Influenza vaccination of health care workers

Hoe meer verpleegkundigen en artsen in het ziekenhuis een griepprik hebben gekregen, hoe minder patiënten in het ziekenhuis griep en/of een longontsteking oplopen. Deze conclusie trekt UMCG-onderzoeker Josien Riphagen op basis van haar onderzoek. Zij ontwikkelde een campagne waardoor de vaccinatiegraad onder ziekenhuispersoneel toenam met maar liefst 23,7%. Het aantal patiënten dat griep en/of een longontsteking opliep in het ziekenhuis daalde hierdoor van 9,7% naar 3,9%. “Verpleegkundigen en artsen die de griepprik halen, dragen dus echt bij aan het voorkomen dat het griepvirus zich verspreidt naar patiënten”, vertelt Riphagen. Zij promoveert op 28 oktober aan de Rijksuniversiteit Groningen. Riphagen ontwikkelde de campagne voor de griepvaccinatie op basis van een vragenlijstonderzoek onder ziekenhuispersoneel. “Hierdoor kregen we inzicht in bevorderende en belemmerde factoren voor het halen van de griepprik door ziekenhuismedewerkers.” Als voorbeeld noemt Riphagen dat het belangrijk is om de griepprik op een handig tijdstip aan te bieden, bijvoorbeeld tijdens de wisseling van diensten. De vaccinatiecampagne werd ondersteund door de Vereniging Verpleegkundigen en Verzorgenden Nederland. UMC’s Aan het onderzoek deden alle acht Universitaire Medische Centra (UMC’s) in Nederland mee. Twee ziekenhuizen hadden al een heel effectieve vaccinatiecampagne voor het personeel en namen deel als externe controle. Van de zes andere ziekenhuizen voerde de helft de nieuwe vaccinatiecampagne in en de andere UMC’s voerden de eigen griepcampagne uit zoals in voorgaande jaren. Het effect van de campagne blijkt duidelijk uit de grote toename van de vaccinatiegraad onder het ziekenhuispersoneel. Patiënten Riphagen onderzocht hoeveel patiënten in het ziekenhuis besmet raakten met griep en/of een longontsteking opliepen. In elk ziekenhuis ging ze dit na op de afdelingen Interne Geneeskunde en de Kinderafdeling. De onderzoeksperiode betrof de griepseizoenen 2009/2010 en 2010/2011. Riphagen stelde vast dat op de afdelingen Interne Geneeskunde 9,7% van de patiënten in de controle UMC’s griep en/of een longontsteking kreeg, en 3,9% van de patiënten in de UMC’s waar de nieuwe vaccinatiecampagne was ingevoerd. Deze daling in het aantal infecties hangt samen met de hogere vaccinatiegraad onder het personeel. Meer ziekenhuizen De griepvaccinatiecampagne die Riphagen ontwikkelde en invoerde bleek ook kostenbesparend te zijn. “De kracht van deze gestructureerde griepvaccinatiecampagne is dat we zoveel mogelijk aansluiten bij de opvattingen van ziekenhuispersoneel. Het ontbreekt nu nog vaak aan kennis. Verpleegkundigen en artsen moeten weten dat de vaccinatie niet alleen nuttig is voor henzelf, maar vooral ook voor hun patiënten”, aldus Riphagen. Inmiddels heeft de Afdeling Epidemiologie van het UMCG subsidie gekregen van ZonMw voor de implementatie van de vaccinatiecampagne in andere ziekenhuizen in Noord Nederland

Contributing factors to influenza vaccine uptake in general hospitals:an explorative management questionnaire study from the Netherlands

BACKGROUND: The influenza vaccination rate in hospitals among health care workers in Europe remains low. As there is a lack of research about management factors we assessed factors reported by administrators of general hospitals that are associated with the influenza vaccine uptake among health care workers. METHODS: All 81 general hospitals in the Netherlands were approached to participate in a self-administered questionnaire study. The questionnaire was directed at the hospital administrators. The following factors were addressed: beliefs about the effectiveness of the influenza vaccine, whether the hospital had a written policy on influenza vaccination and how the hospital informed their staff about influenza vaccination. The questionnaire also included questions about mandatory vaccination, whether it was free of charge and how delivered as well as the vaccination campaign costs. The outcome of this one-season survey is the self-reported overall influenza vaccination rate of health care workers. RESULTS: In all, 79 of 81 hospitals that were approached were willing to participate and therefore received a questionnaire. Of these, 42 were returned (response rate 52%). Overall influenza vaccination rate among health care workers in our sample was 17.7% (95% confidence interval: 14.6% to 20.8%). Hospitals in which the administrators agreed with positive statements concerning the influenza vaccination had a slightly higher, but non-significant, vaccine uptake. There was a 9% higher vaccine uptake in hospitals that spent more than €1250,- on the vaccination campaign (24.0% versus 15.0%; 95% confidence interval from 0.7% to 17.3%). CONCLUSIONS: Agreement with positive statements about management factors with regard to influenza vaccination were not associated with the uptake. More economic investments were related with a higher vaccine uptake; the reasons for this should be explored further

How to develop a program to increase influenza vaccine uptake among workers in health care settings?

Background: Apart from direct protection and reduced productivity loss during epidemics, the main reason to immunize healthcare workers (HCWs) against influenza is to provide indirect protection of frail patients through reduced transmission in healthcare settings. Because the vaccine uptake among HCWs remains far below the health objectives, systematic programs are needed to take full advantage of such vaccination. In an earlier report, we showed a mean 9% increase of vaccine uptake among HCWs in nursing homes that implemented a systematic program compared with control homes, with higher rates in those homes that implemented more program elements. Here, we report in detail the process of the development of the implementation program to enable researchers and practitioners to develop intervention programs tailored to their setting. Methods: We applied the intervention mapping (IM) method to develop a theory-and evidence-based intervention program to change vaccination behaviour among HCWs in nursing homes. Results: After a comprehensive needs assessment, we were able to specify proximal program objectives and selected methods and strategies for inducing behavioural change. By consensus, we decided on planning of three main program components, i.e., an outreach visit to all nursing homes, plenary information meetings, and the appointment of a program coordinator - preferably a physician - in each home. Finally, we planned program adoption, implementation, and evaluation. Conclusion: The IM methodology resulted in a systematic, comprehensive, and transparent procedure of program development. A potentially effective intervention program to change influenza vaccination behaviour among HCWs was developed, and its impact was assessed in a clustered randomised controlled trial

Effects of a multi-faceted program to increase influenza vaccine coverage among health care workers:A hospital-based cluster randomized controlled trial

Background: Immunizing health care workers (HCWs) against influenza has proven to protect their patients. Despite recommentations of the World Health Organization and the Dutch Health Council, influenza vaccine uptake among hospital HCWs remains low in the Netherlands Objectives: To assess the effects of implementing a hospital- based multi-faceted influenza immunization program on vaccine coverage in health care workers (HCW) and on patient morbidity. Methods: We conducted a cluster randomized controlled trial among all eight University Medical Centers (UMC) of The Netherlands during the influenza seasons of 2009- 2010 and 2010-2011. Participants were hospital staff of three intervention (n = 27,900 in 2009), three control (n = 22,451) and two external non-randomized intervention UMCs (n = 16,893), and 3,367 patients admitted to the departments of pediatrics and internal medicine during both influenza epidemics. We offered a vaccination implementation progran to staff of intervention and external UMCs, but not to control UMCs. The primary outcome measure was influenza vaccine coverage among HCW. Secondary outcome measures were work absenteeism and patient morbidity. Results: In 2009, the coverage of seasonal, first pandemic and second pandemic vaccine was 32.3%, 61.7% and 45.8% in the intervention UMCs. Corresponding figures for control UMCs were significantly lower at 20.4%, 38.0%, and 17.8%, respectively (p <0.05). In 2010, the coverage of the seasonal vaccine was 28.6% and 17.8% in intervention and control UMCs, respectively (p <0.05). During their stay, influenza and/or pneumonia was reduced in patients of intervention UMCs compared to control UMCs (work in progress). Rates of HCWs' absenteeism and influenza testing rates during epidemics were higher in intervention than control UMCs. Conclusions: Adoption of the program improved the influenza vaccine coverage among hospital staff. An increase in coverage was associated with decreased patient morbidity from influenza and/or pneumonia

Cost-effectiveness of a screening strategy for Q fever among pregnant women in risk areas: a clustered randomized controlled trial

Contains fulltext : 87399.pdf (publisher's version ) (Open Access)BACKGROUND: In The Netherlands the largest human Q fever outbreak ever reported in the literature is currently ongoing with more than 2300 notified cases in 2009. Pregnant women are particularly at risk as Q fever during pregnancy may cause maternal and obstetric complications. Since the majority of infected pregnant women are asymptomatic, a screening strategy might be of great value to reduce Q fever related complications. We designed a trial to assess the (cost-)effectiveness of a screening program for Q fever in pregnant women living in risks areas in The Netherlands. METHODS/DESIGN: We will conduct a clustered randomized controlled trial in which primary care midwife centres in Q fever risk areas are randomized to recruit pregnant women for either the control group or the intervention group. In both groups a blood sample is taken around 20 weeks postmenstrual age. In the intervention group, this sample is immediately analyzed by indirect immunofluorescence assay for detection of IgG and IgM antibodies using a sensitive cut-off level of 1:32. In case of an active Q fever infection, antibiotic treatment is recommended and serological follow up is performed. In the control group, serum is frozen for analysis after delivery. The primary endpoint is a maternal (chronic Q fever or reactivation) or obstetric complication (low birth weight, preterm delivery or fetal death) in Q fever positive women. Secondary aims pertain to the course of infection in pregnant women, diagnostic accuracy of laboratory tests used for screening, histo-pathological abnormalities of the placenta of Q fever positive women, side effects of therapy, and costs. The analysis will be according to the intention-to-screen principle, and cost-effectiveness analysis will be performed by comparing the direct and indirect costs between the intervention and control group. DISCUSSION: With this study we aim to provide insight into the balance of risks of undetected and detected Q fever during pregnancy. TRIAL REGISTRATION: ClinicalTrials.gov, protocol record NL30340.042.09