Attitudes and Practices Regarding Influenza Vaccination Among Healthcare Workers Providing Services to Individuals With Spinal Cord Injuries and Disorders

Knowledge and attitudes of healthcare workers about influenza vaccination

BACKGROUND

Influenza infection is a highly contagious viral disease. It may cause several nosocomial outbreaks. This study aimed to evaluate the knowledge and attitudes of healthcare workers (HCWs) about influenza vaccination and to identify factors associated with the uptake of influenza vaccination.

METHODS

We conducted a cross-sectional study over 5 months between November 2021 and March 2022. Data was collected using an anonymous self-administered questionnaire. We included all HCWs at Taher Sfar University Hospital who were willing to participate in the study.

RESULTS

A total of 395 HCWs were included. They were mainly women (78.7%) with an average age of 27 years. The medical personnel was the largest group (67.8%). Most respondents considered the vaccination to be optional and knew that it should be renewed every year, but 97.5% of them judged the efficacy of the vaccine to be low. The influenza vaccination uptake was only 20.2%. The main reasons for accepting vaccination were to protect patients and families. However, misconceptions about the severity and the risk of influenza and the belief that barrier measures were sufficient to prevent infection were the main causes of avoiding vaccination. The factors associated with adherence to vaccination were being a medical professional, old age, longer professional experience, and considering vaccination to be mandatory for HCWs.

CONCLUSION

Our study showed a low adherence to influenza vaccination with misconceptions about vaccine efficacy and safety. More efforts are needed to improve the knowledge of HCW about the vaccine and boost the adherence rates.

Factors associated to influenza vaccination among hospital's healthcare workers in the Autonomous Community of Madrid, Spain 2021-2022

Influenza vaccination (IV) aims primarily to protect high-risk groups against severe influenza-associated disease and death. It is recommended in Spain for high-risk groups, including Healthcare workers (HCWs). However, vaccination uptake has been consistently below desirable levels. The objective of this study were to evaluate influenza vaccination coverage using data from the regional vaccination registry, during 2021-2022 season, among HCWs in public hospitals in Autonomous Community of Madrid (CAM) and to explore factors associated with influenza vaccination. We conducted a cross-sectional study using administrative data retrieved from the Regional Department of Health data repositories. A multilevel logistic regression model was designed to estimate Level 1 (individual) and Level 2 (contextual) variables that are associated with HCẂs vaccination. The study population was HCWs from 25 public hospitals in CAM who were active during the period of the influenza 2021-2022 vaccination campaign. The global influenza vaccination coverage (IVC) was 52.1 %. All study Level 1 variables were significantly associated with vaccine uptake. Greater IVC is associated with individual characteristics: female (OR1.14; 95 %CI 1.09-1.19), older age 59-69 years old (OR1.72; 95 %CI 1.60-1.84), born in Spain, medical staff, more than one high-risk condition (OR1.24; 95 %CI 1.10-1.40; respectively) and vaccinated in two previous campaigns (OR25.64; 95 %CI 24.27-27.09). IVC was highest among HCWs celiac disease (65.5 %) followed by diabetes mellitus (65.1 %) and chronic inflammatory disease (64.3 %). The hospital where the study subject worked also showed an effect on the vaccination uptake, although Level 2 variable (hospital complexity) was not positively associated. IVC in HCWs remains suboptimal. These findings may prove useful to tailor strategies to reach specific groups. It is recommended to delve into the identification of factors associated with the HCWs workplace that may have a positive impact on IV.

Effect of Primary Care Center Characteristics, Healthcare Worker Vaccination Status and Patient Economic Setting on Patient Influenza Vaccination Coverage Rates

BACKGROUND

Reaching the public health organizations targets of influenza vaccination in at-risk patient groups remains a challenge worldwide. Recognizing the relationship between the healthcare system characteristics and the economic environment of the population with vaccination uptake can be of great importance to improve.

METHODS

Several characteristics were correlated in this retrospective ecological study with data from 6.8 million citizens, 15,812 healthcare workers across 258 primary care health centers, and average income by area of the care center in Spain.

RESULTS

No correlation between HCW vaccination status and patient vaccination was found. A weak negative significant correlation between the size of the population the care center covers and their vaccination status did exist (6 mo.-59 yr., r = 0.19, p = 0.002; 60-64 yr., r = 0.23, p < 0.001; ≥65 yr., r = 0.23, p ≥ 0.001). The primary care centers with fewer HCWs had better uptake in the at-risk groups in the age groups of 60-64 yr. (r = 0.20, p = 0.002) and ≥65 (r = 0.023, p ≥ 0.001). A negative correlation was found regarding workload in the 6 mo.-59 yr. age group (r = 0.18, p = 0.004), which showed the at-risk groups that lived in the most economically deprived areas were more likely to be vaccinated.

CONCLUSIONS

This study reveals that the confounding variables that determine influenza vaccination in a population and in HCWs are complex. Future influenza campaigns should address these especially considering the possibility of combining influenza and SARS-CoV-2 vaccines each year.

Factors Affecting Vaccine Attitudes Influenced by the COVID-19 Pandemic

The development of vaccines has significantly contributed to the success of disease prevention. However, there has been a sharp decline in immunization rates since COVID-19 spread globally. Seemingly overnight, the world shut down and most non-essential medical procedures were postponed. Since the COVID-19 vaccine became available, and the world started going back to normal these vaccine rates have not recovered. In this paper, we review the published literature to explore how convenience factors, perceived risk of vaccination, media or anti-vaccination ideals/movements, and healthcare professionals affect an individual’s compliance to be vaccinated to better understand the factors that contribute to the change in overall vaccination rates.

The mediating role of product judgment and country of origin effect on health literacy and behavioral intention: A study on COVID-19 vaccines perception of Turkish consumers

This study is conducted on people in Turkey who had at least one dose of vaccination and it evaluates their differences in attitude in terms of health literacy, product judgment, the country of origin, intention to recommend and motivation to boycott. The 393 vaccine consumers were selected through convenient sampling and the data was collected through online questionnaires. The data was later analyzed by SPSS and AMOS. Normality, reliability tests and frequency analysis were conducted on the data. Afterward, a correlation was calculated using factor loadings to determine the relationship between the variables. The last was conducting the PATH analysis. Some consumers are prejudiced toward COVID-19 vaccines due to perceived distrust, hesitation, and lack of product information. Determining the prejudices of consumers, underlying causes and making inferences will provide more useful information on COVID-19 vaccines to health institutions, vaccine manufacturers, consumers and other organizations.

Vaccine hesitancy and health care providers: Using the preferred cognitive styles and decision- making model and empathy tool to make progress

Low vaccination rates among health care providers (HCPs) pose a risk to themselves, their colleagues, their patients, and the general public. This paper seeks to frame the issues surrounding health care provider vaccine hesitancy and vaccination rates, as well as explore factors influencing respective decision-making, including health care occupation and demographic characteristics. This paper will then propose the use of the Preferred Cognitive Style and Decision-Making (PCSDM) Model and the Empathy Tool to increase health care provider vaccination rates, and will end by discussing several recommendations. It is important while discussing HCP vaccination rates to not view them as a monolithic group or apply “one-size-fits-all” approaches, and thus it is essential to present information and engage in conversations in ways that align with how the HCP takes in and processes information and decisions. Furthermore, it is vital to increase health literacy across the spectrum of HCP programs and professions. To this end, it is important to teach and incorporate the PCSDM Model and Empathy Tool, along with information about how individuals think and make decisions, into vaccine education programs and training sessions.

COVID-19 vaccine acceptance and hesitancy among healthcare workers in South Africa

BACKGROUND

We assessed willingness to accept vaccination against coronavirus disease 2019 (COVID-19) among healthcare workers(HCWs) at the start of South Africa's vaccination roll-out.

RESEARCH DESIGN AND METHODS

We conducted a cross-sectional survey among HCWs in Cape Town in March-May 2021 and assessed predictors of vaccination intentions.

RESULTS

We recruited 395 participants; 64% women, 49% nurses, and 13% physicians. Of these, 233(59.0%) would accept and 163 (41.0%) were vaccine hesitant i.e. would either refuse or were unsure whether they would accept COVID-19 vaccination. People who did not trust that COVID-19 vaccines are effective were the most hesitant (p = 0.038). Older participants and physicians were more likely to accept vaccination than younger participants (p < 0.01) and other HCWs (p = 0.042) respectively. Other predictors of vaccine acceptance were trust that vaccines are compatible with religion (p < 0.001), consideration of benefits and risks of vaccination (p < 0.001), willingness to be vaccinated to protect others (p < 0.001), and viewing vaccination as a collective action for COVID-19 control (p = 0.029).

CONCLUSIONS

COVID-19 vaccine hesitancy is high among HCWs in Cape Town. Reducing this would require trust-building interventions, including tailored education.

Knowledge, attitude and behavior towards vaccinations among nursing- and health care students in Hesse. An observational study

Objective: Work-related vaccinations are recommended for employees in nursing and health care professions due to their elevated risk of infection because of job-related exposure. These vaccinations prevent work-related infections, protect patients and help to maintain the medical infrastructure. Thorough training and imparting of knowledge about vaccinations and work-related infections are essential pillars of the vaccination decision and thus for achieving a protective immune status. The present study examines the knowledge, attitudes and behavior of nursing- and health care students in Hesse regarding work-related infections and vaccinations. Methods: In spring 2018, seven nursing schools in Hesse took part in an anonymous survey study. A total of 690 surveys from students of various health care professions were included in the study. The content of the survey was based on the recommendations of the Standing Committee on Vaccination (STIKO), a literature review and sample questions from the World Health Organization (WHO) regarding "vaccine hesitancy". Vaccination cards were also evaluated based on the STIKO recommendations concerning standard vaccinations and occupational vaccinations for health care workers. Results: The risk of acquiring a work-related infection was estimated to be quite high over all years of training. Gaps in knowledge were particularly evident in the area of vaccinations. Only three quarter of those surveyed believed that the effectiveness of vaccinations has been proven, and nearly 30% believed that the doses of the drugs used in vaccines were dangerous. Over 80% of the students had never had an influenza vaccination documented in their vaccination card. Conclusions: The knowledge about vaccinations imparted in the course of the education should be expanded. A special course on the subject of vaccinations and the immune system with practical elements could contribute to a better understanding of how vaccinations work and misunderstandings could be eliminated in early stages of the training through the dialog between the students and the teacher in the classroom and the occupational physician as part of preventive occupational health check-ups.

COVID-19 Vaccination Acceptance Among Healthcare Workers and Non-healthcare Workers in China: A Survey

Background: The coronavirus pneumonia is still spreading around the world. Much progress has been made in vaccine development, and vaccination will become an inevitable trend in the fight against this pandemic. However, the public acceptance of COVID-19 vaccination still remains uncertain.

Methods: An anonymous questionnaire was used in Wen Juan Xing survey platform. All the respondents were divided into healthcare workers and non-healthcare workers. Multinomial logistic regression analyses were performed to identify the key sociodemographic, cognitive, and attitude associations among the samples of healthcare workers and non-healthcare workers.

Results: A total of 2,580 respondents completed the questionnaire, including 1,329 healthcare workers and 1,251 non-healthcare workers. This study showed that 76.98% of healthcare workers accepted the COVID-19 vaccine, 18.28% workers were hesitant, and 4.74% workers were resistant. Among the non-healthcare workers, 56.19% workers received the COVID-19 vaccine, 37.57% workers were hesitant, and 6.24% workers were resistant. Among the healthcare workers, compared with vaccine recipients, vaccine-hesitant individuals were more likely to be female (AOR = 1.52, 95% CI: 1.12–2.07); vaccine-resistant individuals were more likely to live in the suburbs (AOR = 2.81, 95% CI: 1.44–3.99) with an income of 10,000 RMB or greater (AOR = 2.00, 95% CI: 1.03–3.90). Among the non-healthcare workers, vaccine-hesitant individuals were more likely to be female (AOR = 1.66, 95% CI: 1.31–2.11); vaccine-resistant individuals were also more likely to be female (AOR = 1.87, 95% CI: 1.16–3.02) and older than 65 years (AOR = 4.96, 95% CI: 1.40–7.62). There are great differences between healthcare workers and non-healthcare workers in their cognition and attitude toward vaccines.

Conclusions: Our study shows that healthcare workers are more willing to be vaccinated than non-healthcare workers. Current vaccine safety issues continue to be a major factor affecting public acceptance, and to expand vaccine coverage in response to the COVID-19 pandemic, appropriate vaccination strategies and immunization programs are essential, especially for non-healthcare workers.

Factors associated with influenza vaccination acceptance in Mexican healthcare workers: A multicenter cross-sectional study

Adherence of healthcare workers (HCWs) to influenza vaccination is far from optimal despite its being the most effective intervention for preventing influenza. In order to evaluate factors associated with influenza vaccination acceptance among Mexican HCWs during the 2017-2018 influenza season, a multicenter cross-sectional study spanning public and private hospitals was conducted. Participants were consecutively invited to answer a self-administered questionnaire. A total of 1513 out of 1553 questionnaires were evaluated. The median age of the participants was 32 (26-44) years and 65.8% were women. Nurses and physicians comprised 53.0% of the surveyed population. Total self-reported adherence to influenza vaccination among HCWs during the 2017-2018 season was 63.5% and varied across participating hospitals (P < 0.001). Factors positively associated with influenza vaccination were incremental doses of influenza vaccine received within the last 5 years (aOR = 1.94, 95% CI = 1.78-2.10), City 3 (aOR = 1.62, 95% CI = 1.19-2.20) and City 1 (aOR = 1.39, 95% CI = 1.02-1.91), whereas factors negatively associated were lack of a previous dose of influenza vaccine (aOR = 0.03, 95% CI = 0.01-0.08) and unawareness of the vaccination campaign (aOR = 0.57, 95% CI = 0.44-0.72). Lack of information and poor communication were barriers identified by both vaccinated and unvaccinated personnel. This study concluded that adherence to influenza vaccination in Mexican HCWs is suboptimal and that the factors associated with receipt of influenza vaccine are similar to those reported in other studies.

COVID-19 Vaccine Acceptance among Health Care Workers in the United States

Background: Acceptance of the COVID-19 vaccine will play a major role in combating the pandemic. Healthcare workers (HCWs) are among the first group to receive vaccination, so it is important to consider their attitudes about COVID-19 vaccination to better address barriers to widespread vaccination acceptance. Methods: We conducted a cross sectional study to assess the attitude of HCWs toward COVID-19 vaccination. Data were collected between 7 October and 9 November 2020. We received 4080 responses out of which 3479 were complete responses and were included in the final analysis. Results: 36% of respondents were willing to take the vaccine as soon as it became available while 56% were not sure or would wait to review more data. Only 8% of HCWs do not plan to get vaccine. Vaccine acceptance increased with increasing age, education, and income level. A smaller percentage of female (31%), Black (19%), Lantinx (30%), and rural (26%) HCWs were willing to take the vaccine as soon as it became available than the overall study population. Direct medical care providers had higher vaccine acceptance (49%). Safety (69%), effectiveness (69%), and speed of development/approval (74%) were noted as the most common concerns regarding COVID-19 vaccination in our survey.

The vaccination rate among children with nonprogressive neurodevelopmental disorders in Bosnia and Herzegovina: A single centre experience

PURPOSE

The aim of this study is to determine the factors influencing the decrease of the vaccination rate among children with nonprogressive neurodevelopmental disorders in Bosnia and Herzegovina.

METHODS

This study included 149 parents of children with nonprogressive neurodevelopmental disorders. The children were rehabilitated at the University Clinical Hospital Mostar, from October 2017 to February 2019.

RESULTS

The vaccination rate of children with nonprogressive neurodevelopmental disorders was 34.9% (P < 0.001). Based on the results of this study, physicians were the most common source of information on vaccines and vaccination procedures for parents (70.3%), whereas the media was rarely used as the source of the information (33%) (P < 0.001). Of the cases, 58.4% accepted the opinion of the pediatrician (P = 0.041). The vaccination of children was postponed on the physician's recommendation in 87.6% of the cases (P < 0.001). Among healthcare professionals, neuropediatricians or neurophysiatrists (P = 0.023), together with pediatricians (P < 0.001), most often suggested postponing the vaccination.

CONCLUSION

Overall, this study showed that the majority of children with nonprogressive neurodevelopmental disorders were unvaccinated. The majority of the parents trusted the physicians' opinion on vaccination. Neuropediatricians and neurophysiatrists most often postponed the regular vaccination of children.

Vaccination attitudes, beliefs and behaviours among primary health care workers in northern Croatia

Primary health care workers (HCWs) provide almost all vaccine services in Croatia, so they play an essential role in vaccine recommendations and uptake. The aim of this study was to determine the level of vaccine hesitancy among primary HCWs, to identify differences between nurses and physicians in attitudes, beliefs and behaviours towards vaccination, and to determine predictors of vaccine hesitancy among HCWs. We conducted a cross-sectional study from July to December in 2018 among physicians and nurses employed in the services of epidemiology, public health, school medicine, pediatrics and general practice/family medicine in Primorje-Gorski Kotar County, a primarily urban region with a population around 300 000 in the northern part of Croatia. The list of primary HCWs offices was obtained from the Croatian Health Insurance Fond website. We used a self-administered questionnaire on their attitudes, beliefs and behaviours relative to vaccination. Obtained response rate was 65.5% (324/495) of eligible primary HCWs; 64.1% (143/223) of physicians and 66.5% (181/272) of nurses. Seventeen percent of HCWs were identified as vaccine hesitant, and in univariate analysis, we observed an association between HCWs occupation and their own vaccination against flu (p = 0.001), measles (p = 0.016) and HPV (p = 0.025). Nurses and physicians differed (p < 0.001) in their general attitude, beliefs and behaviours towards vaccination, with a higher level of hesitancy among nurses. In multiple logistic regression, those more likely to be vaccine-hesitant were nurses (AOR = 5.73, 95%CI = 2.48-13.24), those who were uncertain or would never receive a vaccine against measles (AOR=11.13; 95%CI=5.37-23.10) and HPV (AOR=5.02; 95%CI=2.60-9.74), as well as those who had encountered a serious adverse event following immunization (AOR=7.55; 95%CI=3.13-19.18). As personal hesitancy may have a negative impact on vaccination education and recommendations, and therefore vaccine coverage, it is necessary to implement interventions to increase vaccination knowledge and confidence among primary health care workers, especially nurses.

Seasonal influenza self-vaccination behaviours and attitudes among nurses in Southeastern France

BACKGROUND

Despite seasonal influenza vaccination (SIV) being recommended to healthcare professionals to protect themselves and their patients, uptake is low, especially among nurses. We sought to study self-vaccination behaviours, attitudes and knowledge about SIV among nurses in Southeastern France.

METHODS

A cross-sectional survey with community and hospital-based hospital nurses was conducted with the same standardised questionnaire. Multi-model averaging approaches studied factors associated with the following dependent variables: self-reported SIV uptake; and considering SIV a professional responsibility.

RESULTS

1539 nurses completed the questionnaire (response rate: 85%). SIV was the most frequently cited vaccine (49%) regarding nurses' unfavourable opinions towards specific vaccines. Thirty-four percent of nurses reported being vaccinated at least once during the 2015-2016 or 2016-2017 seasons. A lack of perceived personal vulnerability to influenza, a fear of adverse effects, and a preference for homeopathy constituted the main deterrents of SIV. Nurses held various misconceptions about the SIV, but 69% considered its benefits to be greater than its risks. The multi-model averaging approach showed that considering SIV as a professional responsibility was the main factor associated with SIV uptake among nurses (Nagelkerke's partial R-squared: 15%). This sense of responsibility was strongly associated with trust in various vaccine information sources.

CONCLUSION

Nurses had low SIV uptake rates and held various concerns and a lack of knowledge surrounding the vaccine. This is concerning considering the impact that these factors can have on nurses and patients' health, especially considering the increased role that nurses could have surrounding SIV in the near future.

Feasibility of using postal and web-based surveys to estimate the prevalence of tuberculosis among health care workers in South Africa

INTRODUCTION

Health Care Workers (HCWs) are among the highest risk groups for contracting tuberculosis (TB), which is ranked the third most common occupational health disease in South Africa. Little is known about the true extent of the burden of TB among South African HCWs and current surveillance approaches are inadequate. The study aimed to determine the feasibility of using postal and web-based surveys accessed through registries of registered professionals to estimate the prevalence of TB among HCWs in South Africa.

MATERIALS AND METHODS

We conducted a cross sectional survey on a sample of professional nurses and doctors (general practitioners) registered on the Medpages database platform; a subscription based registry for practising health care professionals. The survey included professionals who were actively involved in the clinical management of patients, either in public or private health care facilities. The paper based survey, including pre-paid return envelopes, was distributed via the post office and web-based surveys were distributed via e-mail through a hyperlink. Descriptive statistics were used to summarize the data and the Chi-square test to determine associations between categorical variables. Active TB was defined as any history of TB.

RESULTS

Out of a total of 3,400 health care professionals contacted, 596 (18%) responses were received: 401 (67%) web-based and 195 (33%) postal. A significantly higher percentage of complete forms were from postal compared to web-based (97% [189/195] versus 87% [348/401], p<0.001). Younger (<60 years) professionals were more likely to use the web-based compared to postal (87% [236/270] versus 71% [134/189], p<0.001). Overall, the prevalence of active TB infection was 8.7%, (95%CI: 6.3%-11.7%) and there was no difference observed between doctors and nurses (10.8% [18/167] versus 7.5% [22/292], p = 0.236).

CONCLUSION

This novel approach demonstrated the feasibility of using an existing registry of professionals to conduct surveys to estimate the prevalence of TB. Our findings showed a high TB prevalence; however the estimate might have been biased by the low response rate. Further research to optimise our approach could lead to a viable option in improving surveillance among health care professionals.

Vaccine hesitancy and healthcare providers

While most people vaccinate according to the recommended schedule, this success is challenged by individuals and groups who delay or refuse vaccines. The aim of this article is to review studies on vaccine hesitancy among healthcare providers (HCPs), and the influences of their own vaccine confidence and vaccination behaviour on their vaccination recommendations to others. The search strategy was developed in Medline and then adapted across several multidisciplinary mainstream databases including Embase Classic & Embase, and PschInfo. All foreign language articles were included if the abstract was available in English. A total of 185 articles were included in the literature review. 66% studied the vaccine hesitancy among HCPs, 17% analysed concerns, attitudes and/or behaviour of HCPs towards vaccinating others, and 9% were about evaluating intervention(s). Overall, knowledge about particular vaccines, their efficacy and safety, helped to build HCPs own confidence in vaccines and their willingness to recommend vaccines to others. The importance of societal endorsement and support from colleagues was also reported. In the face of emerging vaccine hesitancy, HCPs still remain the most trusted advisor and influencer of vaccination decisions. The capacity and confidence of HCPs, though, are stretched as they are faced with time constraints, increased workload and limited resources, and often have inadequate information or training support to address parents' questions. Overall, HCPs need more support to manage the quickly evolving vaccine environment as well as changing public, especially those who are reluctant or refuse vaccination. Some recommended strategies included strengthening trust between HCPs, health authorities and policymakers, through more shared involvement in the establishment of vaccine recommendations.

Influenza Vaccination of Healthcare Workers and Vaccine Allocation for Healthcare Workers During Vaccine Shortages

Influenza causes substantial morbidity and mortality annually, particularly in high-risk groups such as the elderly, young children, immunosuppressed individuals, and individuals with chronic illnesses. Healthcare-associated transmission of influenza contributes to this burden but is often under-recognized except in the setting of large outbreaks. The Centers for Disease Control and Prevention has recommended annual influenza vaccination for healthcare workers (HCWs) with direct patient contact since 1984 and for all HCWs since 1993. The rationale for these recommendations is to reduce the chance that HCWs serve as vectors for healthcare-associated influenza due to their close contact with high-risk patients and to enhance both HCW and patient safety. Despite these recommendations as well as the effectiveness of interventions designed to increase HCW vaccination rates, the percentage of HCWs vaccinated annually remains unacceptably low. Ironically, at the same time that campaigns have sought to increase HCW vaccination rates, vaccine shortages, such as the shortage during the 2004-2005 influenza season, present challenges regarding allocation of available vaccine supplies to both patients and HCWs. This two-part document outlines the position of the Society for Healthcare Epidemiology of America on influenza vaccination for HCWs and provides guidance for the allocation of influenza vaccine to HCWs during a vaccine shortage based on influenza transmission routes and the essential need for a practical and adaptive strategy for allocation. These recommendations apply to all types of healthcare facilities, including acute care hospitals, long-term-care facilities, and ambulatory care settings.

Factors Associated with Healthcare Worker Acceptance of Vaccination: A Systematic Review and Meta-analysis

Background and objective.

Healthcare workers experience occupational risk of infection and may transmit infections to patients. Vaccination provides an efficient means of protecting workers and patients, but uptake may be low. We sought to identify factors influencing vaccine acceptance by healthcare workers in order to obtain insights leading to more effective vaccination programs in this population.

Design.

Systematic review and meta-analysis.

Methods.

We searched Medline, Embase, and CINAHL databases to identify studies published up to May 2012. Factors influencing vaccination acceptance were devised a priori. Random-effects meta-analysis was performed to generate summary estimates of effect. Heterogeneity and publication bias were explored using statistical tools.

Results.

Thirty-seven studies evaluating a variety of vaccines (against influenza, pertussis, smallpox, anthrax, and hepatitis B) were included. Homogeneous effects on vaccine acceptance were identified with desire for self-protection (odds ratio [OR], 3.42 [95% confidence interval (CI), 2.42–4.82]) and desire to protect family and friends (OR, 3.28 [95% CI, 1.10–9.75]). Concern that vaccine transmits the illness it was meant to prevent decreased acceptance (OR, 0.42 [95% CI, 0.30–0.58]). Differences in physician and nurse acceptance of immunization were seen between Asian and non-Asian studies.

Conclusions.

Consideration of self-protection (rather than absolute disease risk or protection of patients) appears the strongest and most consistent driver of healthcare workers’ decisions to accept vaccination, though other factors may also be impactful, and reasons for between-study divergence in effects is an important area for future research. This finding has important implications for the design of programs to enhance healthcare worker vaccine uptake.

Infect Control Hosp Epidemiol2014;35(6):699–708

Knowledge of and attitudes to influenza in unvaccinated primary care physicians and nurses

Primary healthcare workers, especially nurses, are exposed to the vast majority of patients with influenza and play an important role in vaccinating patients. Healthcare workers’ misconceptions about influenza and influenza vaccination have been reported as possible factors associated with lack of vaccination. The objective of this study was to compare the characteristics of unvaccinated physicians and unvaccinated nurses in the 2011–2012 influenza season. We performed an anonymous web survey of Spanish primary healthcare workers in 2012. Information was collected on vaccination and knowledge of and attitudes to the influenza vaccine. Multivariate analysis was performed using unconditional logistic regression. We included 461 unvaccinated physicians and 402 unvaccinated nurses. Compared with unvaccinated nurses, unvaccinated physicians had more frequently received seasonal influenza vaccination in the preceding seasons (aOR 1.58; 95% CI 1.11–2.25), and more frequently believed that vaccination of high risk individuals is effective in reducing complications (aOR 2.53; 95% CI 1.30–4.95) and that influenza can be a serious illness (aOR 1.65; 95% CI 1.17–2.32). In contrast, unvaccinated physicians were less concerned about infecting patients (aOR 0.62; 95% CI 0.40–0.96). Unvaccinated nurses had more misconceptions than physicians about influenza and the influenza vaccine and more doubts about the severity of annual influenza epidemics in patients with high risk conditions and the prevention of complications by means of the influenza vaccination. For unvaccinated physicians, strategies to improve vaccination coverage should stress the importance of physicians as a possible source of infection of their patients. The effectiveness of influenza vaccination of high risk persons should be emphasized in nurses.

[Primary health care professionals attitudes towards influenza immunzation in Catalonia]

Objetivo

Los trabajadores sanitarios tienen riesgo de adquirir la gripe y actuar como vectores para la transmisión nosocomial. El objetivo del estudio fue la valoración de los conocimientos y actitudes de los profesionales sobre la vacunación antigripal, y determinar los factores asociados a ella por parte de profesionales de atención primaria en Cataluña.

Diseño

Estudio transversal mediante una encuesta anónima vía web.

Emplazamiento

Profesionales sanitarios de atención primaria del Instituto Catalán de la Salud.

Participantes

Se incluyó a 1.212 profesionales de atención primaria. Se excluyó a los profesionales con contraindicación para recibir la vacuna o indicación de vacunación por condición médica de riesgo y aquellos que hubieran participado en la red centinela de vigilancia de la gripe Pla d’Informació Diària d’Infeccions Respiratòries Agudes de Catalunya (PIDIRAC).

Resultados

Se consideraron 423 respuestas válidas, con una cobertura vacunal global del 46,6%. Se vacunaron más los que tenían de 45 a 54 años, los pediatras, los vacunados en las 3 temporadas anteriores o en alguna de ellas y los que convivían con enfermos crónicos. Se observó asociación entre estar vacunado y considerar que la vacunación es la mejor medida preventiva, preocupación por contraer la gripe y considerar importante la vacunación del personal sanitario.

Conclusiones

Las actividades dirigidas a aumentar la cobertura de vacunación en profesionales sanitarios deberían dirigirse fundamentalmente a corregir concepciones erróneas sobre la vacunación de la gripe en profesionales sanitarios.

Healthcare worker influenza declination form program

BACKGROUND

Health care worker (HCW) vaccination rates have been low for many years (approximately 50%). Our goal was to implement an influenza declination form program (DFP) to assess feasibility, participation, HCW vaccination, and costs.

METHODS

This was a prospective interventional pilot study using mixed methods to evaluate the DFP implementation processes and outcomes. We conducted a formative evaluation and interviews; data were transcribed and coded into themes. Secondary outcomes included self-reported HCW influenza vaccine uptake (pre-/postsurvey) and program costs; data were evaluated using descriptive and bivariate analyses.

RESULTS

The DFP was compatible with ongoing strategies and unit culture. Barriers included multiple hospital shifts and competing demands. Facilitators included complementary ongoing strategies and leadership engagement. HCW vaccination rates were higher post- versus preimplementation (77.4% vs 53.5%, P =.01). To implement the DFP at site 1, using a mobile flu cart, 100% of declination forms were completed in 42.5 staff hours over <2 months. At site 2, using a vaccination table on all staff meeting days, 49% of forms were completed in 26.5 staff hours over 4.5 months. Average cost of staff time was $2,093 per site.

CONCLUSION

DFP implementation required limited resources and resulted in increased HCW influenza vaccine rates; this may have positive clinical implications for influenza infection control/prevention.

Employee influenza vaccination in a large cancer center with high baseline compliance rates: comparison of carrot versus stick approaches

BACKGROUND

Influenza is a major complication in patients with cancer and hematopoietic cell transplant recipients. We set out to maximize influenza vaccination rates in health care personnel at our large ambulatory cancer center with high baseline compliance and to assess alternatives to mandatory policies.

METHODS

Baseline influenza vaccine compliance rates at our center were >85%. During 2011 an incentive-based "carrot" campaign was implemented, and in 2012 a penalty-based "stick" approach to declining staff was required. Yearly approaches were compared using Kaplan-Meier survival estimates.

RESULTS

Both the incentive and penalty approaches significantly improved the baseline rates of vaccination (2010 vs 2011 P = .0001 and 2010 vs 2012 P < .0001), and 2012 significantly improved over 2011 (P < .0001). Staff with direct patient contact had significantly higher rates of vaccination compared with those with indirect and minimal contact in every campaign year, except in the penalty-driven campaign from 2012 (P < .001, P < .001, and P = .24 and P < .001, P < .001, and P = .17, respectively).

CONCLUSIONS

A multifaceted staff vaccination program that included education, training, and active declination was more effective than a program offering incentives. Improvements in vaccination rates in the penalty-driven campaign were driven by staff without direct care responsibilities. High compliance with systemwide influenza vaccination was achieved without requiring mandatory vaccination.

Managing an online survey about influenza vaccination in primary healthcare workers

Online surveys are increasingly used due to their speed and efficiency. The aim of this study was to analyze factors that may have contributed to the quality and speed of response of an online survey on influenza vaccination in primary healthcare workers. A multicenter study including family physicians, nurses and pediatricians from primary healthcare teams from seven Spanish Autonomous Communities was designed. The centers were selected by simple random sampling. The survey remained active and accessible for 56 days and four reminders were sent. The odds ratios (OR) and their 95% confidence intervals (CI) were calculated to assess the association of sociodemographic variables and responding to the survey before the second reminder. Complete, validated information was obtained from 1965 primary healthcare workers. The total response rate was 36.2%. More nurses (46.3%) responded before the second reminder and more family physicians (52.8%) after the second reminder. The adjusted OR shows that family physicians responded later (AOR 1.46, 95% CI 1.2–1.8) than nurses. The responses obtained in the first 24 h after the initial sending and the reminders accounted for 41.7% of the completed surveys, indicating the importance of reminders.

Healthcare Workers' Knowledge and Attitudes About Pertussis and Pertussis Vaccination

Objective.

To determine knowledge and attitudes about pertussis and pertussis vaccination among healthcare workers (HCWs).

Design.

Self-administered, Web-based survey.

Setting.

Tertiary-care academic medical center.

Participants.

Medical center employees who participated in direct patient care were recruited to complete the survey through institutional e-mail.

Results.

Of 14,893 potentially eligible employees, 1,819 (12%) completed the survey. Most respondents (87%) did not plan to receive the pertussis vaccine. Intent to receive vaccination (which included recent history of vaccination) was associated with the following 4 factors: receipt of a physician recommendation for vaccination (odds ratio [OR], 9.01), awareness of Centers for Disease Control and Prevention recommendations for pertussis vaccination for HCWs (OR, 6.89), receipt of encouragement to be vaccinated from a coworker (OR, 4.72), the belief that HCWs may spread pertussis to patients and family (OR, 1.80). Two factors were negatively associated with intent to receive vaccination: the presence of children in the HCW's home (OR, 0.69) and employment as a nurse (OR, 0.59). Reasons cited by those who did not intend to receive vaccination included lack of a personal recommendation for vaccination (78%), receipt of vaccination as a child (51%), and perception that there was no significant risk for contracting pertussis (38%).

Conclusions.

Of the HCWs surveyed, only 13% intended to receive the pertussis vaccine. A perceived lack of recommendation for vaccination and inaccurate conceptions about pertussis and pertussis vaccination were cited as reasons HCWs did not intend to be vaccinated. Institutional pertussis vaccination campaigns should focus on the risks of healthcare-associated pertussis and new recommendations for pertussis vaccination.

Influenza Vaccination Rates and Motivators Among Healthcare Worker Groups

Background.

The rate of influenza vaccination among healthcare workers (HCWs) is approximately 40%. Differences in vaccination rates among HCW groups and reasons for accepting or rejecting vaccination are poorly understood.

Objectives.

To determine vaccination rates and motivators among different HCW groups during the 2004-2005 influenza season.

Design.

Cross-sectional survey conducted between July 10 and September 30, 2005.

Setting.

Two tertiary care teaching hospitals in an urban center.

Participants.

Physicians, nurses, nursing aides, and other staff. Surveys were collected from 1,042 HCWs (response rate, 42%).

Results.

Sixty-nine percent of physicians (n = 282) and 63% of medical students (n = 145) were vaccinated, compared with 46% of nurses (n = 336), 42% of nursing aides (n = 135), and 29% of administrative personnel (n = 144). Physicians and medical students were significantly more likely to be vaccinated than all other groups (P < .0001). Pediatricians (84%) were more likely than internists (69%) and surgeons (43%) to be vaccinated (P < .0001). Among the HCWs who were vaccinated, 33.4% received the live attenuated influenza vaccine (LAIV) and 66.6% received trivalent inactivated influenza vaccine (TIV). Vaccinated HCWs were less likely than unvaccinated HCWs to report an influenza-like illness (P = .03). Vaccination with LAIV resulted in fewer episodes of influenza-like illness than did receiving no vaccine (P = .03). The most common reason for rejecting vaccination was a concern about availability. Understanding that HCWs may transmit the virus to patients correlated with vaccine acceptance (P = .0004).

Conclusions.

Significant differences in vaccination exist among physician specialties and employee groups, and there are inadequate vaccination rates among those with the greatest amount of patient contact, potentially providing a basis for group-specific interventions.

Visualizing knowledge and attitude factors related to influenza vaccination of physicians

PURPOSE

To characterize groups of primary healthcare physicians according to sociodemographic data, years of professional experience and knowledge of and attitudes to influenza, and to evaluate differences between groups with respect to influenza vaccination in the 2011-2012 season.

METHODS

We carried out an anonymous web survey of Spanish primary healthcare physicians in 2012. Information on vaccination, and knowledge of and attitudes to influenza was collected. Multiple correspondence analysis and cluster analysis were used to define groups of physicians.

RESULTS

We included 835 physicians and identified three types. Type B were physicians with low professional experience of influenza. Types A and C were physicians with high professional experience with influenza, type A also had a high awareness of influenza and seasonal vaccination. Types A and C were older and more often male than type B (p<0.0001). Knowledge of influenza was greatest in type A and lowest in type B. Awareness of influenza was greatest in type A and lowest in type C. In type A, 71.0% of physicians were vaccinated in the 2011-2012 season, compared with 48.1% and 33.6% from types B and C, respectively (p<0.001).

CONCLUSIONS

Additional efforts should be made to increase interest and concerns about preventing the transmission of influenza in physicians who do not believe influenza is a severe disease and are not concerned about its transmission.

Healthcare worker compliance with seasonal and pandemic influenza vaccination

Healthcare workers (HCWs) can be an important source of transmission of influenza to patients and family members, and their well-being is fundamental to the maintenance of healthcare services during influenza outbreaks and pandemics. Unfortunately, studies have shown consistently low levels of compliance with influenza vaccination among HCWs, a finding that became particularly pronounced during recent pandemic vaccination campaigns. Among the variables associated with vaccine acceptance in this group are demographic factors, fears and concerns over vaccine safety and efficacy, perceptions of risk and personal vulnerability, past vaccination behaviours and experience with influenza illness, as well as certain situational and organisational constructs. We report the findings of a review of the literature on these factors and highlight some important challenges in interpreting the data. In particular, we point out the need for longitudinal study designs, as well as focused research and interventions that are adapted to the most resistant HCW groups. Multi-pronged strategies are an important step forward in ensuring that future influenza vaccination campaigns, whether directed at seasonal or pandemic strains, will be successful in ensuring broad coverage among HCWs.

Associations between perceptions of evidence and adoption of H1N1 influenza infection prevention strategies among healthcare workers providing care to persons with spinal cord injury

AIM

To examine associations between perceptions of evidence (research evidence, clinical expertise, patient preferences) and outcomes of a nationwide programme to implement H1N1 influenza prevention guidelines.

BACKGROUND

Healthcare workers do not consistently adhere to recommended infection control practices and this may be associated with their perceptions of evidence sources.

DESIGN

Cross-sectional mailed survey.

METHOD

A survey of healthcare workers was administered in August 2010 after implementation of H1N1 prevention guidelines. Outcomes of interest were ratings of adherence to H1N1 prevention guidelines.

FINDINGS

Respondents with complete data (N = 283) were included in analyses. Facility-level adherence to guidelines was associated with opinions of clinical experts. Healthcare workers who rated clinical expertise as aligning with recommendations also rated their facilities as being more adherent to guidelines. Perceptions of research evidence and patient preferences were not associated with facility adherence. Personal adherence was not associated with perceptions of evidence, except among those healthcare workers who rated both clinical experts and patients as unsupportive of guidelines; these practitioners were less likely to adhere to recommended personal hygiene practices.

CONCLUSION

Efforts to implement guidelines might be most effective when capitalizing on the influence of clinical experts. To better explain variability in guideline adherence, inclusion of a broader array of variables is recommended for future studies.

Knowledge of and attitudes to influenza vaccination in healthy primary healthcare workers in Spain, 2011-2012

Annual influenza vaccination is recommended for healthcare workers, but many do not follow the recommendation. The objective of this study was to investigate the factors associated with seasonal influenza vaccination in the 2011–2012 season. We carried out an anonymous web survey of Spanish primary healthcare workers in 2012. Information on vaccination, and knowledge and attitudes about the influenza vaccine was collected. Workers with medical conditions that contraindicated vaccination and those with high risk conditions were excluded. Multivariate analysis was performed using unconditional logistic regression. We included 1,749 workers. The overall vaccination coverage was 50.7% and was higher in workers aged ≥ 55 years (55.7%), males (57.4%) and paediatricians (63.1%). Factors associated with vaccination were concern about infection at work (aOR 4.93; 95% CI 3.72–6.53), considering that vaccination of heathcare workers is important (aOR 2.62; 95%CI 1.83–3.75) and that vaccination is effective in preventing influenza and its complications (aOR 2.40; 95% CI 1.56–3.67). No association was found between vaccination and knowledge of influenza or the vaccine characteristics. Educational programs should aim to remove the misconceptions and attitudes that limit compliance with recommendations about influenza vaccination in primary healthcare workers rather than only increasing knowledge about influenza and the characteristics of the vaccine.

The effect of physicians' awareness on influenza and pneumococcal vaccination rates and correlates of vaccination in patients with diabetes in Turkey: an epidemiological Study "diaVAX"

We aimed to examine the effect of increased physician awareness on the rate and determinants of influenza and pneumococcal vaccinations in diabetic patients. Diabetic patients (n = 5682, mean [SD] age: 57.3 [11.6] years, 57% female) were enrolled by 44 physicians between Sept 2010 and Jan 2011. The physicians were initially questioned regarding vaccination practices, and then, they attended a training program. During the last five years, the physicians recommended influenza and pneumococcal vaccinations to 87.9% and 83.4% of the patients, respectively; however; only 27% of the patients received the influenza and 9.8% received the pneumococcal vaccines. One year after the training, the vaccination rates increased to 63.3% and 40.7%, respectively. The logistic regression models revealed that variables which increased the likelihood of having been vaccinated against influenza were: longer duration of diabetes, presence of hyperlipidemia and more use of concomitant medications whereas more use of anti-hyperglycemic medications was associated with increased odds of vaccination. On the other hand, older age, longer duration of diabetes and presence of a cardiovascular disease were variables which decreased the likelihood of having been vaccinated against pneumococcal disease during the past five years. However, during the study period, variables which decreased the odds of having been vaccinated included: older age and anti-hyperglycemic medications for influenza, and presence of hyperlipidemia and a family history of hypertension for pneumococcal disease. While variables which increased the likelihood of vaccination in the same period were: increased number of co-morbidities for influenza, and family history of diabetes for pneumococcal disease. We conclude that increased awareness of physicians may help improve vaccination rates against influenza and pneumococcal disease. However, diabetic patients with more severe health conditions are less likely to having been vaccinated. More structural/systematic vaccination programs are needed to increase the vaccination rates in patients with diabetes.

Knowledge, attitudes and beliefs of health care workers towards influenza vaccination

BACKGROUND

Influenza vaccination is routinely offered to health care workers in the U.K. to prevent nosocomial spread to patients and illness among health care workers. Despite its importance uptake has been low in the U.K.

AIMS

To describe the knowledge, attitudes and behaviour of health care workers towards influenza vaccination offered as part of occupational health and to understand their relative importance in promoting uptake of influenza vaccine. We also sought to make comparisons with other vaccines more readily accepted as part of occupational health.

METHODS

An online survey was distributed by e-mail to health care workers in the South Central Strategic Health Authority. The questionnaire included the following: demographic characteristics; vaccination status; and knowledge, attitudes and behaviour towards influenza, MMR and hepatitis B vaccination. We used logistic regression to identify the independent predictors of receipt of influenza vaccine.

RESULTS

The survey was completed by 998 health care workers representing just over 1% of health care workers in the region. Of those, 69% thought that overall benefits of influenza vaccination were greater than the risks and inconvenience (versus 92% for hepatitis B and 86% for MMR). The following predicted receipt of influenza vaccine: belief that influenza poses a risk to one's own health (OR 3.74; 95% CI 2.45-5.71); belief that influenza vaccine is harmful (OR 0.25; 95% CI 0.16-0.37); and belief that influenza vaccine will protect patients (OR 2.96; 95% CI 1.89-4.62).

CONCLUSIONS

Staff knowledge, attitudes and beliefs concerning influenza and its vaccine are an important predictor of uptake and should be a target for campaigns to promote uptake.

Low influenza vaccination rates among child care workers in the United States: assessing knowledge, attitudes, and behaviors

Influenza can spread quickly among children and caregivers in child day care settings. Vaccination is the most effective method to prevent influenza. We determined 2009 pandemic influenza A (H1N1) (pH1N1) and seasonal influenza vaccination rates during the 2009-2010 influenza season among child care center employees, assessed knowledge and attitudes regarding the vaccines, and determined factors associated with vaccine receipt. Using a cross-sectional study design, from January 30-March 1, 2010, we surveyed 384 (95%) of 403 employees at 32 licensed child centers in the United States about personal and work characteristics, vaccine receipt, and knowledge and attitudes regarding each vaccine. Forty-five (11%) and eighty five (22%) respondents reported receiving the pH1N1 and seasonal influenza vaccines, respectively. The most common reasons cited for not getting either vaccine were "I don't think I need the vaccine," "I don't think the vaccine will keep me from getting the flu," and "the vaccine is not safe." Factors independently associated with receipt of either vaccine included belief in its efficacy, having positive attitudes towards it, and feeling external pressure to get it. Child care center employees had low rates of pH1N1 and seasonal influenza vaccination largely due to misconceptions about the need for and efficacy of the vaccine. Public health messages should address misconceptions about vaccines, and employers should consider methods to maximize influenza vaccination of employees as part of a comprehensive influenza prevention program.

The public acceptance of smallpox vaccination to fight bioterrorism in Japan: results of a large-scale opinion survey in Japan

OBJECTIVES

This study examines the public acceptance of smallpox vaccinations in the event of a terrorist attack using smallpox. The article also provides public health professionals with the information necessary for such smallpox management.

METHODS

A questionnaire survey was conducted in a city in Japan asking about prospective action when smallpox vaccination is advised after a terrorist attack and factors that could influence individual decisions about such vaccination.

RESULTS

Only a tiny fraction of people (0.12%) expressed their rejection of vaccination. Of the respondents, 63.6% showed their intent to be vaccinated promptly when such a measure was required; 28.6% wanted to decide for themselves, having some reservations. Those in the younger age group, those suffering from hypertension/cardiac diseases, and those who considered the threat of smallpox terrorism less seriously were likely to reserve their vaccination decisions until after examining information.

CONCLUSIONS

Communication programs regarding smallpox vaccination should be well planned beforehand and should especially target those people who reserve their decisions at such times. Health professionals should also be well equipped with all information necessary for appropriate and effective smallpox management in the face of such a bioterrorism attack or the strong potential of one.

Predicting seasonal influenza vaccination among hospital-based nurses

A descriptive cross-sectional online survey of a convenience sample of 202 hospital-based nurses was conducted to explore the factors associated with influenza vaccination. The findings suggest that the independent predictors of influenza vaccination were perception of job as a risk increasing factor (OR = 12.14; 95% CI [1.89, 78.08]), workplace vaccination clinics and campaigns (OR = 2.88; 95% CI [1.12, 7.38]), vaccination in the previous season (OR = 34.80; 95% CI [12.99, 93.28]), viewing vaccination as an inconvenience (OR = 0.22; 95% CI [0.07, 0.67]), and one's belief that the immune system provides better protection than the vaccine (OR = 0.29; 95% CI [0.11, 0.77]). In conclusion, the findings support the existing literature with regards to low vaccination rates among health care providers. Furthermore, the identification of the predictors of influenza vaccination among nurses may assist administrators and policy makers with the implementation of evidence-based vaccination strategies.

Reflections on the influenza vaccination of healthcare workers

Despite all that is known about the dangers of nosocomial transmission of influenza to the vulnerable patient populations in our healthcare facilities, and the benefits of the influenza vaccination, the low rates of influenza vaccination among healthcare workers (HCWs) internationally shows no sign of significant improvement. With the current voluntary 'opt-in' programmes clearly failing to adequately address this issue, the time has undoubtedly come for a new approach to vaccination to be implemented. Two different approaches to vaccination delivery have been suggested to rectify this situation, mandatory vaccination and 'opt-out' declination forms. It is suggested, however, that these two approaches are inadequate when used by themselves. In order to protect the most vulnerable patients in our healthcare facilities as best we can from serious harm or death caused by nosocomial transmission of influenza, while at the same time respecting HCWs autonomy, and in many jurisdictions, the related legal right to refuse medical treatment, it is recommended that 'op-out' declination forms should be used in conjunction with restricted mandatory vaccination. This 'combined' approach would allow any HCW to refuse the influenza vaccination, but would make the influenza vaccination a mandatory requirement for working in areas where the most vulnerable patients are cared for. Those HCWs not willing to be vaccinated should be required to work in other areas of healthcare.

Determinants of influenza vaccination among healthcare workers

OBJECTIVE

To identify the determinants of influenza vaccination and the moderators of the intention-behavior relationship among healthcare workers (HCWs).

DESIGN

Prospective survey with 2-month follow-up.

SETTING

Three university-affiliated public hospitals.

PARTICIPANTS

Random sample of 424 HCWs.

METHODS

The intention of an HCW to get vaccinated against influenza was measured by means of a self-administered questionnaire based on an extended version of the theory of planned behavior. An objective measure of behavior was extracted 2 months later from the vaccination database of the hospitals.

RESULTS

Controlling for past behavior, we found that the determinants of influenza vaccination were intention (odds ratio [OR], 8.32 [95% confidence interval {CI}, 2.82-24.50]), moral norm (OR, 3.01 [95% CI, 1.17-7.76]), anticipated regret (OR, 2.33 [95% CI, 1.23-4.41]), and work status (ie, full time vs part time; OR, 1.99 [95% CI, 1.92-3.29]). Moral norm also interacted with intention as a significant moderator of the intention-behavior relationship (OR, 0.09 [95% CI, 0.03-0.30]). Again, apart from the influence of past behavior, intention to get vaccinated was predicted by use of the following variables: attitude (beta=.32; P<.001), professional norm (beta=.18; P<.001), moral norm (beta=.18; P<.001), subjective norm (beta=.09; P<.001), and self-efficacy (beta=.08; P<.001). This latter model explained 89% of the variance in HCWs' intentions to get vaccinated against influenza during the next vaccination campaign.

CONCLUSIONS

Our study suggests that influenza vaccination among HCWs is mainly a motivational issue. In this regard, it can be suggested to reinforce the idea that getting vaccinated can reduce worry and protect family members.

Survey of Healthcare Workers’ Attitudes, Beliefs and Willingness to Receive the 2009 Pandemic Influenza A (H1N1) Vaccine and the Impact of Educational Campaigns

Introduction: Vaccination against the 2009 pandemic influenza A (H1N1) represents the best method of controlling spread, morbidity and mortality due to the pandemic. While this has been recommended for all healthcare-workers locally, it is unclear if they are willing to accept the vaccination. Materials and Methods: A cross-sectional survey was conducted before and after an educational talk on pandemic influenza and vaccines to ascertain responses and stated reasons, as well as identify associated factors. Results: For 235 returned forms prior to the talk, 182 (77.4%) responded positively, while 161 of 192 (83.8%) who returned forms after the talk responded positively. Importantly, 12 of 47 (25.5%) initially negative responses turned positive after education. The desire to protect family, self and patients were the 3 most important reasons for staff wanting to receive the vaccine, while the concern regarding potential side effects was the most important reason for refusal. Conclusions: A high rate of willingness to receive pandemic influenza vaccine was found, which was in contrast to acceptance rates elsewhere and during previous influenza seasons. Education can play an important role in altering vaccine acceptance behaviour, with an emphasis on addressing concerns with regard to potential side effects. Key words: Education, Health knowledge, Practices, Vaccination rates

Perceived risks of adverse effects and influenza vaccination: a survey of hospital employees

BACKGROUND

Many hospital employees shun influenza immunization because they want to avoid adverse reactions. We surveyed hospital employees to elucidate whether the conception of the adverse effects of vaccination stems from correct or misperceived incidence rates of vaccine adverse effects. 

METHODS

We used an anonymous self-administered paper questionnaire at a tertiary-care university hospital in Germany, in 2006. Multiple-choice questions probed respondents' knowledge about influenza, influenza vaccine and about rates of 12 possible vaccine adverse effects. We correlated overestimation of each adverse effect with failure to obtain vaccination in 2005-06, stratified by professional group. 

RESULTS

The overall response rate was 34% (652/1898). Of the 304 respondents unvaccinated in 2005-06, 127 (42%) attributed their vaccination status mainly to concerns about adverse effects. Among physicians, failure to obtain influenza vaccination was associated with the overestimation of both non-severe and severe adverse effects. Non-vaccinated nurses were significantly more likely than the vaccinated nurses to overestimate the rates of five of six non-severe adverse effects, but differed significantly in rates of overestimation of merely one of the six severe adverse effects. Overestimation of vaccine-caused absenteeism from work was negatively associated with vaccination rates among all professionals. 

CONCLUSIONS

Overestimation of the actual low rates of influenza vaccine adverse effects was associated with non-receipt of the vaccine among hospital employees. Due to our finding of different misconceptions about adverse effects, educational and promotional programmes should be targeted differentially for nurses and physicians.

Development of a flexible, computerized database to prioritize, record, and report influenza vaccination rates for healthcare personnel

OBJECTIVE

To describe the method used to develop a flexible, computerized database for recording and reporting rates of influenza vaccination among healthcare personnel who were classified by their individual levels (hereafter, "tiers") of direct patient contact.

DESIGN

Three-year descriptive summary.

SETTING

Large, academic, tertiary care medical center in the United States.

PARTICIPANTS

All of the medical center's healthcare personnel.

METHODS

The need to develop a computer-based system to record direct patient care tiers and vaccination data for healthcare personnel was identified. A plan that was to be implemented in stages over several seasons was developed.

RESULTS

Direct patient care tiers were defined by consensus opinion on the basis of the extent, frequency, and intensity of direct contact with patients. The definitions of these tiers evolved over 3 seasons. Direct patient care classifications were assigned and recorded in a computerized database, and data regarding the receipt of vaccination were tracked by using the same database. Data were extracted to generate reports of individual, departmental, and institutional vaccination rates, both overall and according to direct patient care tiers.

CONCLUSIONS

Development of a computerized database to record direct patient care tiers for individual healthcare workers is a daunting but manageable task. Widespread use of these direct patient care definitions will facilitate uniform comparisons of vaccination rates between institutions. This computerized database can easily be used by infection control personnel to accomplish several other key tasks, including vaccination triage in the context of shortage or delay, prioritization of personnel to receive interventions in times of crisis, and monitoring the status of other employee health or occupational health measures.

Influenza outbreak management on a locked behavioral health unit

BACKGROUND

In January 2006, 8 patients on a locked behavioral health (BH) ward were identified with influenza-like illness (ILI) based on syndrome of fever, malaise, myalgia, cough, and rhinitis. Two patients initially had rapid antigen testing positive for influenza and confirmed by polymerase chain reaction. All patients present on the ward (N=26) had been ordered influenza immunizations 6 weeks earlier: 46% (12/26) were immunized, 42% (11/26) refused, 12% (3/26) had no record of immunization. All direct care staff who worked on the unit during the outbreak had been offered immunizations in the fall: 55% (22/40) were immunized.

METHODS

When first symptoms were identified, provider notified infection control nurse and hospital epidemiologist, who instituted control measures: patients were confined to unit, unit was closed to admissions, nonimmunized asymptomatic patients were offered immunization, temperatures were recorded every 4hours, and nonimmunized providers were offered immunizations and prophylaxis. Patients with ILI were either admitted to acute care and placed in Droplet/Contact Precautions until afebrile for 48hours or managed on the unit with modified isolation. All patients remaining on the unit were instructed in hand hygiene and respiratory etiquette; asymptomatic patients were offered oseltamivir phosphate prophylaxis; and previously nonimmunized patients and staff were again offered the vaccine.

RESULTS

Twenty-six patients and 28 staff were on the unit during the outbreak. Eight patients and 8 staff members reported ILI within 5 days. Of the ill patients, 3 had been immunized, 5 had not (2 refused, 3 reason unclear presumed to have refused), and 4 were admitted to acute care and placed in Droplet/Contact Precautions until asymptomatic for 48hours. Of 22 patients who remained on the unit, 4 were symptomatic; 18 asymptomatic patients took prophylaxis, and 1 refused; 8 (89%) patients who had earlier refused vaccine were immunized. Of the 40 staff members, 55% (22/40) were immunized, and 20% (8/40) were symptomatic (all presumptive, encouraged to remain off duty). Fifty percent (4/8) of symptomatic staff had been immunized. After 7 days, no new cases had been identified, and the unit was reopened to admissions. No ill effects resulted from the prophylaxis.

CONCLUSION

Prompt detection of ILI and institution of control measures effectively contained the outbreak; the relatively high immunization rates among both patients and staff helped curtail spread. Refusal of immunization is a long-standing problem among BH patients and staff. Our study shows importance of immunization in preventing outbreaks in inpatient BH settings. Recommendations included development of more aggressive immunization campaign for patients and staff who historically refuse and continued high priority for provider vigilance in immunization campaign and surveillance for symptoms.

Assessment of individual vaccine status in a vaccinology experts' group

RATIONALE

Worldwide, experts in vaccinology have promoted the broad annual coverage of health care workers with the influenza vaccine. Furthermore, pertussis vaccination is now recommended for young adults and health care workers working with newborns.

AIM

To analyse the compliance with these guidelines among experts responsible for the development or dissemination of national immunization schedules.

METHOD

A cross-sectional survey was conducted in a vaccinology workshop group of French experts, using a self-administered questionnaire.

RESULTS

Among 44 experts, the average rate of influenza vaccination was 69.5% (95% confidence interval, 61.6% to 77.3%) between the 2003/04 and 2005/06 flu seasons, whereas the rate of pertussis vaccination during this period was only 30%. The main reasons that the experts gave for not being vaccinated were a lack of time or simply not remembering to do so.

CONCLUSION

Experts had low coverage rates for influenza and pertussis vaccination. To improve these rates, a multifaceted intervention combining audit and feedback strategy with a vaccine day is planned.

Influenza vaccination and decisional conflict among regulated and unregulated direct nursing care providers in long-term-care homes

The purpose of this study was to determine whether direct nursing care providers have decisional conflict about receiving influenza vaccinations and characteristics associated with decisional conflict. The researchers used a self-administered questionnaire mailed to direct nursing care providers in two long-term-care organizations. Most direct nursing care providers in both organizations (80% and 93%, respectively) intended to get the influenza vaccine. Unregulated direct nursing care providers had more decisional conflict than regulated providers, especially related to feeling uninformed about the pros and cons of influenza vaccination. Unclear valuing of the pros and cons of influenza vaccination was related to the age of the direct care providers in both organizations. Decisional conflict and influenza vaccination practices may be determined, in part, by age and by the culture of a health care organization. A decision aid to improve knowledge and clarify values may improve decision quality and increase influenza vaccination rates.

Attitudes and practices regarding influenza vaccination among emergency department personnel

In the United States, infections related to influenza result in a huge burden to the health care system and emergency departments (EDs). Influenza vaccinations are a safe, cost-effective means to prevent morbidity and mortality. We sought to understand the factors that contribute to the professional and personal influenza vaccination practices of health care workers in the ED setting by assessing their knowledge, attitudes, and practices with regards to the influenza vaccine. A cross-sectional study of all full-time ED staff (nurses, emergency medicine residents, and emergency medicine faculty) at an urban academic medical center in Boston treating > 90,000 ED patients annually, was performed. We examined knowledge, attitudes, and practices regarding personal influenza vaccination and support of an ED-based influenza vaccination program using an anonymous, self-administered questionnaire. Of 130 ED staff, 126 individuals completed the survey (97% response rate). Overall, 69% of respondents reported that they were very or extremely likely to be vaccinated before the coming influenza season. Residents (94%) and attending physicians (82%) were significantly more likely than nurses (42%) to be vaccinated (p < 0.001). Respondents likely to be vaccinated this year were more likely to support a vaccination program for ED patients (80% vs. 55% of those not vaccinated,p < 0.001). Providing regular education on the efficacy of preventive vaccination therapy and dispelling misconceptions regarding adverse effects may reduce barriers to vaccination programs. An educational initiative may result in acceptance of influenza vaccination by ED providers themselves, which could result in increased support for an influenza vaccination program for ED patients.