Attitudes of dental healthcare workers towards the influenza vaccination

Influenza viruses are highly contagious. Medical personnel are at risk of occupational exposure to influenza. Data on dental healthcare workers (DHCWs) immunization status has not been published. We conducted a cross-sectional survey of DHCWs and dental students at a German dental university hospital. Surveys, completed between October 2010 and March 2011, focused on reasons of DHCWs for accepting or declining the influenza vaccination. Furthermore, we characterized attitudes towards influenza infection due to the emergence of the H1N1/2009. Compliance rates with the influenza vaccination among DHCWs were low (31.6%). The main reason for not getting vaccinated against the pandemic influenza A/H1N1 virus in the 2009/2010 season was the objection to the AS03-adjuvants (48.5%). Of the DHCWs surveyed, 30.6% (74/242) cited that the H1N1/2009 pandemic influenced their attitudes towards vaccination in general. Our findings confirm the importance of a comprehensive approach to the influenza vaccination, ensuring that DHCWs are correctly informed about the vaccine and that it is convenient to receive it. It could be shown that an immunization campaign at the workplace seems to be capable of improving vaccination rates, one-third of the vaccinees have been vaccinated for the first time.     

南京市医务人员医院感染防控知识水平调研

目的：通过网路知识竞赛了解全市各级医疗机构医务人员的院感防控知识水平。方法：本研究通过网路信息平台向全市各级医疗机构发布院感知识竞赛试卷。试卷类型分为两种：（1）护理组向所有护士开放;（2）非护理组向医生、技师、药师和行政管理者开放。共13套试卷,不同试卷测试不同的院感主题。最终将统计参赛者的人数、职业类型、医院级别,并比较不同类型医务人员的平均分、不同级别医院的平均分以及不同主题试卷的平均分。结果：本次知识竞赛共计7 158位医务人员参加,其中医生2 033（28.40%）、护士4 087（57.10%）、医技558（7.80%）、药师281（3.93%）、行政管理人员123（1.72%）、院感专职人员76（1.06%）。除院感专职人员外,其他医务人员的平均分在66.31-69.48。各级医疗机构的平均分在63.73-69.33。平均分超过70分的试卷包括：院感三基训练（75.46±15.29）、抗菌药物的临床应用（74.17±18.69）、医疗废物的正确处置（73.61±12.23）、手卫生（72.52±16.24）、职业安全防护、隔离技术和环境表面消毒（71.01±16.07）、多重耐药菌的感染预防（70.52±17.96）。结论：目前医务人员对院感的基本概念有所了解,但对预防和控制院感发生的各项措施知之甚少。有效提高医务人员的院感防控意识,帮助其掌握预防院感的措施是医院感染管理迫在眉睫的工作。     

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.     

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.     

Evaluation of obesity in healthcare workers

BACKGROUND: Obesity is an international social problem. OBJECTIVES: This study was aimed at evaluating the relationship of overweight and obesity with social dynamics and correlated biological indicators. SUBJECTS AND METHODS: The study was carried out on a group of healthcare workers employed in a large hospital in the province of Messina (Sicily, Italy). A total of 1010 subjects (377 men and 633 women) aged between 16 and 64 years, living in the province of Messina since birth. The educational level, BMI (Body mass index), arterial blood pressure and ECG of each subject was examined. RESULTS: The results showed that 52% of the men and 66.5% of the women were of normal weight, while the men showed greater susceptibility to overweight (M 33.2% > F 16%). Obesity was found in both sexes (M 13.3%, F 13.6%). Moreover, it was observed that arterial blood pressure tends to increase with age and body weight, and that the incidence of overweight falls as educational level rises. CONCLUSIONS: The study supports the hypothesis that there is a growing incidence of overweight and obesity in subjects of working age employed in the healthcare sector.     

Incidence and recurrent work-related violence towards healthcare workers and subsequent health effects. A one-year follow-up study

AIMS: The aim of the present study was to analyse the incidence of violence and threats of violence during the first year at work after graduating as a healthcare worker, the risk of re-exposure and health effects among respondents previously exposed to violence or threats. METHODS: We analysed baseline data from 5,696 healthcare students and conducted prospective multinomial regression analyses following 2,847 respondents during their first year of employment. RESULTS: At baseline we found that nearly a third of the respondents had been exposed to violence or threats of violence, 8.7% during trainee periods. At follow-up, we found that 24.6% of the healthcare workers had been exposed to violence and 33.4% to threats during the first year at work after graduation. Exposure to violence or threats during trainee periods was a strong predictor of violence (Odds ratio (OR)=3.3) and threats (OR=4.2) at follow-up. The results showed that violence or threats in previous jobs or at other places had a significant impact on the health of the victims at follow-up independent of gender, age, sense of coherence, self-efficacy and health at baseline. Exposure during trainee periods had a small but not quite significant (p=0.06) impact on the health of the victims at follow-up. CONCLUSIONS: The study shows a high risk of violence and threats of violence among healthcare workers during training and the first year at work after graduation, indicating a need for violence prevention planning involving both college and workplaces.     

Awareness, attitudes and behavior of hospital healthcare workers towards a mandatory vaccination directive: two years on

In 2007, the state of New South Wales, Australia instituted a policy directive with compulsory provisions for health care workers to be vaccinated. This study sought to identify staff awareness and attitudes two years after it was implemented. It involved a self administered paper-based questionnaire of HCWs in two tertiary-referral teaching hospitals in Sydney, Australia in 2009. In the early phase, general awareness of the policy was incomplete and detailed knowledge was poor. However, support levels were high. Two years later, while the respondents indicated that they were aware that there was a policy in place, very few of the respondents were able to accurately describe its requirements. Regardless of the level of knowledge, support for the policy was still high (83% vs. 91%, respectively). Despite the high levels of general support for the vaccine policy directive in NSW, this study indicates that including influenza vaccination into the policy could be challenging.     

Comparison of higher-dose intradermal hepatitis B vaccination to standard intramuscular vaccination of healthcare workers.

OBJECTIVE: To compare the immunogenicity of hepatitis B vaccine administered via intradermal (ID) versus intramuscular (IM) route. METHODS: Subjects chose either to specify the route of immunization or to undergo random allocation to vaccination by the ID (0.15 mL) or the IM (1.0 mL) route. Yeast-derived recombinant hepatitis B vaccine was given at 0, 30, and 180 days. Hepatitis B surface antibody (HBsAb) and hepatitis B core antibody (HBcAb) were measured by microparticle enzyme immunoassay. RESULTS: 763 subjects were enrolled. Baseline screening identified 65 subjects (8%) who were positive for HBsAb or HBcAb. Vaccination was completed by 590 (85%) of 698 enrollees (370 ID, 220 IM). Seroconversion rates (geometric mean titers [GMT]>0 IU/mL HBsAb) for those vaccinated ID were 99% and 96% for screening at 9 months and 1 year post-vaccination, respectively; subjects vaccinated intramuscularly had similar rates of 95% and 96%. Seropositivity rates (GMT > or = 10 IU/mL HBsAb) showed a similar pattern, with 95%, 92%, and 73% at 9 months and 1 and 2 years, respectively, for those vaccinated ID, and 94%, 93%, and 81% for those having IM vaccination. GMT for HBsAb was significantly higher for individuals vaccinated IM than for those vaccinated ID (P<.0001). The GMT ratio for the IM and ID routes decreased over time, being 9.3 at 9 months, 7.8 at 1 year, and 5.9 at 2 years. An unanticipated side effect of intradermal vaccination was skin discoloration at injection sites, which persisted for at least 2 years postvaccination. Two thirds (112/166) of respondents reported that they would have selected the ID route despite the discoloration. CONCLUSIONS: Higher-dose ID vaccination (3 vs 1 microg per injection) uses one sixth of the dose required for standard IM vaccination. It is a cost-effective way to vaccinate populations against hepatitis B virus, but the long-term efficacy of the ID route must still be investigated.     

Cost-effectiveness of varicella vaccination of healthcare workers

OBJECTIVE: Although transmission of VZV is recognized as an important cause for morbidity in health care workers (HCWs), there is no general agreement on the recommended immunization policy. This study aimed to evaluate several of such prevention policies in economic terms. SETTINGS: Analysis of the cost per avoided future varicella cases among HCWs in Israel. METHODS: A cost-effectiveness analysis was performed by comparing the cost per avoided case of varicella among a theoretical cohort of 63,353 physician and nurses aged less than 45 years in Israel. Four policies were examined: (a) do nothing (status quo); (b) vaccination of susceptible workers using VZV serotesting; with (c) or without anamnestic history of chickenpox; and (d) presumptive mass vaccination of all eligible workers. A Markov-based model was developed using data from our recent seroepidemiological study in target population and from the literature. RESULTS: Screening and vaccination of susceptible workers using anamnestic selection is expected to reduce future cases, within 20 years since vaccination, from 58.3 to 33.0 with an incremental cost of 23,713 US dollars per avoided cases. Using only serological tests to detect susceptible workers would prevent additional 5.7 cases with an incremental cost of 206,692 US dollars per avoided case. Vaccinating all HCWs without serotesting, raises the costs markedly, with almost identical effectiveness, resulting in an incremental cost of 10.4 million US dollars per avoided case. Sensitivity analyses do not alter the ranking of the options. CONCLUSION: From the employer's perspective, routine varicella vaccination program for HCWs with or without selection of susceptible workers is extremely expensive compared to other high-cost practiced approaches. Substantial reduction in cost of vaccination may alter this conclusion.     

Use of respiratory masks in healthcare workers

Two different types of filtering respiratory masks are available in healthcare settings. The first ones are used to protect patients from droplets coming from the mouth of healthcare workers (HCW) and the second ones are protective masks. For the moment, we lack information regarding application of Ministry of Health recommendations and on adherence of HCW to mask use. Geres, the HCW exposure risk study group, and the INRS, are now conducting a survey in several hospitals in France to evaluate the use of respiratory masks in healthcare settings. Two phases are planned. Phase I is a self survey using a questionnaire for occupational doctors and hygienists and phase II includes three steps on HCW behavior: evaluation of knowledge and practice concerning respiratory masks, evaluation of respiratory mask use, evaluation of wear and fit test in a context of airborne isolation with a FFP1 and FFP2 respiratory mask. Phase I is finished and phase II is beginning. The first phase I data show that the Ministry's recommendations are observed: respiratory masks are available, written recommendations are present; information and training are organized for healthcare workers. Phase II results are not available yet.     

Risk of tuberculosis in correctional healthcare workers

OBJECTIVE: The objective of this study was to determine the prevalence, incidence, and risk factors for occupational infection with tuberculosis among healthcare workers employed in correctional facilities. METHODS: The authors conducted a self-administered survey, clinical interview, and tuberculin skin testing. RESULTS: The overall tuberculin skin test point prevalence rate was 17.7%, the reactivity rate was 2.2%, and the annual incidence was 1.3%. At the multivariate level, after controlling for bacille Calmette-Guérin vaccination, only origin of birth remained significantly associated with prevalence of tuberculosis infection. CONCLUSIONS: Although the prevalence of tuberculin reactivity was high in this population, the risk factors were predominantly demographic rather than occupational. Nevertheless, continued vigilance to control occupational exposure to this and other respiratory pathogens is warranted, given the potential for future outbreaks of tuberculosis, as well as other known and emerging airborne pathogens.     

Epidemiology of latex allergy in healthcare workers

BACKGROUND: Natural rubber latex is a recognized allergen and health care workers have an increased risk of sensitisation and allergic symptoms to latex. OBJECTIVES: The aim of the study was to evaluate prevalence and incidence of latex sensitisation and symptoms in health care workers. METHODS: We analyzed the reported data from the scientific literature and from the follow-up study in health care workers in Trieste Hospitals carrying on since 1999. RESULTS: Latex allergy and sensitisation are significantly higher in health care workers respect to the general population with symptoms, such as urticaria, rhinoconjunctivis and asthma, ranging between 4 and 5.6%. Latex sensitisation evaluated by skin prick test is ranging between 6 to 7.8%. All studies done demonstrated the reduction of symptoms and incidence sensitisations after the changeover to a powder- free environment and the avoidance of unnecessary glove use. CONCLUSIONS: Health care workers have an increased risk of sensitisation and allergic symptoms to latex but the use of un-powdered latex gloves by all workers and use of non-latex gloves by sensitized subjects can reduce symptoms and prevent new sensitisation. Nevetheless the use of no-latex gloves when avaiable has to be the best choice from the preventive point of view.