Sabine Wicker

Influenza Vaccination Compliance Among Health Care Workers in a German University Hospital

Background:Since 1988, the Standing Committee on Vaccination (STIKO) at the Robert Koch-Institute, Berlin, has explicitly recommended that health-care workers (HCWs) should be vaccinated against seasonal influenza. However, acceptance of the influenza vaccination by medical personnel is low.Methods:This study analyzes factors associated with the compliance of HCWs with the seasonal influenza vaccination on the basis of three different anonymized questionnaires during two consecutive influenza seasons: 2006/2007 and 2007/2008. The questionnaires covered details of demographics, frequency of previous vaccinations, reasons for accepting or declining the vaccination, and the HCW’s knowledge of the influenza vaccine and influenza itself.Results:Our study showed that physicians were significantly more likely to have been vaccinated than nurses (38.8% vs 17.4%; p < 0.0001). The main reasons for noncompliance included: supposition of a low risk of infection, fear of side effects, the belief that the influenza vaccine might trigger the influenza virus infection, and scepticism about the effectiveness of the influenza vaccination.Conclusion:Our findings confirm the importance of a comprehensive approach to the vaccination, ensuring that HCWs are correctly informed about the vaccine and that it is convenient to receive it.

Vaccination policies for health-care workers in acute health-care facilities in Europe

The aim of this study was to evaluate existing policies regarding recommended and mandatory occupational vaccinations for health-care workers (HCWs) in Europe. A standardized questionnaire was sent to experts in Infection Control or Occupational Health in all 27 European Union Member States, as well as Norway, Russia, and Switzerland. All 30 countries have established policies about HCW vaccination against vaccine-preventable diseases. However significant gaps and considerable country-to-country variation were found, in terms of number of recommended vaccines and target subgroups of HCWs and health-care settings. Vaccination against hepatitis B and annual vaccination against seasonal influenza are almost universally recommended for HCWs in Europe (29 countries each, including eight countries where vaccination against hepatitis B is mandatory or required for employment). Policies regarding HCW vaccination also exist against mumps (12 countries), measles or rubella (15 countries), varicella (17 countries), diphtheria-tetanus (14 countries), pertussis (9 countries), poliomyelitis (11 countries), hepatitis A (11 countries), tuberculosis (BCG vaccine) (9 countries), and against meningococcus group C or meningococci groups A, C, W135, Y (tetravalent vaccine) (in 4 countries each). Re-evaluation of occupational vaccine policies for HCWs in Europe on a consensus basis is imperative in order to promote HCW and patient safety.

Measles in health-care settings

Despite the availability of an effective and safe vaccine for almost half a century, measles is re-emerging in several developed countries because of the insufficient vaccination coverage among specific subpopulations, the emerging anti-vaccination movement, and the increasing movement of humans across borders. In this context, health-care settings play a critical role in the transmission of infection and generation of numerous cases. Health-care-associated outbreaks may be associated with severe morbidity and mortality among specific groups of patients, disruption of health-care services, and considerable costs. Misdiagnosis or delayed diagnosis of a measles case and inadequate implementation of infection control measures are common in almost all events of nosocomial spread. Measles vaccination of health-care workers is an effective means of prevention of nosocomial measles outbreaks. Eliminating measles by 2010 has not been accomplished. Stronger recommendations and higher vaccination coverage against measles in health-care workers could contribute to eliminate measles in the general population.

Determination of Risk of Infection with Blood-borne Pathogens Following a Needlestick Injury in Hospital Workers

OBJECTIVES Our paper measures the prevalence of hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) in patients at the University Hospital of Frankfurt/Main, and correlates the prevalence with risk factors for exposure to and infection of healthcare workers (HCWs). Individual risk assessments were calculated for exposed HCWs. METHODS Survey of patients admitted to a German University Hospital. Markers for HBV, HCV and HIV were studied and evaluated statistically. Data on needlestick injuries (NSIs) among HCWs were correlated with the prevalence of infectious patients. RESULTS The HBV, HCV and HIV prevalence among patients at the University Hospital were 5.3% (n = 709/13 358), 5.8% (n = 1167/20 163) and 4.1% (n = 552/13 381), respectively. Our results indicate that the prevalence of blood-borne infections in patients was about nine times higher for HBV, approximately 15 times higher for HCV and approximately 82 times higher for HIV than in the overall German population. The highest risk of acquiring a blood-borne infection via NSI was found in the department of internal medicine due to increased prevalence of blood-borne pathogens in patients under treatment. CONCLUSIONS While accidental NSIs were most frequent in surgery, the nominal risk of blood-borne virus infection was greatest in the field of internal medicine. The study underlines the importance of HBV vaccinations and access to HIV-post-exposure prophylaxis for HCWs as well as the use of anti-needlestick devices.

A Common HLA-DPA1 Variant Is Associated with Hepatitis B Virus Infection but Fails to Distinguish Active from Inactive Caucasian Carriers

Background and Aims Chronic infection with the hepatitis B virus (HBV) is a major health issue worldwide. Recently, single nucleotide polymorphisms (SNPs) within the human leukocyte antigen (HLA)-DP locus were identified to be associated with HBV infection in Asian populations. Most significant associations were observed for the A alleles of HLA-DPA1 rs3077 and HLA-DPB1 rs9277535, which conferred a decreased risk for HBV infection. We assessed the implications of these variants for HBV infection in Caucasians. Methods Two HLA-DP gene variants (rs3077 and rs9277535) were analyzed for associations with persistent HBV infection and with different clinical outcomes, i.e., inactive HBsAg carrier status versus progressive chronic HBV (CHB) infection in Caucasian patients (n = 201) and HBsAg negative controls (n = 235). Results The HLA-DPA1 rs3077 C allele was significantly associated with HBV infection (odds ratio, OR = 5.1, 95% confidence interval, CI: 1.9–13.7; p = 0.00093). However, no significant association was seen for rs3077 with progressive CHB infection versus inactive HBsAg carrier status (OR = 2.7, 95% CI: 0.6–11.1; p = 0.31). In contrast, HLA-DPB1 rs9277535 was not associated with HBV infection in Caucasians (OR = 0.8, 95% CI: 0.4–1.9; p = 1). Conclusions A highly significant association of HLA-DPA1 rs3077 with HBV infection was observed in Caucasians. However, as a differentiation between different clinical courses of HBV infection was not possible, knowledge of the HLA-DPA1 genotype cannot be translated into personalized anti-HBV therapy approaches.

Needlestick injuries among health care workers: Occupational hazard or avoidable hazard?

ZusammenfassungEINLEITUNG: Ziel dieser Studie war die Erhebung der Häufigkeit und Ursachen von Nadelstichverletzungen bei Mitarbeitern im Gesundheitswesen sowie die Darstellung möglicher präventiver Maßnahmen. METHODEN: Mit Hilfe zweier unabhängiger anonymer Fragebogenerhebungen wurden Daten über Nadelstichverletzungen von Mitarbeitern eines deutschen Universitätsklinikum erhoben. Um die Vermeidbarkeit der Nadelstichverletzungen zu kalkulieren, wurden im ersten Studienabschnitt Anzahl und Art der Nadelstichverletzungen ermittelt, im zweiten Abschnitt die Ursachen und die Arbeitsbedingungen der Mitarbeiter. ERGEBNISSE: Nadelstichverletzungen wurden durch unsichere Handlungsabläufe, schwierige Arbeitsbedingungen und unsichere Arbeitsgeräte verursacht. In unserer Studie hatten innerhalb der letzten zwölf Monate 31,5% (n = 503/1598) der Befragten mindestens eine Nadelstichverletzung erlitten. Die Rate des Underreporting lag bei circa 75%. Durchschnittlich 50,3% (n = 492/978) der stattgehabten Nadelstichverletzungen hätten durch die Verwendung von sogenannten sicheren Instrumenten vermieden werden können, wohingegen lediglich 15,2% der Nadelstichverletzungen durch organisatorische Maßnahmen vermeidbar gewesen wären. Nach der Einführung der sicheren Instrumente, gaben 91,8% der Mitarbeiter an, mit den sicheren Instrumenten zufrieden zu sein, 83,4% der Beschäftigten waren davon überzeugt, dass sich durch die Verwendung von sicheren Instrumente die Arbeitssicherheit erhöhen würde. DISKUSSION: Die berufliche Exposition gegenüber Blut ist ein häufiges Problem der Mitarbeiter im Gesundheitswesen. Eine systematische und kontinuierliche Erfassung von Nadelstichverletzungen ist unabdingbar, um riskante Praktiken und Arbeitsbedingungen zu identifizieren. Präventive Maßnahmen, beispielsweise die Einführung von sicheren Instrumenten sowie die Schulung sicherer Arbeitsabläufe, sollten im weiteren Zeitverlauf implementiert werden.SummaryOBJECTIVES: The objective of this study was to describe the mechanisms and preventability of occupational percutaneous blood exposure of healthcare workers through needlestick injuries and to discuss rational strategies for prevention. METHODS: To calculate the preventability, we surveyed in a first step the number and kind of needlestick injuries and in a second step the reasons for the injuries and the working conditions of the healthcare workers. Both data sets were collected in independent anonymous questionnaire covering occupational blood exposure among healthcare workers in a German university hospital. RESULTS: Needlestick injuries were caused through unsafe procedures, difficult working conditions and unsafe devices. On average, 50.3% (n = 492/978) of all needlestick injuries could have been avoided by the use of safety devices, whereas only 15.2% could have been prevented by organizational measures. In our study, 31.5% (n = 503/1598) of participant healthcare workers had sustained at least one needlestick injury in the past twelve months. The rate of underreporting was about 75%. After introduction of safety devices, 91.8% of the healthcare workers reported being satisfied with the anti-needlestick devices and 83.4% believed that safety devices would increase the safety of the work environment. CONCLUSIONS: Occupational exposure to blood is a common problem among healthcare workers. The introduction of safety devises is one of the main starting points for avoidance of needlestick injuries, and acceptance among healthcare workers is high. Further targets for preventive measures, such as training in safe working routines, are necessary for improvement of safe work conditions.

Hepatitis B and influenza vaccines: Important occupational vaccines differently perceived among medical students

Healthcare personnel (HCP) are at risk from occupational exposure to airborne and bloodborne pathogens, and the risk of infection among HCP is greater than among the general population. The aim of the study was to characterize attitudes toward occupational recommended vaccines as well as the perception of risks of occupationally acquired infections. We surveyed 650 medical students to assess their perception of influenza and hepatitis B and their opinions and beliefs about influenza and hepatitis B vaccines. We found differences between pre-clinical and clinical students regarding the uptake of influenza and hepatitis B vaccines, about the chances of being occupationally infected with influenza or hepatitis B, and about the likelihood of suffering from severe side-effects following immunization. Interestingly, the risk perception varied drastically between the two vaccine-preventable diseases hepatitis B and influenza. Medical students rated the probability of contracting hepatitis B due to a work-related exposure and the severity of disease significantly higher than for influenza, and this may be an explanation for the greater acceptance of the hepatitis B vaccine. Furthermore, our findings suggest that medical students are frequently inaccurate in assessing their own risk level, and their specific knowledge about both diseases and the severity of these diseases proved to be unsatisfactory.

Healthcare workers' perceptions of mandatory vaccination: results of an anonymous survey in a German University Hospital.

Despite decades of effort to encourage healthcare workers (HCWs) to be immunized, vaccination rates remain insufficient. Among German HCWs, 831 (68.4%) of 1,215 respondents supported mandatory vaccinations for HCWs in general. However, acceptance of mandatory vaccination varied significantly between physicians and nurses and also depended on the targeted disease.

Attitudes of healthcare workers toward pertussis vaccination

Objective: To evaluate the attitudes of pediatric healthcare workers (HCWs) toward pertussis vaccination. Method: A survey was conducted among pediatric HCWs, using an anonymous questionnaire, at a university children’s hospital. Results: Of 298 eligible employees, 121 (40.6%) completed the questionnaire. Lack of information regarding the personal risk of acquiring a pertussis infection and fear of side effects were frequently associated with the refusal of getting immunized. Conclusion: Misconception about pertussis vaccination was prevalent, especially among nursing staff, who are in even closer contact with at-risk children than physicians. Intervention strategies should be designed with focus on nursing staff. Our findings confirm the importance of comprehensive approaches for more education on HCWs to improve acceptance of vaccination.

The Management of Needlestick Injuries

BACKGROUND An estimated 1 million needlestick injuries (NSIs) occur in Europe each year. The Council Directive 2010/32/EU on the prevention of NSIs describes minimum requirements for prevention and calls for the implementation of local, national and Europe-wide reporting systems. The Directive is to be implemented by all EU member states by 11 May 2013. The purpose of this study was to assess (and improve) the procedures for the reporting and treatment of needlestick injuries in a German tertiary-care hospital. METHODS We carried out a prospective observational study of the NSI reporting system in the hospital over a period of 18 months and determined the incidence of NSIs, the prevalence of blood-borne pathogens among index patients, the rate of initiation of post-exposure prophylaxis, and the rate of serological testing of the affected health care personnel. RESULTS 519 instances of NSI were reported to the accident insurance doctor over the period of the study, which consisted of 547 working days. 86.5% of the index patients underwent serological study for hepatitis B and C (HBV and HCV) and for the human immune deficiency virus (HIV); this resulted in two initial diagnoses (one each of active hepatitis B and hepatitis C) in the index patient. 92 of 449 index patients, or one in five, was infected with at least one blood-borne pathogen. HIV post-exposure prophylaxis was initiated in 41 health care workers. One case of hepatitis C virus transmission arose and was successfully treated. Other than that, no infection was transmitted. CONCLUSION Complete reporting of NSIs is a prerequisite for the identification of risky procedures and to ensure optimal treatment of the affected health care personnel. The accident insurance doctor must possess a high degree of interdisciplinary competence in order to treat NSI effectively.