Requiring Influenza Vaccination for Health Care Workers

Annual influenza vaccination for health care workers has the potential to benefit health care professionals, their patients, and their families by reducing the transmission of influenza in the health care setting. Furthermore, staff vaccination programs are cost-effective for health care institutions because of reduced staff illness and absenteeism.Despite international recommendations and strong ethical arguments for annual influenza immunization for health care professionals, staff utilization of vaccination remains low. We have analyzed the ethical implications of a variety of efforts to increase vaccination rates, including mandatory influenza vaccination.A program of incentives and sanctions may increase health care worker compliance with fewer ethical impediments than mandatory vaccination.IT IS GENERALLY ACCEPTED that vaccinating health care workers against influenza reduces the transmission of the virus in health care settings, decreases staff illness and absenteeism, and indirectly benefits patients by decreasing their chance of being infected.¹ There are also very few risks associated with influenza vaccination, with the most frequently reported side effect being mild pain or swelling at the injection site. The results of a randomized double-blind controlled trial conducted over three consecutive years showed that localized pain or swelling following influenza vaccination was generally rare and that there were no absences from work because of vaccine-adverse events in the study population.² Influenza vaccination programs for health care workers are cost-effective in both direct medical costs and indirect costs of staff absenteeism.² Vaccinating employees and reducing absenteeism can save employers US $2.58 for every dollar invested in an influenza vaccination program.³ The influenza vaccine is approximately 80% effective in healthy adults, with the effectiveness being even higher when there is a close match between the vaccine and the circulating strain of the virus.⁴Evidence on whether vaccinating health care workers against influenza is beneficial for patients has been surprisingly inconclusive. For example, a recent systematic review had equivocal findings on the effect of staff vaccination on the rates of influenza among elderly patients.⁵ There have been a number of smaller, recent studies that have shown some improvement in patient outcomes when staff were immunized against influenza.^6,7 In all studies, the quality of evidence is undermined by relatively low levels of vaccination among health care workers, even in intervention groups. For example, Carman et al.''s study in long-term-care geriatric hospitals across west and central Scotland found that the vaccination rate for health care workers was only 50.9% compared with 4.9% when it was not explicitly offered.⁶There is evidence that vaccinating healthy people younger than 60 years (which includes health care workers) results in decreases of influenza cases among those groups.⁵ Reduction in virus transmission may be particularly important in institutions and wards caring for young children, immunocompromised individuals, or the elderly. The vaccine is only 60% to 70% effective for individuals 65 years and older; despite approximately 80% of this population being immunized against influenza,⁸ they remain susceptible to infection if exposed to the virus. In elder-care settings, influenza among staff precedes illness among residents, suggesting that health care workers introduce the virus into the setting.⁹These findings highlight the fact that, despite the value of vaccination, health care workers are notoriously noncompliant with vaccination regimes. International guidelines recommend annual vaccination for all health care workers with patient contact,¹⁰ but worldwide, rates of influenza immunization among health care workers range between 2% and 60%,¹¹ well below the 83% to 94% required for the whole population to be resistant to spread of an influenza virus.¹²Health care institutions have used a variety of methods to increase immunization rates among employees, including education, reminder notices, small incentives, easy access to free vaccination, active promotion within the workplace, and compulsory vaccination as a condition of employment.^13–19 Most of these programs have achieved only small increases in vaccination rates, apart from employment-related mandatory vaccination.¹⁹ For example, a program in Australian Capital Territory elder-care facilities included the provision of reminders and information about the importance and benefits of influenza vaccination, but resulted in only 28% of staff obtaining vaccination.¹⁸ Similarly, in a tertiary Australian hospital in which an influenza vaccination promotion program had been in place since 2001, only 24% of staff reported being fully vaccinated despite 96% of staff indicating that they were willing to update their vaccination status.¹⁷ In the United States, surveyed health care institutions have reported staff influenza vaccination rates ranging from 15% to 40%, despite national recommendations that health care workers receive vaccinations annually.¹⁴ A study conducted in neonatal intensive care units in the United States found that influenza immunization compliance rates among staff ranged between 15% and 20% and that 76% of staff continued to care for patients despite reporting flu-like symptoms.²⁰ In the United Kingdom, less than 25% of health care workers are vaccinated against influenza each year despite being aware of the potential benefits of vaccination.¹⁶Many reasons for this low level of acceptance have been proposed; however, it seems most likely that continued resistance to accepting vaccination is largely because of attitudinal barriers.²¹ Most health care workers believe that they are healthy and thus will derive no benefit from vaccination or that the risk of adverse events following immunization outweighs the benefits. Alternatively, they are simply unaware of the recommendations for annual influenza immunization.²⁰ It is possible that some health care workers may be conscientious objectors to vaccination; however, active refusals are unlikely to be a significant contributor to the low levels of vaccination among health care workers.Health care workers vary considerably in their health care knowledge, educational level, primary work environment, race, and culture. These factors affect the use of vaccination. For example, health care workers 50 years and older, of higher socioeconomic status, and with greater duration of employment at the same institution are more likely to accept vaccination than are those of lower socioeconomic status and shorter duration of employment, suggesting they are more familiar with influenza vaccination recommendations or possible risks and benefits to health care workers and patients.²² To be effective, interventions to raise immunization rates need to identify specific barriers and concerns expressed by health care workers about influenza immunization and then target themthrough the implementation of policies, education programs, and improved access to vaccination.¹⁴Programs that actively target previously identified barriers have had a greater impact than have generic programs on staff vaccination rates. Increases in acceptance rates and reduced staff illness and absenteeism have been achieved by improving access to vaccination with a mobile unit, addressing common misconceptions through staff education, making vaccination free of charge, and offering small incentives to staff members who participated in the program.^13,23 Targeting previously identified barriers resulted in increases in vaccination rates from 42% to 77% over a period of three years in one setting and from 4.9% to 50.9% in another.^13,16 A US program that combined free vaccination with an educational component increased influenza vaccination coverage rates from 5% to 44% in one year.²⁴ These rates, however, remain significantly below the 83% to 94% levels required to achieve herd immunity.Despite considerable evidence that the vaccination of health care workers benefits workers, their patients, their families, and their institutions, few health care professionals take advantage of vaccination programs unless these programs are actively promoted or required as a condition of employment. Even when programs are actively promoted, the increases in vaccination rates generally remain below levels required to achieve herd immunity and, therefore, are unlikely to secure the potential benefits from high rates of vaccination.     

Health Care of People at Work Agricultural Workers

Three per cent of the working population of Great Britain areemployed in agriculture. In spite of the reduction in theirnumbers in recent years it remains a substantial population—some 350 000 people. Medical supervision is notable chieflyby its absence, though the Agricultural Safety Inspectoratehas for years been engaged in improving standards of safetyin dealing with mechanical, toxic and infective hazards. Thisarticle discusses some of the hazards to which agriculturalworkers are exposed and suggests some health precautions thatmight be adopted to protect them.Requests for reprints shouldbe addressed to: Dr D. M. Smith, Health and Safety Executive,Government Buildings, Block ‘C’ Whittington Road,Worcester WR5 2LJ.     

职业健康促进对铅作业工人的影响

目的 通过制定和实施一系列职业健康促进对铅作业工人的卫生行为进行干预,观察其对工人的影响。方法 以曲阜市某蓄电池厂铅作业工人223名为研究对象,制定和实施干预措施并对比干预前后健康知识知晓率、吸烟率、生物监测指标等的变化以评价职业健康促进的效果。结果 通过干预措施的制定和实施,工人健康相关知识的知晓率提高,由培训前的52.5%提高到培训后的87.9%。干预后12个月血铅值较干预前平均降低18.52%（P〈0.01）,尿δ-氨基乙酰丙酸（δ-ALA）值较干预前平均降低38.48%（P〈0.01）;职业性铅吸收和铅中毒的发生减少,血铅值2.9μmol/L以上的人数由7人减少到3人,1.9μmo1/L以上人数由16人减少到9人。结论 开展职业健康促进,加强健康教育,改善卫生行为,是预防慢性职业性铅中毒的有效途径之一。     

实验动物从业人员的健康问题

目的了解实验动物从业人员的健康状况,探讨保障健康的防控重点。方法通过文献检索、实地考察,探讨实验动物从业人员所处的职业性暴露因素及其防控措施。结果实验动物从业人员职业性暴露因素主要有生物因素、化学因素、物理因素和心理因素4个方面。职业性暴露的潜在危害主要取决于以下3个方面：接触潜在危害的概率、接触潜在危害的数量、从业人员的心理状况。结论针对实验动物从业人员的职业性暴露因素,可通过采取严格执行相应的操作规程、加强监督管理和进行心理疏导等措施,确保实验动物从业人员的健康。     

外来务工人员的职业卫生问题与对策

目的通过对外来务工人员职业卫生服务中存在主要问题分析,提出了改善外来务工人员职业卫生管理构建和谐社会的5项建议。发现职业卫生存在以下问题：①职业病呈现高发状态。②外来务工人员职业卫生知识知晓率低。③职业健康监护和职业卫生防护措施不到位。采取对策：①建立健全工伤保险制度,保障流动人口的公平享受合法权益;②加强各部门之间的协作,保障职业病诊断的顺利进行。③设立职业病基金,保障流动人口职业病待遇;④建立健全职业病防治体系,加强职业病防治队伍建设。⑤加强流动人口的职业健康教育,提高职业健康风险认知。     

以社区妇女保健为基础的外来女劳务工心理保健模式的效果

目的分析以社区妇女保健为基础的外来女劳务工心理保健模式的效果,为社区心理卫生工作提供参考。方法对干预社区实施以社区妇女保健为基础的外来女劳务工心理保健模式,对照社区实施传统的社区心理保健模式;干预一年后,对不同模式的效果进行分析。结果干预后,干预社区的外来女性劳务工主观心理异常率为18.4%、SCL-90的总得分为(137.89±34.33)分,均显著低于对照社区的21.4%及(148.83±39.48)分,也低于干预社区干预前的23.7%及(162.41±43.15)分;主动采取心理保健措施率为56.3%,则显著高于对照社区的47.0%,也高于干预社区干预前的43.7%。结论以社区妇女保健为基础的外来女劳务工心理保健模式比传统的社区心理保健模式具有良好的效果。     

Review of Pesticide Education Materials for Health Care Providers Providing Care to Agricultural Workers

CONTEXT: Pesticide exposure is an important environmental and occupational health risk for agricultural workers and their families, but health care providers receive little training in it. OBJECTIVE: To evaluate the medical resources available to providers caring for patients, particularly farmworkers, exposed to pesticides and to recommend a selective bibliography for use in educating clinicians about pesticides and health care. These resources are divided into 3 domains: (1) the working knowledge, (2) the skill set, and (3) the references needed to care for these patients. METHODS: We searched library databases dating back to 1995, as well as conference materials and Internet resources. Materials were included only if they were readily available through customary sources. Materials were randomly divided into 2 groups. Two authors wrote detailed reviews for each group. The remaining authors read each document and review, making changes that were agreed upon by the team. Review procedures were standardized to examine the contemporary relevance, quality, and overall strengths and weaknesses of the material relative to guidelines developed for each domain. These guidelines were developed from the authors' experience, national focus groups, and literature review. RESULTS: While no 1 resource adequately addresses all needs, a number of resources were identified addressing the categories of working knowledge, skill set, and reference materials. Few of the reviewed materials address the cultural competence of providers treating farmworkers. Additional education resources are needed.     

接触芳香烃类作业人员职业健康的早期指标

目的通过对长期接触芳香烃类有害物质作业人员的健康监护早期指标的研究,动态监护此类作业人员体内氧化应激状态,及时掌握人体损伤程度,为早期采取干预措施提供技术依据。方法采用比色法检测血清中丙二醛(MDA)、谷胱甘肽过氧化物酶(GSH-PX)及超氧化物歧化酶(SOD)的含量。结果实验组和对照组血清中MDA平均值分别为4.46 nmol/mL和2.01 nmol/mL;实验组和对照组GSH-PX平均值分别为272.2 U/mL和312.5 U/mL;实验组和对照组SOD平均值分别为110.0 U/mL和97.5 U/mL(P<0.05)。结论长期接触芳香烃类有害物质可使机体内自由基含量增高,体内氧化应激状态加剧,表明血清中MDA及SOD含量可作为该作业人群健康监护的早期指标。     

Susceptibility to Varicella Zoster Virus Infection in Health Care Workers

Varicella zoster virus (VZV) is an occupational hazard for apercentage of health care staff. Nine hundred and seventy staffmembers attending the Occupational Health Department at CorkUniversity Hospital took part in the survey. A latex agglutinationassay was used to determine the health care workers immune statusto VZV. Of the 970 workers tested, 928 (95.7%) were immune toVZV. The sensitivity, specificity and predictive value of anenquiry regarding a history of chicken-pox was determined ona sample of 206.health care workers: The positive predictivevalue was 95% (119/125) and the negative predictive value was11% (4/35). The sensitivity of the enquiry was 79% (119/150).the specificity was 40% (4/10), reducing to 61% (119/195) and36% (4/11) respectively when individuals with uncertain hitorieswere included in the calculations. The advantages and disadvantagesof selective staff screening are discussed. In the authors opinionall health care workers involved in the clinical care of patientsshould be screened by serology for past VZV infection beforetaking up duty and those who are susceptible to VZV should bemade aware of the risks and health effects associated with VZVif contracted.     

Studies on Occupational Health Problems in Agricultural Tobacco Workers

An epidemiological study with X-ray, lung function, urine andblood tests was undertaken to ascertain the incidence of ‘greensymptoms’ among 290 tobacco workers handling cured oruncured tobacco leaves. The frequency of symptoms was foundto be very high (86–20 per cent). The urinary excretionrate of nicotine and its major metabolite, cotinine, was significantlyincreased in most of the cases. ⁰Requests for reprints should be addressed to: Dr S.K. Ghosh, National Institute of Occupational Health, Ahmedabad-380016, India.     

医护人员突发公共卫生事件知识调查分析

目的：考察突发公共卫生事件下,医护人员对事件相关知识和信息的了解状况,及其对情绪的影响。方法：采用自编调查问卷,调查一所综合性医院中各类医护人员。结果：突发公共卫生事件下,各类医护人员对与突发事件相关的知识和信息的了解以及信息来源,均无显著差异。较之本院工作人员,外院进修人员对信息透明和知情的要求最低。在知情的情况下治疗和护理SARS病人,医护人员更多体验正性情绪;而不知情的情况下的情绪反应更多是负性的。结论：在突发公共卫生事件下,应让医护人员及时充分地享有和运用各类信启、资源,增强心理储备和情绪调节,避免因信息缺失带来过多负性情绪反应。     

Interpersonal Relations Between Health Care Workers and Young Clients: Barriers to Accessing Sexual and Reproductive Health Care

Interpersonal relations between health care providers and young clients have long being cited as an important element for improving client up take of services, satisfaction and overall health outcomes. In an era of HIV and AIDS this forms a critical determinant to young people accessing sexual and reproductive health care. This study explores to what extent interpersonal relations form a barrier to young peoples access to and satisfaction of health services. The study draws on data from 200 client exit interviews and four in-depth interviews conducted with university students and university health care staff in Kwazulu-Natal, South Africa. While young people are aware of the importance of utilising STI, HIV and family planning services they experienced barriers in their relationship with providers. This served as a deterrent to their use of the health facility. Adequate training in interpersonal relations for youth-friendly service provision is essential in helping overcome communication problems and enabling providers to interact with young clients at a more personal level.     

农民工职业健康监护存在问题和建议

随着改革开放的深入开展,大量的农民工进入城市,农民工推动经济发展的作用日益明显,然而,由于劳动合同制度的不健全,使得农民工健康权益难以得到保障。尤其是近年来连续发生的云南出现多例矽肺、张海超的开胸验肺等多起农民工职业危害事件为我们敲响了警钟,如何解决农民工职业卫生管理存在的问题和控制职业病,直接关系到我国的经济和社会发展的稳定和全局。为了了解我市农民工职业危害的现状,     

Diabetes Prevention Education Program for Community Health Care Workers in Thailand

To evaluate the effects of a 4-month training program on the knowledge of CHCWs. CHCWs from 69 communities in Chiang Mai province in Thailand were assigned to the intervention group (IG, n = 35) or control group (CG, n = 34). All CHCWs were assessed for knowledge at baseline and at 4-months. The intervention group received a training program of 16 sessions of 2.5 h each within a 4-month period. A mix of classroom and E-learning approaches was used. All CHCWs were assessed for knowledge at baseline, 4-month, and follow-up at 8-month. Assessment was based on a pretested examination addressing understanding of nutritional terms and recommendations, knowledge of food sources related to diabetes prevention and diet-disease associations. Overall, the knowledge at baseline of both groups was not significantly different and all CHCWs scored lower than the 70% (mean (SD), 56.5% (6.26) for IG and 54.9% (6.98) for CG). After 4-month, CHCWs in the IG demonstrated improvement in total scores from baseline to 75.5% (6.01), P < .001 and relative to the CG 57.4% (5.59), P < .001. The follow up phase at 8-month, IG were higher in total scores than CG (71.3% (7.36) and 62.4% (6.81), P < .001). The diabetes prevention education program was effective in improving CHCWs’ health knowledge relevant to diabetes prevention. The innovative learning model has potential to expand chronic disease prevention training of CHCWs to other parts of Thailand.     

Interdisciplinary Relationships between Chaplains and Social Workers in Health Care Settings

As professional members of interdisciplinary teams in health care settings, chaplains and social workers must be prepared to interface with each other in a competent manner and to work cooperatively in caring for the needs of patients and their families. This article shares the results of a combined qualitative and quantitative research study (N = 403) that focused on determining chaplains' perceptions of their professional collaborative relationships with social workers. The findings indicate that chaplains have an overall positive perception of their interdisciplinary relationships with social workers. However, the results suggest areas that should be addressed in order to maintain and improve their functioning as colleagues who each play a critical role in providing holistic treatment.     

Antibody Responses against Pneumocystis jirovecii in Health Care Workers Over Time

In a previous cross-sectional study, we showed that clinical staff working in a hospital had significantly higher antibody levels than nonclinical staff to Pneumocystis jirovecii. We conducted a longitudinal study, described here, to determine whether occupation and self-reported exposure to a patient with P. jirovecii pneumonia were associated with antibody levels to P. jirovecii over time. Baseline and quarterly serum specimens were collected and analyzed by using an ELISA that targeted different variants of the Pneumocystis major surface glycoprotein (MsgA, MsgB, MsgC1, MsgC3, MsgC8, and MsgC9). Clinical staff had significantly higher estimated geometric mean antibody levels against MsgC1 and MsgC8 than did nonclinical staff over time. Significant differences were observed when we compared the change in antibody levels to the different MsgC variants for staff who were and were not exposed to P. jirovecii pneumonia–infected patients. MsgC variants may serve as indicators of exposure to P. jirovecii in immunocompetent persons.