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• W2023406568 abstract "The title of this study itself raises a great many questions. Should healthcare workers be vaccinated against influenza? If so, which healthcare workers should be vaccinated? What is the evidence for vaccination in these groups and how strong is this evidence? Do healthcare workers believe the evidence and translate this into behaviour? Why do so few healthcare workers accept influenza vaccination as recommended by the Department of Health? Above all, how can we improve vaccination rates in this group if the evidence warrants it? Canning et al. (2005) sought to investigate the reasons which healthcare assistants and nurses in two Liverpool hospitals offered for non-vaccination, given a previous vaccination rate of only 7.6% in this group. Although the study cites evidence to support vaccination of healthcare workers, it is worth examining this evidence in greater detail. Arguments proposed in favour of vaccination are that it not only reduces illness and sickness absence in staff but also, and even more appealingly, has the potential to reduce mortality in patients of vaccinated healthcare workers. The authors quote two studies in support of vaccination to reduce sickness absence in healthcare staff. Although a 28% reduction in sickness absence in the first study, conducted in two paediatric hospitals, appears impressive, the absolute benefit was only 0.4 days (1.0 vs. 1.4 in vaccinees compared with controls) (Saxen & Virtanen 1999) and indeed there was no reduction in illness episodes or days of respiratory illness. The second study by Wilde et al. (1999) was conducted in young healthy staff, 75% of whom were junior medical staff. Although there was a significant reduction in serologically proven influenza, there was no significant reduction in days of illness and sickness absence. Neither study included staff from primary care, a fact which may be relevant in terms of generalisability. A systematic review also showed that influenza vaccination of healthy adults leads to benefits in terms of reduced sickness absence but again this benefit only amounted to 0.4 days (95% confidence interval 0.1–0.8 days) (Demicheli et al. 2000). The possibility that vaccination of vectors of influenza might prevent illness in high-risk individuals is reminiscent of indirect evidence suggesting that vaccinating schoolchildren may have reduced mortality in older people in Japan (Reichert et al. 2001). In a study from Glasgow in 1995, influenza vaccination of staff was associated with reduced mortality from 17% to 10% in older long-stay patients, presumably also by reducing the potential of staff to act as vectors for the disease (Potter et al. 1997). Carman et al. (2000) also found a reduction in mortality amongst inpatients from 22.4% to 13.6%, but no reduction in non-fatal influenza, by increasing the influenza vaccination rate to 50% in vaccine hospitals (from 4% in non-vaccine hospitals). So the evidence suggests that potential benefits to patients may be just as, if not more, important when compared with benefits to healthcare workers themselves. Understanding attitudes to influenza vaccination and the measures that might increase vaccination uptake amongst healthcare workers is therefore important if vaccination of healthcare staff is to be increased. Negative attitudes have been previously shown to affect vaccine uptake amongst healthcare staff adversely (Watanakunakorn et al. 1993) and although positive attitudes to vaccination are associated with subsequent influenza vaccination amongst healthcare workers (Beguin et al. 1998), just as in at-risk patients (Honkanen et al. 1996), this may not consistently be the case (Yassi et al. 1994). Previous studies in patients have identified factors that either promote or prevent vaccination personnel as recipient, provider or system factors (Gyorkos et al. 1994), a model broadly supported by Canning's study. Personal factors including knowledge, attitudes and beliefs of recipients (Nexoe et al. 1999), provider factors such as recommendation from a health professional (Kyaw et al. 1999) and organizational systems for delivering the vaccine have been associated with increased vaccination uptake (Nichol et al. 1990). Personal factors preventing influenza vaccination in healthcare staff include concerns about side effects (Nichol & Hauge 1997), uncertainty about vaccine effectiveness, doubts about the severity of the illness (Ballada et al. 1994) and a perception that they were at low risk or would fight off the infection naturally (Harbarth et al. 1998). Negative attitudes were prevalent amongst many groups of health workers and even amongst respiratory physicians(Sockrider et al. 1998). Personal factors promoting vaccination in healthcare workers include belief in prevention, vaccine efficacy (Beguin et al. 1998) that vaccination avoids illness and protects patients (Nichol & Hauge 1997). Provider factors such as availability of vaccine, social pressure to be vaccinated and time to attend clinics (Nafziger & Herwaldt 1994) have been shown to increase influenza vaccine uptake amongst health workers. System factors such as recommendation from the occupational health department (Yassi et al. 1994), better access to vaccines, free of charge (Nichol & Hauge 1997) and underpinned by national health policy promoting influenza vaccination (Weingarten et al. 1989) are associated with influenza vaccination amongst health workers. Some working environments such as geriatric wards where both awareness of vaccine benefits and morbidity and mortality from respiratory illness are high are associated with higher rates of influenza vaccination (Yassi et al. 1994). Canning et al. confirm some findings from these studies and the results are helpful in a UK context because most previous research was conducted in North America and Europe where attitudes to vaccination are influenced by differences in cultural beliefs and health policy, and many of the studies predate the inclusion in 1998 of healthcare staff into current UK influenza vaccination policy (Department of Health 2000). Canning et al. did not find any factors that made vaccination more or less likely in contrast to other studies where age (over 50), previous vaccination and vaccine knowledge were found to be determinants of uptake (Heimberger et al. 1995, Nichol & Hauge 1997). However, the study, like many of its predecessors, by relying on questionnaire and quantitative rather than qualitative methodologies, may have failed to include systematically all of the factors identified as likely to affect vaccine uptake or fully taken into account the range or complexity of beliefs of healthcare professionals, because of differences in attitudes to vaccination between the different professional backgrounds or different ethnic groups of healthcare workers. In particular, the views of social care workers (such as home helps, home care workers and residential home carers), who are key personnel in delivering care in the community to many vulnerable elderly, has not yet been sought. Cultural differences amongst healthcare workers in attitudes to vaccination based on a growing body of research into ethnic and cultural variations in health beliefs and actions may also be important in terms of future research. The authors point to lack of awareness of the vaccine and its benefits, particularly protection for patients, as the most important barrier to vaccination and recommend solutions that address the barrier in a multifaceted and systematic way using an educational model as the basis for increased vaccination of healthcare workers. Such a model has previously been used successfully as the basis for improving vaccination rates in patients in general practice (Siriwardena 1999, Siriwardena et al. 2002, Siriwardena 2003, Siriwardena et al. 2003a,b ) and may form the basis of similar studies in healthcare workers." @default.
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• W2023406568 title "Healthcare workers and influenza vaccination Commentary on Canning HS, Phillips J & Allsup S (2005) Healthcare workers beliefs about influenza vaccine and the reasons for non-vaccination ? a cross-sectional survey. Journal of Clinical Nursing 14, 922?925" @default.
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• W2023406568 doi "https://doi.org/10.1111/j.1365-2702.2007.01467.x" @default.
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