Promotion of influenza vaccination among health care workers: findings from a tertiary care children’s hospital in Italy

Cozza et al. BMC Public Health (2015) 15:697 DOI 10.1186/s12889-015-2067-9 RESEARCH ARTICLE Open Access Promotion of influenza vaccination among health care workers: findings from a tertiary care children’s hospital in Italy Vanessa Cozza1,2, Valeria Alfonsi3, Maria Cristina Rota3, Valerio Paolini2 and Marta Luisa Ciofi degli Atti4* Abstract Background: The aims of this study were: a) to evaluate attitudes and practices of health care workers (HCWs) towards influenza vaccination and their opinion regarding a vaccination promotion toolkit; b) to estimate hospital HCWs’ influenza vaccination coverage rates (VC). Methods: The Bambino Gesù Children’s Hospital (OPBG) is an academic hospital in Italy. Since 2009, free influenza vaccination is offered to HCWs during working hours. In October-December 2013, a communication campaign based on a standardized toolkit was conducted. In December 2013, we performed a cross-sectional survey in a sample of hospital wards, based on a self-administered questionnaire including participants’ characteristics; self-reported influenza vaccination history; reasons for vaccination or missed vaccination; opinion regarding the toolkit. Multivariable logistic analysis was used to assess independent predictors of influenza vaccination status. Annual VC for years 2009–2013 was estimated by using the number of seasonal influenza vaccine doses administered to HCWs as numerator, and the number of hospital HCWs as denominator. Results: Out of 191 HCWs who participated in the survey, 35.6 % reported at least one influenza vaccination during their life; 6.8 % adhered to annual revaccination. Years of service and professional category were significantly and independently associated with vaccination (adjusted-OR: 2.4 for > 10 years of service, compared to < 5 years of service; adjusted-OR: 2.6 for physicians compared to nurses). Patient protection was the main reported reason for vaccination (34.3 %); considering influenza a mild disease was the main reason for non-vaccination (36.9 %); poor vaccine effectiveness was the main reason for missed annual revaccination (28.8 %). Overall, 75 % of respondents saw at least one promotion tool; 65.6 % of them found the information useful. Hospital VC decreased from 30 % in 2009, to 5 % in 2012. In 2013, VC was 14 %. Conclusions: Satisfactory influenza VC in HCWs is hard to achieve. In 2013, along with the toolkit implementation, we observed an increase in HCWs’ vaccination coverage, nevertheless, it remained unsatisfactory. Tailored information strategies targeting nurses and recently employed HCWs should be implemented. Institution of declination statements, adding influenza vaccination to financial incentive systems, or vaccination requirements should also be considered to increase influenza VC among HCWs. Keywords: Influenza vaccine, Healthcare workers, Communication campaign, Attitudes * Correspondence: 4 Clinical Epidemiology Unit, Medical Direction, Bambino Gesù Children’s Hospital, Piazza Sant’Onofrio, 4, Rome 00165, Italy Full list of author information is available at the end of the article © 2015 Cozza et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http:// creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Cozza et al. BMC Public Health (2015) 15:697 Background Vaccination against seasonal influenza is recommended to health care workers (HCWs) by national and international institutions [1–4], in order to reduce the risk of acquiring influenza and transmitting the infection to vulnerable patients [5–8]. Influenza outbreaks may also cause HCWs’ absenteeism, resulting in inadequate staffing, diminished quality of care and increased costs [9, 10]. A recent meta-analysis confirmed that HCWs’ influenza vaccination is effective in preventing mortality and influenza cases among patients of healthcare facilities [11]. However, influenza vaccination coverage among HCWs remains suboptimal worldwide [12–15]. In Europe, data from 10 countries for the 2010–2011 influenza season showed a vaccination coverage <35 % in 8 countries, and ranging from 41 to 64 % in the remaining two countries [14]. In Italy, influenza vaccination of HCWs is recommended by the Ministry of Health and is offered free of charge by the national health service (NHS) [4]. However, data on vaccination coverage (VC) among HCWs are not routinely collected and the few ad-hoc studies have consistently found low coverage rates (12-34 %), also during the 2009–2010 pandemic [16–18]. Misperceptions about the severity of influenza, lack of knowledge on the benefits of the vaccination and fear of adverse events are frequently reported as reasons for missed vaccination [12, 16, 18]. Perceived lack of leadership support is also a potential barrier to HCWs’ influenza vaccination [12]. In 2011, the European Commission funded the HProImmune project [19], aiming at increasing awareness among HCWs of several vaccine preventable diseases, enhancing their knowledge on immunization and promoting vaccinations. The HProImmune consortium comprised 10 associated partners from 7 countries (Greece, Romania, Poland, Lithuania, Italy, Cyprus and Germany) and 2 European collaborating partners (WHO/EURO Centre for Environment and Health and Health Protection Agency - UK). Within this project, influenza vaccination was identified as a priority and a toolkit for immunization promotion was developed on the basis of healthcare personnel’s needs and perspectives, as identified through a literature review and through qualitative methods (i.e. focus groups) exploring behaviours and barriers towards immunization. In Autumn 2013, the Bambino Gesù Children’s Hospital, the largest Italian children’s hospital, used the HProImmune influenza toolkit to promote influenza vaccination for HCWs. In this article, we present: a) the results of a survey conducted among HCWs to assess attitudes and practices regarding influenza vaccination, and opinion regarding the toolkit; b) estimates of the hospital’s HCWs’ vaccination coverage rates for influenza from 2009 to 2013. Page 2 of 7 Methods Vaccination offer and communication campaign The Bambino Gesù Children’s Hospital (OPBG) is a tertiary care academic hospital, with 607 inpatient-bed, located in Rome, Italy. Since 2009, free influenza vaccination is offered to HCWs through mobile teams and dedicated vaccination sessions, from October to December. Information about the vaccination offer is sent to all hospital wards and posted on the hospital’s intranet. The number of influenza vaccine doses administered to HCWs is recorded by the Medical direction. In OctoberDecember 2013, a communic (...truncated)