CALABRESE, GIULIA

GALLONE, MARIA SERENA

TAFURI, SILVIO

English

Giulia Calabrese

Maria Serena Gallone

Silvio Tafuri

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American Journal of Infection Control

Knowledge, attitudes, and practices of occupational health physicians in the promotion of vaccinations recommended for health care workers: An Italian study

Archivio istituzionale della ricerca - Università di Bari

awareness or indifference to the guidelines and data that indicatePPSA are not necessary for neurosurgery patients with drains ordevices.10The Joint Commission tracks use of prophylactic antibiotics andrates of discontinuation after 24 hours for a number of surgical pro-cedures, but they do not presently do so for neurosurgicalprocedures.11 It is reasonable to expect they will do so in the future.A combined effort by pharmacists and physicians to establish con-sensus and develop local practice guidelines can have a tremendousinfluence on prescribing practices because local guidelines are morelikely to be accepted and adhered to than national guidelines.9,10 Inthe absence of such, physicians may allow anecdotal experience toguide their use of PPSA.12 Pharmacists can employ persuasive tech-niques (eg, advise practitioners on how to prescribe antibiotics) orrestrictive techniques (eg, limit how antibiotics can be prescribed)to scale down the frequency of inappropriate antimicrobial admin-istration. A Cochrane Review found that both interventions wereequally effective.13Practice surveys such as this are associatedwith a number of limi-tations. Although our cohort was small, we believe that the varietyof responses we received effectively demonstrates that institu-tions are still administering PPSA to neurosurgery patients despiterecommendations to the contrary, and that practitioners need moreeducation and local guidelines on use of antibiotic prophylaxis inthis population.AcknowledgmentsThe authors thank the Neurocritical Care Society, specifically Dr.DaiWai Olson, for providing assistance in facilitating and distrib-uting the survey.References1. Abu Hamdeh S, Lytsy B, Ronne-Engström E. Surgical site infections in standardneurosurgery procedures- a study of incidence, impact and potential risk factors.Br J Neurosurg 2014;28:270-5.2. Gelabert-González M, Ginesta-Galan V, Sernamito-García R, Allut AG,Bandin-Diéguez J, Rumbo RM. The Camino intracranial pressure device in clinicalpractice. Assessment in a 1000 cases. Acta Neurochir (Wien) 2006;148:435-41.3. May AK, Fleming SB, Carpenter RO, Diaz JJ, Guillamondegui OD, Deppen SA, et al.Influence of broad-spectrum antibiotic prophylaxis on intracranial pressuremonitor infections and subsequent infectious complications in head-injuredpatients. Surg Infect (Larchmt) 2006;7:409-17.4. Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, et al.Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J HealthSyst Pharm 2013;70:195-283.5. Leverstein-van Hall MA, Hopmans TEM, van der Sprenkel JWB, Blok HEM,van der Mark WA, Hanlo PW, et al. A bundle approach to reduce the incidenceof external ventricular and lumbar drain-related infections. J Neurosurg2010;112:345-53.6. Schade RP, Schinkel J, Visser LG, Van Dijk JMC, Voormolen JHC, Kuijper EJ.Bacterial meningitis caused by the use of ventricular or lumbar cerebrospinalfluid catheters. J Neurosurg 2005;102:229-34.7. Brown EM, Pople IK, de Louvois J, Hedges A, Bayston R, Eisenstein SM, et al. Spineupdate: prevention of postoperative infection in patients undergoing spinalsurgery. Spine 2004;29:938-45.8. Little AS, White WL. Prophylactic antibiotic trends in transsphenoidal surgeryfor pituitary lesions. Pituitary 2011;14:99-104.9. Akalin HE. Surgical prophylaxis: the evolution of guidelines in an era of costcontainment. J Hosp Infect 2002;50(Suppl A):S3-7.10. Khan SA, Rodrigues G, Kumar P, Rao PGM. Current challenges in adherence toclinical guidelines for antibiotic prophylaxis in surgery. J Coll Physicians SurgPak 2006;16:435-7.11. The Joint Commission. Improving America’s hospitals: the Joint Commission’sannual report on quality and safety 2013. [Internet]. 2013. Available from:http://www.jointcommission.org/assets/1/6/TJC_Annual_Report_2013.pdf.Accessed May 15, 2015.12. Charani E, Castro-Sanchez E, Sevdalis N, Kyratsis Y, Drumright L, Shah N, et al.Understanding the determinants of antimicrobial prescribing within hospitals:the role of “prescribing etiquette”. Clin Infect Dis 2013;57:188-96.13. Davey P, Brown E, Charani E, Fenelon L, Gould IM, Holmes A, et al. Interventionsto improve antibiotic prescribing practices for hospital inpatients. CochraneDatabase Syst Rev 1996;(4):CD003543.Aaron Lord receives support from the NYU-HHC Clinical and Translational ScienceInstitute via grant No. UL1 TR000038 from the National Center for Advancing Trans-lational Sciences of the National Institutes of Health.AL conducted study conception and design, acquisition of data, analysis and inter-pretation of data, drafting of the manuscript, and final appraisal for publication. BCconducted study design, critical revision of the manuscript, and final appraisal forpublication. ASL conducted study conception and design, critical revision of themanu-script, and final appraisal for publication.Conflicts of interest: None to report.Ariane Lewis, MD*Departments of Neurology and Neurosurgery Division ofNeurocritical Care NYU Langone Medical Center, New York, NY* Address correspondence to Ariane Lewis, MD, Departments ofNeurology and Neurosurgery, Division of Neurocritical Care, NYULangone Medical Center, 530 First Ave, HCC 5A, New York, NY10016.E-mail address: ariane.kansas.lewis@gmail.com (A. Lewis).Barry M. Czeisler, MDDepartments of Neurology and Neurosurgery, Division ofNeurocritical Care NYU Langone Medical Center, New York, NYAaron S. Lord, MDDepartments of Neurology and Neurosurgery, Division ofNeurocritical Care NYU Langone Medical Center, New York, NYhttp://dx.doi.org/10.1016/j.ajic.2016.06.039Knowledge, attitudes, andpractices of occupationalhealth physicians in thepromotion of vaccinationsrecommended for healthcare workers: An ItalianstudyTo the Editor:In Italy, the National Immunization Plan established the vacci-nations strictly recommended for health care workers (HCWs).According to Italian law, occupational health physicians (OHPs) arein charge of the vaccine proposal and administration.1Nationalfiguresof thevaccinationcoverageachievedamongHCWsare not available, but there are several ad hoc surveys especially forinfluenza and hepatitis B vaccinations. In the last 10 years, severalstudies have investigated coverage for hepatitis B vaccines amongHCWs, and the rates always were >80%. Conversely, the coveragefor influenza vaccine was constantly low, and standards recom-mended by the Ministry of Health have not been achieved. Fewauthors have investigated the immunity formeasles,mumps, rubella,and varicella of HCWs andmedical students, who are at higher riskof contagion, as recently documented in a nosocomial outbreak ofmeasles in France.1-3In a survey carried out in 2014, we interviewed OHPs from hos-pitals of 6 regions of the south of Italy (approximately 14 million1758 Letters to the Editor / American Journal of Infection Control 44 (2016) 1755-63habitants)bya standardized, anonymousquestionnaire sentbye-mail.The questionnaire investigated perceptions about the professionalrisk linked to vaccine-preventable infectious disease and about therisk of HCWs as a source of spread of infectious disease for pa-tients, knowledge of vaccinations recommended in the NationalImmunization Plan for HCWs, attitude of OHPs in the promotion ofvaccines, and opinion on mandatory vaccination for HCWs.We contacted 258 OHPs; of these, 161 took part in the survey(response rate, 62.4%). Of them, 84 (52.2%) worked in a hospital andwere enrolled. Hepatitis B (66.7%), influenza (64.3%), and tubercu-losis (42.9%) were reported as the major professional biological risksfor HCWs. According to the opinion of 61% of OHPs, HCWs are athigher risk of being a source of contagion of influenza for theirpatients.Only 11.9% of enrolled OHPs correctly indicated all vaccina-tions (hepatitis B, influenza, measles, mumps, rubella, varicella, andpertussis) recommended for HCWs in the National ImmunizationPlan 2012-2014: 71.4% chose the hepatitis B vaccine, 67.9% chosethe influenza vaccine, and only approximately one-third of physi-cians knew that themeasles, mumps and rubella (MMR) and varicellavaccines are recommended for HCWs.Approximately 56% of respondents proposed HCWs receive theinfluenza vaccination every year, and 66.7% checked vaccinationstatus during the first medical examination.Of the interviewed OHPs, 60.7% reported a favorable opinionabout the introduction of mandatory vaccination for HCWs.Questions about the general attitudes about vaccines revealedthat 70.2% of OHPs stated that vaccines are useful tools to controlor eliminate very important diseases; 4.8% reported that vaccinescould be valuable only in some settings, such as developing coun-tries; 4.8% affirmed that natural immunity is more important thanvaccine-related immunity; and 20.2% did not refer any opinion.Our results showed several criticisms in the field of vaccina-tions for HCWs; in particular, the survey revealed an important lackof knowledge (eg, >80% of OHPs did not know all vaccinations rec-ommended for HCWs, approximately 50% were not able to identifythe responsibilities of OHPs in immunization strategies).Results of our study are consistent with previous observations.In a survey conducted in 2014 among 135 OHPs, Betsch et al docu-mented a dramatic lack of knowledge about vaccination strategiesand concluded that reasons for vaccination gaps in HCWsmight havetheir roots in occupational physicians’ incomplete knowledge of vac-cination recommendations. Attitudes, which are related tomisperceptions, also influence which vaccinations are recom-mended to HCWs. Official recommendations, and not personalattitudes and misconceptions, should guide occupational vaccina-tion behavior.4From a national perspective, the major concern is linked to thetraining of OHPs: Italian occupational health postdegree schools werefor a long time focused on the prevention andmanagement of chem-ical and physical hazards in works setting, whereas biological riskwas not a sufficient part of the background of Italian occupationaldoctors.In the scientific literature, there are few studies about the knowl-edge and attitudes of OHPs regarding vaccinations. Several studieshave investigated the attitudes of HCWs toward vaccinations becauselow immunization coverage among HCWs has been related to per-sonal decisions and not immunization strategies.5-7Vaccinations are a principal public health tool, and the deci-sion to vaccinate or not must be determined not in a 1-to-1interaction (OHP vs HCW) but in the public health perspective thathas to use all traditional strategies of vaccine promotion (risk com-munication, active call, recall, and immunization registers) andspecific plans for hospital settings, such as the publication of cov-erage achieved in each hospital ward.Recently, a decline in the vaccination coverage among new-borns has been described, linked to the resurgence of antivaccinationmovements.8 Antivaccination movements often repeat that a reasonnot to get vaccinated is that few HCWs receive recommended vac-cinations. In this scenario, improving vaccination coverage amongHCWs is strictly needed for the reliability of the National HealthService.References1. Prato R, Tafuri S, Fortunato F, Martinelli D. Vaccination in healthcare workers:an Italian perspective. Expert Rev Vaccines 2010;9:277-83.2. Tafuri S, Germinario C, Rollo M, Prato R. Occupational risk from measles inhealthcare personnel: a case report. J Occup Health 2009;51:97-9.3. Fortunato F, Tafuri S, Cozza V, Martinelli D, Prato R. Low vaccination coverageamong Italian healthcare workers in 2013. Hum Vaccin Immunother2015;11:133-9.4. Betsch C, Wicker S. Personal attitudes and misconceptions, not officialrecommendations guide occupational physicians’ vaccination decisions. Vaccine2014;32:4478-84.5. Maltezou HC, Katerelos P, Poufta S, Pavli A, Maragos A, Theodoridou M. Attitudestoward mandatory occupational vaccinations and vaccination coverage againstvaccine-preventable diseases of health care workers in primary health care centers.Am J Infect Control 2013;41:66-70.6. Guthmann JP, Fonteneau L, Ciotti C, Bouvet E, Pellissier G, Lévy-Bruhl D,et al. Vaccination coverage of health care personnel working in healthcare facilities in France: results of a national survey, 2009. Vaccine 2012;30:4648-54.7. Tafuri S, Martinelli D, Caputi G, Arbore A, Lopalco PL, Germinario C, et al. An auditof vaccination coverage among vaccination service workers in Puglia, Italy. AmJ Infect Control 2009;37:414-6.8. Germinario C, Gallone MS, Tafuri S. How to fight anti-vaccinists prejudices: theviewpoint of public health. Epidemiol Prev 2014;38(Suppl):120-3.Conflicts of interest: None to report.Giulia Calabrese, MDDepartment of Biomedical Science and Human Oncology, Universityof Bari Aldo Moro, Bari, ItalyMaria Serena Gallone, MD*Department of Biomedical Science and Human Oncology, Universityof Bari Aldo Moro, Bari, ItalySilvio Tafuri, MD PhDDepartment of Biomedical Science and Human Oncology, Universityof Bari Aldo Moro, Bari, Italy* Address correspondence to Maria Serena Gallone, MD,Department of Biomedical Science and Human Oncology, AldoMoro University of Bari, Bari, Italy.E-mail address: serenagallone@gmail.com (M.S. Gallone).http://dx.doi.org/10.1016/j.ajic.2016.05.042An alternative to singing“Happy Birthday”:Healthcare provider’srhyme for handwashingtimeA literature search on the topic of hand hygiene reveals a pleth-ora of evidence describing the known fact that good hand hygieneis recognized by the Centers for Disease Control and Prevention asthemost effectivemethod of preventing hospital-acquired infections.11759Letters to the Editor / American Journal of Infection Control 44 (2016) 1755-63

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Knowledge, attitudes, and practices of occupational health physicians in the promotion of vaccinations recommended for health care workers: An Italian study

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