Nudging influenza vaccination among health care workers

Our online randomized controlled trial on 6230 healthcare workers (HCWs) tests the impact that three nudges – social norms, reminding the impact on beneficiaries, and defaults – have on the intention to vaccinate against seasonal influenza across job families. Willingness to get a flu shot was higher among subjects invited to imagine themselves working at the local health authority (LHA) with the greatest immunization coverage within their region relative to their counterparts prompted to imagine working at the LHA with the lowest coverage. Reminding the impact of flu vaccination on beneficiaries had different effects across job families, with physicians caring more benefits for themselves, nurses about patients’ benefits, and technicians about family and friends. Default responses anchoring toward a high rather than a low vaccination intention increased the willingness to immunize among all HCW except physicians. Targeted nudges can be considered in developing interventions to promote influenza vaccination among HCWs.     

Attitudes and knowledge regarding influenza vaccination among hospital health workers caring for women and children

This cross-sectional study of 340 obstetrics/gynecology, 123 neonatology, and 244 pediatric health care workers (HCWs) was designed to evaluate compliance with recommendations concerning the use of influenza vaccine during pregnancy and among pediatric subjects. The results clearly show that only a marginal number of the HCWs in all three fields currently recommend vaccine use for pregnant women and healthy young children. Moreover, all of the HCWs were seriously deficient in terms of their general knowledge of influenza prevention and their own personal vaccination coverage was low. Extensive and sustained efforts to overcome cultural limitations concerning influenza and its prevention are urgently required among HCWs caring for women and children in order to ensure effective compliance with the current recommendations.     

Factors that influence influenza vaccination among healthcare workers in a French geriatric hospital.

In a geriatric hospital in France, only 80 (21%) of 390 healthcare workers (HCWs) were vaccinated against influenza. Predictive factors for accepting influenza vaccination were occupation as a physician (odds ratio [OR], 9.79), previous receipt of influenza vaccination (OR, 36), and desire to protect their own health (OR, 2.42) and residents' health (OR, 3.68). Predictive factors for refusing influenza vaccination were occupation as a nurse (OR, 6.41) or nursing assistant (OR, 4.04) and belief that homeopathic medication is more effective than the vaccine (OR, 5.75).     

Health behavior associated with influenza vaccination among healthcare workers in long-term-care facilities.

OBJECTIVE: To investigate the health behavior associated with influenza vaccination among healthcare workers (HCWs) in long-term-care facilities. DESIGN: A cross-sectional, self-administered survey of HCWs, augmented with focus groups to further examine attitudes toward influenza vaccination. SETTING: Two long-term-care facilities participated in the survey. The focus groups were held at one of the two facilities. PARTICIPANTS: All HCWs were invited to participate in the survey and all nonmanagerial staff members were invited to participate in the focus groups. The response rate for the survey was 58% (231 of 401). RESULTS: Vaccinated HCWs had a more positive attitude toward influenza vaccination and a greater belief that the vaccine is effective. This was not accompanied by differences in vaccine knowledge or values of potential preventive outcomes. Nonvaccinated respondents were more likely to believe that other preventive measures, such as washing hands, taking vitamins and supplements, eating a nutritious diet, exercising, and taking homeopathic or naturopathic medications, were more effective than vaccination. Additional findings from the focus groups suggest that HCWs believe that the main purpose of influenza vaccination programs is to protect residents' health at the expense, potential harm, and burden of responsibility of the staff. CONCLUSIONS: This study identifies challenges to and opportunities for improving vaccination rates among HCWs. A message that emphasizes the health benefits of vaccination to staff members, such as including vaccination as part of a staff "wellness" program, may improve the credibility of influenza immunization programs and coverage rates.     

Effect of a hospital campaign for influenza vaccination of healthcare workers.

OBJECTIVE: To identify the factors that inhibit or motivate influenza vaccination among healthcare workers (HCWs). METHODS: In March 2000, we prepared 34-item questionnaire for both vaccine recipients and nonrecipients regarding demographic characteristics, factors motivating and inhibiting vaccination, and knowledge and attitudes about influenza vaccination. On the basis of the results of our survey, an aggressive hospital vaccination campaign was undertaken. In April 2004, after the 4-year campaign, the same questionnaire was again administered to HCWs. RESULTS: In both 2000 and 2004, the main motives for undergoing influenza vaccination were "hospital campaign" and "recommendation by colleagues"; the percentage of respondents who were motivated by the hospital campaign had remarkably increased from 27% in 2000 to 52% in 2004 (P<.001), whereas the percentage who were motivated by recommendation by colleagues had not changed significantly (21% vs 14%). Overall, the 4 reasons most frequently cited by HCWs for noncompliance with vaccination were insufficient available time, confidence in their health, doubt about vaccine efficacy, and fear of injection. In 2000, vaccination rates were below 30%, irrespective of occupation. After an aggressive vaccination campaign, the increase in the vaccination rate was highest among the nursing staff, increasing from 21% in 2000 to 92% in 2004, whereas the vaccination rate among the physicians was still below 60%. CONCLUSION: We conclude that a hospital campaign can markedly improve influenza vaccination rates among HCWs. Both a mobile cart system and free vaccine supply contributed to improving the vaccination rates in our study. In addition, a specifically tailored intervention strategy was required.     

Factors influencing uptake of influenza vaccination among hospital-based health care workers

BACKGROUND: Vaccination of health care workers against influenza has been shown to lower mortality among elderly patients, but uptake of voluntary vaccination among health care workers remains low. AIMS: Factors influencing uptake of vaccination were examined among a cross-section of health care workers based in an NHS Trust. METHODS: A structured, self-administered questionnaire was mailed to a random sample of health care workers based in the acute services sector of a UK National Health Service Trust, 6 months following a voluntary immunization programme implemented as part of the Scottish Executive Health Department winter planning arrangements for 2000-2001. The programme was promoted using posters in clinical areas and a single leaflet given to all staff through a paycheck advice note. RESULTS: Five hundred and fifty-one health care workers (53%) responded to the questionnaire and influenza vaccination was accepted by 150 (28%). The occupational health poster strongly influenced the decision to accept vaccination [odds ratio (OR) = 11.01; 95% confidence interval (CI) = 2.13-56.80; P < 0.0001]. Other significant influences included female sex (OR = 9.11; 95% CI = 1.26-65.72) and perceived risk of contracting flu without the vaccine (OR = 7.70; 95% CI = 1.44-41.05). Misconceptions regarding the purpose of the vaccination campaign were common and concern regarding possible side-effects was a deterring factor for vaccination uptake. CONCLUSION: Our study showed that visual material displayed throughout the workplace strongly influenced the acceptance of influenza vaccination. Future campaigns should also emphasize the positive benefits to patients of health care worker immunization, with readily accessible information regarding side-effects available from all sources.     

Changing the default to promote influenza vaccination among health care workers

BackgroundThe prevention of health care acquired infections is an important objective for patient safety and infection control in all health care settings. Influenza vaccination uptake among health care workers (HCWs) is the most effective method to prevent transmission to patients, but vaccination coverage rates are low among HCWs. Several educational campaigns have been developed to increase the influenza vaccination coverage rates of HCWs, but showed only small effects. The aim of this study was to test an opt-out strategy in promoting uptake among HCWs in a tertiary care center for patients with complex chronic organ failure.MethodsHCWs were randomly assigned to one of two conditions. In the opt-out condition (N = 61), participants received an e-mail with a pre-scheduled appointment for influenza vaccination, which could be changed or canceled. In the opt-in condition (N = 61), participants received an e-mail explaining that they had to schedule an appointment if they wanted to get vaccinated.ResultsThe findings show no statistically detectable effect of condition on being vaccinated against influenza. However, HCWs in the opt-out condition were more likely to have an appointment for influenza vaccination, which in turn increased the probability of getting vaccinated.ConclusionTo change the default to promote influenza vaccination among HCWs might be an easy and cost-effective alternative to the complex vaccination campaigns that have been proposed in recent years.     

Motivating factors for high rates of influenza vaccination among healthcare workers

Background

Recent guidance from related regulatory agencies and medical societies supports mandatory vaccination of healthcare workers (HCW) against influenza. At St. Jude Children's Research Hospital, a pediatric oncology referral center, more than 90% of HCWs receive vaccine each year without a policy mandating immunization. Factors associated with HCW uptake of influenza vaccines have not previously been evaluated in a high compliance rate setting.

Methods

A structured, anonymous, electronic questionnaire was distributed in August 2010 to employees (HCW and non-HCW). Demographics, prior receipt of influenza vaccines, reasons for acceptance or refusal of seasonal and 2009 H1N1 pandemic vaccine, and attitudes on mandatory vaccination were assessed.

Results

95.0% of 925 HCWs and 63.1% of all 3227 qualifying employees responded to the survey. 93.8% and 75.2% of HCW reported receiving seasonal and 2009 H1N1 influenza vaccines, respectively, in the 2009-2010 season. Benefits to self and/or patients were cited as the most frequent reasons for accepting seasonal (83.5% and 78.3%, respectively) and 2009 H1N1 (85.9% and 81.1%, respectively) vaccination. 36.6% of HCWs opposed mandating influenza vaccination; 88.2% and 59.9% of whom reported receiving the seasonal and 2009 H1N1 influenza vaccines, respectively. Violation of freedom of choice and personal autonomy were the most frequently reported reasons for opposition.

Conclusion

In this cohort of HCWs with a high influenza vaccination rate, realistic assessments of the potential benefits of vaccination appear to have driven the choice to accept immunization. Despite this, mandating vaccination was viewed unfavorably by a significant minority of vaccinated individuals. Employee concerns over autonomy should be addressed as institutions transition to mandatory vaccination policies.     

Factors influencing influenza vaccination rates among healthcare workers in Greek hospitals

Influenza vaccination rates are generally low among healthcare workers (HCWs) worldwide. In September 2005, the Hellenic Center for Disease Control and Prevention conducted a nationwide campaign to promote influenza vaccination in hospital HCWs. During the 2005-2006 influenza season, the overall vaccination rate among HCWs was 16.36% (range: 0-85.96%). The self-reported vaccination rate during the previous season was 1.72%, indicating a 9.5-fold increase. Compared with physicians, significantly fewer technical personnel were vaccinated, whereas administrative personnel were more likely to receive the vaccine. Among clinicians, rates for internal medicine departments exceeded those of surgical departments by a factor of 2.71 and laboratory medicine departments by a factor of 2.36. Multivariate analysis showed lower vaccination rates in large hospitals (>200 beds) than in smaller hospitals and lower rates in hospitals with specialist services (intensive care unit, psychiatry or dermatology) than in general hospitals. Factors associated with higher rates included working in northern Greece, in a paediatric or an oncology hospital, or in a prefecture with avian influenza H5N1 activity. In conclusion, in Greece influenza vaccination rates among HCWs remain low, but the implementation of a nationwide campaign had a considerable impact. Efforts should focus on hospital- and HCW-associated factors to increase vaccination uptake.     

Increased influenza vaccination of healthcare workers at a pediatric cancer hospital: results of a comprehensive influenza vaccination campaign.

A comprehensive influenza vaccination campaign improved vaccination rates among healthcare workers with direct patient care responsibilities from 45% during the 2003-2004 influenza season to 80% during the 2004-2005 season. A strategy of weekly feedback to unvaccinated employees was the most important factor in enhancing the rate of vaccination acceptance and was particularly effective among the nursing staff.     

Modeling the effects of influenza vaccination of health care workers in hospital departments

Nowadays health care worker (HCW) vaccination is widely recommended. Although the benefits of this strategy have been demonstrated in long-term care settings, no studies have been performed in regular hospital departments. We adapt a previously developed model of influenza transmission in a long-term care nursing home department to study the effects of HCW vaccination in hospital wards. We study both the effectiveness and efficiency in reducing the hazard rates of influenza virus infection for patients. Most scenarios under study show a similar or higher impact of hospital HCW vaccination than has been predicted for the long-term care nursing home department. Therefore, it seems justified to extend the recommendations for HCW vaccination, based on results in the long-term care setting, to short-term care settings as well.     

Seasonal influenza vaccination coverage and barriers among healthcare workers in an Egyptian Province

Background:Influenza vaccination uptake by Egyptian healthcare workers remains sub-optimal despite local initiatives and infection control programs to increase it.Objective:To assess vaccination coverage and investigate health care workers’ barriers and also motivators toward seasonal influenza vaccination.Methods:An interview questionnaire survey and focus group sessions were conducted to measure uptake and assess barriers to seasonal influenza vaccination among HCWs in main hospitals and primary care centers in Ismailia city.Results:There were 980 participants, of whom 131 (13.4%) reported having received influenza vaccination in last season 2018/2019. Females were 76.8% of participants, and nurses were the main occupational category of study sample (80.4%). The most commonly reported motivator (97.7%) was “protection of oneself and family members” among the vaccinated participants. The top barriers among non-vaccinated ranked by their Relative Importance Index (RII), included lack of instruction by supervisors RII=0.82, lack of awareness about vaccine benefits RII=0.79 and lack of awareness from where to get the vaccine RII=0.71. Predictors of non-vaccination included belief that the vaccine itself may induce influenza (OR: 1.9 p<0.05, CI, 1.3-2.8) and the perception that vaccination is ineffective (OR: 2.8 p<0.05, CI, 1.5-5.2), and lack of knowledge about the vaccinations recommended for health care workers (OR: 1.9 p<0.05, CI, 1.2-2.8).Conclusions:Addressing specific barriers to influenza vaccination uptake among healthcare workers may improve vaccination rate. Targeted evidence-based promotion campaigns and programs should be established to overcome identified barriers.Key words: Seasonal influenza vaccination, health care workers, barriers     

宁波市医务人员流感疫苗接种情况及影响因素分析

目的了解浙江省宁波市医务人员流感疫苗接种情况,探讨影响医务人员流感疫苗接种的主要因素。方法采用二阶段抽样法对浙江省宁波市30家各级医疗机构1 217名医务人员进行问卷调查,了解其一般情况、流行性感冒(流感)和流感疫苗知识、2010—2012流感疫苗接种率、2012—2013流感疫苗接种意愿及不考虑接种的原因等信息。结果2010—2012年2个流行季节医务人员流感疫苗接种率为12.37%;38.39%的医务人员表示会在2012年流感高峰到来前接种流感疫苗,如果疫苗免费接种则有62.13%的医务人员考虑接种;不考虑接种的因素包括"疫苗效果有限"(66.76%)、"担心疫苗副作用"(55.52%)、"身体好没必要接种"(54.15%)、"每年接种太麻烦"(43.20%)和"疫苗不免费"(35.30%)等;多因素分析结果显示,2年内接种过流感疫苗、认为接种流感疫苗是预防流感最有效的手段、知晓医务人员是推荐接种流感疫苗人群、知晓流感疫苗可以用医保支付、流感疫苗知识掌握好、二级医疗机构、在医技/护士/医生岗位可提高宁波市医务人员流感疫苗的接种意愿;而知晓流感疫苗每年接种1次、三级医疗机构、在感染/传染和其他科室可降低医务人员流感疫苗的接种意愿。结论宁波市医务人员流感疫苗接种率较低,不考虑接种的主要原因是对流感疫苗有效性和安全性缺乏信心、对流感危害认识不足以及疫苗不免费。     

The effect of smoking on influenza, influenza vaccination efficacy and on the antibody response to influenza vaccination

We examined the relation between cigarette smoking and (1) the occurrence of influenza, (2) the efficacy of influenza vaccination and (3) the antibody response to influenza vaccination in fifteen family practices in South-Limburg, the Netherlands, during the influenza season 1991 1992. Data were used from a randomized double-blind placebo-controlled trial into the efficacy of influenza vaccination in which smoking status was measured 10 weeks after the start of the trial. A total of 1838 subjects aged 60 years or older, of whom 1531 subjects (321 smokers, 1152 non-smokers and 58 cigar/pipe smokers) who returned the smoking questionnaire and were not previously vaccinated, were used in the analyses. The main outcome measures were serological influenza (fourfold increase of antibody titre between 3 weeks and 5 months after vaccination); clinical influenza as determined by criteria of the Dutch Sentinel Stations from self reported symptoms in postal questionnaires 10 weeks and 5 months after vaccination; increases after vaccination and decreases after 5 months in logarithmic titres of antibody against the vaccine strains. No relation between smoking and either serological or clinical influenza was found, although the risk for serological influenza was slightly (not significantly) elevated in smokers compared to non-smokers. A statistical interaction was found between smoking and vaccination when serological influenza was the outcome measure indicating that the efficacy of vaccination was greater in smokers than in non-smokers (comparison of model with and without interaction; likelihood ratio test, p < 0.0001). This finding is supported by a greater titre rise 3 weeks after vaccination for two out of four strains, but not by the antibody response after vaccination in previous studies on influenza and other infectious diseases. Also, this possible difference of immunogenicity is not reflected in a better protection for clinical influenza. The rise in antibody titre 3 weeks after vaccination was higher in smokers for A/Singapore/6/86 and B/Beijing/11/87, but not for the other two strains. Decline in titres after 5 months was similar for smokers and non-smokers. We conclude that smoking has no clinical or preventive significance for risk of influenza in the elderly.     

Influenza vaccination among healthcare workers in a university children's hospital.

OBJECTIVES: To evaluate the attitudes of pediatric healthcare workers (HCWs) toward influenza vaccination and to increase their rate of immunization. METHODS: A survey was conducted among pediatric HCWs using an anonymous questionnaire. Survey results were used to design an intervention to increase the immunization rate of staff. Immunization rates before (2003-2004) and after (2004-2005) intervention were assessed using immunization clinic records. SETTING: A university children's hospital in Switzerland. INTERVENTIONS: (1) An informational letter based on misconceptions noted in the survey, (2) educational conversations with head nurses, (3) more "walk-in" immunization clinics, and (4) a direct offer of influenza immunization on the wards. RESULTS: Among vaccine nonrecipients, doubts about the efficacy and necessity of influenza immunization were prevalent and more often reported by nurses than physicians (75% vs 41%, P = .002; and 55% vs 23%, P = .001, respectively). Physicians more often than nurses reported lack of time as a reason for not receiving influenza vaccination (23% vs 5%, P = .01). After intervention, the immunization rate of HCWs increased from 19% to 24% (P = .03). The immunization rate of physicians increased from 43% to 64% (P = .004). No change was noted among nurses (13% vs 14%) and other HCWs (16% vs 16%). CONCLUSIONS: Misconceptions about influenza vaccination were prevalent among pediatric staff, particularly nurses. Active promotion and educational efforts were successful in increasing the immunization rate of physicians but not nurses and other HCWs.     

青岛市医务人员流感疫苗接种及影响因素分析

目的 了解山东省青岛市医务人员流感疫苗接种情况, 探索影响医务人员接种流感疫苗的主要因素。方法 采用整群分层抽样方法对青岛市6家不同级别医疗机构的1 301名医务人员进行调查。对流感及流感疫苗认知现状进行描述性分析, 用logistic回归模型对疫苗接种率的影响因素进行单因素和多因素分析。结果 2013—2014年流感季流感疫苗接种率为4.8%(63/1 301), 未接种的主要原因是担心出现疫苗不良反应, 占43.4%(412/950)。多因素分析结果显示, 社区乡镇卫生院(OR=8.23, 95%CI=3.78~17.93)、二级医院(OR=2.27, 95%CI=1.02~5.06)、之前3年不连续接种(OR=2.01, 95%CI=1.08~3.77)或每年均接种流感疫苗(OR=3.49, 95%CI=1.23~9.92)、担心流感季节患流感(OR=2.72, 95%CI=1.46~5.05)、认同不接种流感疫苗, 容易得流感(OR=2.49, 95%CI=1.26~4.91)和得流感会后悔(OR=3.03, 95%CI=1.29~7.08)、季前接种意愿为有可能(OR=2.73, 95%CI=1.42~5.26)、可能性大(OR=6.44, 95%CI=2.55~16.26)的医务人员更容易接种流感疫苗。结论 医务人员流感疫苗接种率很低, 担心疫苗安全性是阻碍接种的首要原因;医院层级、流感疫苗接种史、季前接种意愿和态度心理等因素是医务人员季节性流感疫苗接种影响因素。