Strategies to Increase Flu Vaccination Coverage among Healthcare Workers: A 4 Years Study in a Large Italian Teaching Hospital

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Abstract

Flu vaccination is recommended among healthcare workers (HCWs). The low vaccination coverage registered in our hospital among HCWs called for new engaging approaches to improve flu vaccination coverage. The aim of this study was to evaluate the efficacy of different strategies implemented during the last four years (2015–2019). A quasi-experimental study was conducted, involving almost 4000 HCWs each year. Starting from the 2015–2016 campaign, new evidence-based strategies were progressively implemented. At the end of each campaign, an evaluation of the vaccination coverage rate reached was performed. Moreover, during the last three campaigns, differences in coverage among job category, wards involved or not in on-site vaccination (OSV) intervention, age classes and gender were analyzed. An increasing flu vaccination coverage rate was registered, from 6% in 2015–2016 to almost 22% at the end of 2018–2019. The overall number of vaccinated HCWs increased, especially at younger ages. OSV strategy always leads to better results, and physicians always show a higher vaccination coverage than nurses and other HCWs. The implemented strategies were effective in achieving higher flu vaccination coverage among HCWs in our hospital and therefore can be considered valuable examples of good prevention practices in hospital settings.

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Most cited references 39

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Educational outreach visits: effects on professional practice and health care outcomes.

Mary Ann Thomson O'Brien, Stephen Rogers, Gro Jamtvedt … (2007)

Educational outreach visits (EOVs) have been identified as an intervention that may improve the practice of healthcare professionals. This type of face-to-face visit has been referred to as university-based educational detailing, academic detailing, and educational visiting. To assess the effects of EOVs on health professional practice or patient outcomes. For this update, we searched the Cochrane EPOC register to March 2007. In the original review, we searched multiple bibliographic databases including MEDLINE and CINAHL. Randomised trials of EOVs that reported an objective measure of professional performance or healthcare outcomes. An EOV was defined as a personal visit by a trained person to healthcare professionals in their own settings. Two reviewers independently extracted data and assessed study quality. We used bubble plots and box plots to visually inspect the data. We conducted both quantitative and qualitative analyses. We used meta-regression to examine potential sources of heterogeneity determined a priori. We hypothesised eight factors to explain variation across effect estimates. In our primary visual and statistical analyses, we included only studies with dichotomous outcomes, with baseline data and with low or moderate risk of bias, in which the intervention included an EOV and was compared to no intervention. We included 69 studies involving more than 15,000 health professionals. Twenty-eight studies (34 comparisons) contributed to the calculation of the median and interquartile range for the main comparison. The median adjusted risk difference (RD) in compliance with desired practice was 5.6% (interquartile range 3.0% to 9.0%). The adjusted RDs were highly consistent for prescribing (median 4.8%, interquartile range 3.0% to 6.5% for 17 comparisons), but varied for other types of professional performance (median 6.0%, interquartile range 3.6% to 16.0% for 17 comparisons). Meta-regression was limited by the large number of potential explanatory factors (eight) with only 31 comparisons, and did not provide any compelling explanations for the observed variation in adjusted RDs. There were 18 comparisons with continuous outcomes, with a median adjusted relative improvement of 21% (interquartile range 11% to 41%). There were eight trials (12 comparisons) in which the intervention included an EOV and was compared to another type of intervention, usually audit and feedback. Interventions that included EOVs appeared to be slightly superior to audit and feedback. Only six studies evaluated different types of visits in head-to-head comparisons. When individual visits were compared to group visits (three trials), the results were mixed. EOVs alone or when combined with other interventions have effects on prescribing that are relatively consistent and small, but potentially important. Their effects on other types of professional performance vary from small to modest improvements, and it is not possible from this review to explain that variation.

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Vaccine hesitancy among healthcare workers in Europe: A qualitative study.

Emilie N Karafillakis, Irina Dinca, Franklin Apfel … (2016)

Healthcare workers (HCWs) are often referred to as the most trusted source of vaccine-related information for their patients. However, the evidence suggests that a number of HCWs are vaccine-hesitant. This study consists of 65 semi-structured interviews with vaccine providers in Croatia, France, Greece, and Romania to investigate concerns HCWs might have about vaccination. The results revealed that vaccine hesitancy is present in all four countries among vaccine providers. The most important concern across all countries was the fear of vaccine side effects. New vaccines were singled out due to perceived lack of testing for vaccine safety and efficacy. Furthermore, while high trust in health authorities was expressed by HCWs, there was also strong mistrust of pharmaceutical companies due to perceived financial interests and lack of communication about side effects. The notion that it is a doctor's responsibility to respond to hesitant patients was reported in all countries. Concerns were also seen to be country- and context-specific. Strategies to improve confidence in vaccines should be adapted to the specific political, social, cultural and economic context of countries. Furthermore, while most interventions focus on education and improving information about vaccine safety, effectiveness, or the need for vaccines, concerns raised in this study identify other determinants of hesitancy that need addressing. The representativeness of the views of the interviewed HCWs must be interpreted with caution. This a qualitative study with a small sample size that included geographical areas where vaccination uptake was lower or where hesitancy was more prevalent and it reflects individual participants' beliefs and attitudes toward the topic. As HCWs have the potential of influencing patient vaccination uptake, it is crucial to improve their confidence in vaccination and engage them in activities targeting vaccine hesitancy among their patients.

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Transmission of influenza: implications for control in health care settings.

R. A. Weinstein, C Bridges, M. J. Kuehnert … (2003)

Annual influenza epidemics in the United States result in an average of >36,000 deaths and 114,000 hospitalizations. Influenza can spread rapidly to patients and health care personnel in health care settings after influenza is introduced by visitors, staff, or patients. Influenza outbreaks in health care facilities can have potentially devastating consequences, particularly for immunocompromised persons. Although vaccination of health care personnel and patients is the primary means to prevent and control outbreaks of influenza in health care settings, antiviral influenza medications and isolation precautions are important adjuncts. Although droplet transmission is thought to be the primary mode of influenza transmission, limited evidence is available to support the relative clinical importance of contact, droplet, and droplet nuclei (airborne) transmission of influenza. In this article, the results of studies on the modes of influenza transmission and their relevant isolation precautions are reviewed.

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Author and article information

Journal

Journal ID (nlm-ta): Vaccines (Basel)

Journal ID (iso-abbrev): Vaccines (Basel)

Journal ID (publisher-id): vaccines

Title: Vaccines

Publisher: MDPI

ISSN (Electronic): 2076-393X

Publication date (Electronic): 13 February 2020

Publication date Collection: March 2020

Volume: 8

Issue: 1

Electronic Location Identifier: 85

Affiliations

[1 ]Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; andreabarbara89@ 123456hotmail.it (A.B.); dipumpomarcello@ 123456gmail.com (M.D.P.); alessia.tognetto@ 123456gmail.com (A.T.); dott.tamburrano@ 123456gmail.com (A.T.); dvmedi@ 123456gmail.com (D.V.); umberto.moscato@ 123456unicatt.it (U.M.); gianfranco.damiani@ 123456unicatt.it (G.D.); walter.ricciardi@ 123456unicatt.it (W.R.); patrizia.laurenti@ 123456unicatt.it (P.L.)

[2 ]Hospital Hygiene Unit, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy

[3 ]Section of Occupational Medicine, Institute of Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; carloviora@ 123456hotmail.it (C.V.); silviacavalieri23@ 123456gmail.com (S.C.)

[4 ]Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy; andrea.cambieri@ 123456policlinicogemelli.it (A.C.); filippo.berloco@ 123456policlinicogemelli.it (F.B.)

[5 ]Department of Human Sciences, Society and Health, Università degli Studi di Cassino e del Lazio Meridionale, 03043 Cassino, Italy; g.capelli@ 123456unicas.it

Author notes

[* ]Correspondence: danieleignazio.lamilia@ 123456policlinicogemelli.it ; Tel.: +39-0630154396

Author information

Andrea Barbara https://orcid.org/0000-0001-5321-4537

Daniele Ignazio La Milia https://orcid.org/0000-0002-0860-4605

Alessia Tognetto https://orcid.org/0000-0003-2140-9051

Andrea Tamburrano https://orcid.org/0000-0001-9903-2624

Doriana Vallone https://orcid.org/0000-0002-2183-4413

Umberto Moscato https://orcid.org/0000-0002-2568-3966

Filippo Berloco https://orcid.org/0000-0001-5752-0064

Article

Publisher ID: vaccines-08-00085

DOI: 10.3390/vaccines8010085

PMC ID: 7157643

PubMed ID: 32069869

SO-VID: 6136ac57-8b62-4259-9d23-9a2fdc9e1385

License:

Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

Strategies to Increase Flu Vaccination Coverage among Healthcare Workers: A 4 Years Study in a Large Italian Teaching Hospital

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Jiangsu Journal of Preventive Medicine

Most cited references 39

Educational outreach visits: effects on professional practice and health care outcomes.

Vaccine hesitancy among healthcare workers in Europe: A qualitative study.

Transmission of influenza: implications for control in health care settings.

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