaccine-preventable diseases considering their exposure risks. This review provides insight into vaccination coverage rates and barriers of vaccination of HCWs against vaccine-preventable diseases, especially hepatitis B virus (HBV) vaccination currently in place in Nigeria and provides recommendations for policy creation. A narrative review of peer-reviewed published original research, reports, and reviews was done after identifying relevant literature using Goggle Scholar as the major search engine. Peer-reviewed articles in databases such as PubMed, Medline, African Journals Online, and Google Scholar were reviewed. Nigeria, like many other countries in sub-Sahara Africa, has no clear policy on vaccination of HCWs against vaccine-preventable diseases; this constitutes a significant challenge that contributes to poor uptake of vaccination by HCWs. HBV is a major occupational health hazard that HCWs face in the course of their work. HCWs, in Nigeria, are at increased risk of hepatitis B infection because Nigeria is a holoendemic area. Lack of vaccination policy for HCWs, poor risk perception, cost of the vaccine, and unavailability of vaccine are some of the major barriers to vaccine uptake and coverage among HCWs. There is a need to create and appropriately implement policies explicitly meant for HCWs vaccination. Model program options that can be adopted across health institutions at an affordable cost are recommended.

Influenza vaccination of healthcare workers in Italy: could mandatory vaccination be a solution to protect patients?

Several studies have reported that influenza infections in healthcare workers (HCWs) can lead to nosocomial outbreaks. HCWs can potentially be infected with influenza every year, and may continue to work, encouraging the spread of the virus. Different strategies, such as informative interventions on influenza and influenza vaccination, 'onsite' vaccination weeks, communicative strategies through dedicated web and social media pages, and mandatory informed dissent form, were organized for HCWs working at the University Hospital of Palermo, during previous influenza seasons. However, the increased vaccination rates observed among HCWs still remain far from the 75% recommended by Public Health Authorities. The level of coverage observed in countries with mandatory vaccination policies for HCWs, couldsuggest the adoption of this strategyforincrease influenza vaccination adherence in Italy.

Hepatitis B vaccination coverage among health care workers in China.

ObjectivesNation-wide hepatitis B vaccination coverage among healthcare workers (HCWs) is not well researched in China. This study aims to investigate the self-reported hepatitis B vaccination status among HCWs in China.MethodsWe conducted a cross-sectional survey of health_care workers’ vaccination statuses in 120 hospitals in China by collecting demographic and vaccination data. Univariate and multivariate logistic regression analysis were used to assess factors associated with hepatitis B vaccination coverage.ResultsEighty-six percent (2,666/3,104) of respondents reported having received at least one dose of the hepatitis B vaccination and 60% (1,853/3,104) reported having completed ≥3 doses of the hepatitis B vaccination. Factors associated with completing ≥3 doses of the hepatitis B vaccination included workplaces offering free hepatitis B vaccination with vaccination management, age, medical occupation, hospital level, acceptable hepatitis B knowledge and having received training on hepatitis B. HCWs in workplaces offering a free hepatitis B vaccine with vaccination management were 1.4 times more likely (OR = 1.4, 95% CI: 1.1–1.8) to complete their hepatitis B vaccination compared to HCWs in workplaces that did not offer a free hepatitis B vaccine. Either the possession of acceptable hepatitis B knowledge or an age of 30–39 years increased the odds of complete hepatitis B vaccination by 1.3-fold (95% CIs: 1.1–1.5 and 1.1–1.7, respectively) over their referent category. The receipt of training on hepatitis B was also associated with a higher percentage of completing the hepatitis B vaccination (OR = 1.5, 95% CI: 1.2–1.8). The main self-reported reason for incomplete hepatitis B vaccination was “forgot to complete follow-up doses” among 43% (234/547) of respondents. Among those who never received any hepatitis B vaccination, only 30% (131/438) intended to be vaccinated. Obtaining immunity from work (40%) and hospitals that did not provide hepatitis B vaccination activities (40%) were the top reasons mentioned for refusing hepatitis B vaccination.ConclusionsThe complete hepatitis B vaccination rate among HCWs in China is low, and the desire of HCWs for vaccination is indifferent; therefore, education campaigns are needed. In addition, a free national hepatitis B vaccination policy for HCWs that includes vaccination management should be prioritized to improve hepatitis B coverage among HCWs who are at-risk for HBV infection.

Vaccination policies for healthcare workers in Europe

Health-care workers (HCWs) are at increased risk for acquisition of vaccine-preventable diseases (VPDs) and vaccination is justified in order to protect them from occupational exposure and to prevent the spread of VPDs that pose a threat to susceptible patients. Review of European vaccination policies for HCWs revealed significant differences between countries in terms of recommended vaccines, implementation frame (mandatory or recommendation), target HCW groups and health-care settings. Further, the few published studies available identified indicate significant immunity gaps among HCWs against VPDs in Europe. In order to achieve higher vaccination coverage against VPDs stronger recommendations are needed. The issue of mandatory vaccination should be considered for diseases that can be transmitted to susceptible patients (influenza, measles, mumps, rubella, hepatitis B, pertussis, varicella). The acceptance of vaccinations and of mandatory vaccinations by HCWs is a challenge and appears to be VPD-specific.

Need for a comprehensive, consistently applied national hepatitis B vaccination policy for healthcare workers in higher educational institutions: a case study from South Africa

Hepatitis B virus (HBV) is transmitted by infected blood and other body fluids, placing healthcare workers (HCWs) and student HCWs at increased risk of HBV infection through occupational exposure. To establish the existence, content and implementation of hepatitis B (HB) vaccination policies for student HCWs being trained at higher educational institutions (HEIs) in South Africa. Self-administered structured questionnaires were sent to 23 nursing colleges and 11 universities in South Africa that train doctors, nurses or dentists. Twelve (35%) questionnaires were returned. Ten HEIs had a policy consisting mainly of recommendations given to students at registration. Nine HEIs made HB vaccinations available, with four HEIs covering the cost through student fees. Seven HEIs did not require a record of previous vaccination. Six HEIs did not accept non-responders (NRs), three HEIs would only accept an NR after receiving a second three-dose vaccination series and counselling, six HEIs regarded an HBV carrier as infectious, and 10 HEIs would accept HBV carriers as students. The low response rate makes it difficult to generalize the results, but may suggest a lack of an HB vaccination policy for student HCWs at non-responding HEIs. Policies of responding HEIs regarding HB vaccination, HBV carriage and response to HB vaccination were variable, sometimes inappropriate and not sufficiently comprehensive to protect student HCWs against occupationally acquired HBV. This emphasizes the need for a comprehensive, consistently applied, nationally coordinated vaccination policy to ensure that student HCWs receive proper protection against HBV infection.

Vaccination policies for health-care workers in acute health-care facilities in Europe

The aim of this study was to evaluate existing policies regarding recommended and mandatory occupational vaccinations for health-care workers (HCWs) in Europe. A standardized questionnaire was sent to experts in Infection Control or Occupational Health in all 27 European Union Member States, as well as Norway, Russia, and Switzerland. All 30 countries have established policies about HCW vaccination against vaccine-preventable diseases. However significant gaps and considerable country-to-country variation were found, in terms of number of recommended vaccines and target subgroups of HCWs and health-care settings. Vaccination against hepatitis B and annual vaccination against seasonal influenza are almost universally recommended for HCWs in Europe (29 countries each, including eight countries where vaccination against hepatitis B is mandatory or required for employment). Policies regarding HCW vaccination also exist against mumps (12 countries), measles or rubella (15 countries), varicella (17 countries), diphtheria-tetanus (14 countries), pertussis (9 countries), poliomyelitis (11 countries), hepatitis A (11 countries), tuberculosis (BCG vaccine) (9 countries), and against meningococcus group C or meningococci groups A, C, W135, Y (tetravalent vaccine) (in 4 countries each). Re-evaluation of occupational vaccine policies for HCWs in Europe on a consensus basis is imperative in order to promote HCW and patient safety.

European survey of hepatitis B vaccination policies for healthcare workers

The risk of transmission of hepatitis B virus (HBV) to healthcare workers (HCWs) is well known. Under current European Union (EU) legislation, all employers should perform a risk assessment to identify those exposed to HBV and offer vaccination. Immunization should happen early after the start of their career to avoid infection and development of carrier status. Cross-sectional survey of country representatives, to find out how policies are put into practice in European countries. Answers were received from 17 countries, representing 89% of the population and 90% of HCWs in the EU-25. HBV vaccination was mandatory for medical, and nursing and other paramedical staff in five countries, and recommended in all other countries. It was mandatory for medical students and student nurses in five countries and recommended in nine other. Pre-vaccination serotesting was done in six countries. The vaccination schedule most often used was 0, 1, 6 months. Combined vaccine (hepatitis A virus /HBV) was used in 10 countries. Post-vaccination serotesting was done in 14 countries. Data on HBV vaccination coverage were available in 11 countries and published in five of them. Coverage was 85-93%. These results show the variation as to how EU legislation is translated into practice in European countries. More consultation between key actors at EU level could help to optimize the way this matter is dealt with. A battery of measures and interventions-including introduction of immunization programmes against HBV infection and increasing immunization coverage in HCWs-can contribute to further reducing HBV transmission to HCWs.

Exploring determinants of acceptance of the pandemic influenza A (H1N1) 2009 vaccination in nurses

This study investigated the anticipated vaccination rate against pandemic human influenza A (H1N1) 2009 in the health care setting. Self-administered questionnaires were used to assess nurses' acceptance of vaccination against seasonal flu and H1N1. They were sent to nurses by post through various nurses' unions before initiation of the vaccination program. Only 13.3% of the respondents planned to receive the H1N1 vaccine, compared with 37.5% for the seasonal influenza vaccine. Vaccination against seasonal influenza in the preceding season strongly predicted the likelihood of H1N1 vaccination. The main reason cited for H1N1 vaccination was self-protection, and reasons for rejecting vaccination included possible side effects, ineffectiveness of the vaccine, and the mild nature of the disease. Personal contact with patients with H1N1 or severe acute respiratory syndrome at work did not significantly increase the likelihood of receiving the H1N1 vaccine. More than 40% of the respondents were undecided at the time of the survey. The promotion of vaccination against seasonal influenza may play a role in improving H1N1 vaccination coverage. Efforts are needed to address concerns about vaccination risk and to incorporate H1N1 vaccination in standard infection control practice with policy support.

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.