Public health in emergency medicine
Attitudes and Practices Regarding Influenza Vaccination Among Emergency Department Personnel

https://doi.org/10.1016/j.jemermed.2007.07.070Get rights and content

Abstract

In the United States, infections related to influenza result in a huge burden to the health care system and emergency departments (EDs). Influenza vaccinations are a safe, cost-effective means to prevent morbidity and mortality. We sought to understand the factors that contribute to the professional and personal influenza vaccination practices of health care workers in the ED setting by assessing their knowledge, attitudes, and practices with regards to the influenza vaccine. A cross-sectional study of all full-time ED staff (nurses, emergency medicine residents, and emergency medicine faculty) at an urban academic medical center in Boston treating > 90,000 ED patients annually, was performed. We examined knowledge, attitudes, and practices regarding personal influenza vaccination and support of an ED-based influenza vaccination program using an anonymous, self-administered questionnaire. Of 130 ED staff, 126 individuals completed the survey (97% response rate). Overall, 69% of respondents reported that they were very or extremely likely to be vaccinated before the coming influenza season. Residents (94%) and attending physicians (82%) were significantly more likely than nurses (42%) to be vaccinated (p < 0.001). Respondents likely to be vaccinated this year were more likely to support a vaccination program for ED patients (80% vs. 55% of those not vaccinated, p < 0.001). Providing regular education on the efficacy of preventive vaccination therapy and dispelling misconceptions regarding adverse effects may reduce barriers to vaccination programs. An educational initiative may result in acceptance of influenza vaccination by ED providers themselves, which could result in increased support for an influenza vaccination program for ED patients.

Introduction

In the United States, over 36,000 deaths and up to 114,000 hospital admissions annually are related to influenza (1, 2, 3). Influenza vaccinations are a safe, cost-effective means to prevent morbidity and mortality (4, 5, 6). To reduce the likelihood of infection, as well as to limit the rate of transmission to hospitalized patients, the Centers for Disease Control and Prevention recommend that all health care workers (HCW) involved in direct patient care receive influenza vaccinations annually (7). Research suggests that providers who get vaccinated themselves are more likely to recommend influenza vaccination to their patients (8, 9, 10). Moreover, an important determinant of patients' influenza vaccination behaviors is their provider's recommendation to get vaccinated (11, 12). However, despite long-standing recommendations for the routine influenza vaccination of HCWs, the vaccination rate in the United States is reported to be 38% (13).

The emergency department (ED) setting has been proposed as a venue for expanding vaccination coverage to adults at high risk for complications from influenza infection (14, 15, 16, 17, 18, 19, 20). A majority of unvaccinated ED patients indicated that they would accept vaccination if it were offered (14, 15). Over half of emergency physicians reported their willingness to prescribe influenza vaccination (16, 17). Still, every year in the United States, there are an estimated 2.8 million people treated in the ED setting with limited access to health care who are at high risk for influenza-related complications, but who go without being vaccinated (18). We sought to understand the factors that contribute to the professional and personal influenza vaccination practices of HCW in the ED setting by assessing their knowledge, attitudes, and practices with regards to the influenza vaccine. We hypothesized that barriers to being vaccinated against influenza among HCWs would differ by provider type. We also hypothesized that acceptance of influenza vaccination by HCWs in the ED was associated with support for an influenza vaccination program for ED patients.

Section snippets

Study Design and Protocol

In September 2005, we performed a cross-sectional study of all full-time ED staff (nurses, emergency medicine residents, and emergency medicine faculty) at an urban academic medical center in Boston treating > 90,000 ED patients annually. We examined knowledge, attitudes, and practices regarding personal influenza vaccination and support of an ED-based influenza vaccination program using an anonymous, self-administered questionnaire. We excluded temporary or per diem ED personnel. Research

Results

Of 130 ED staff, 126 individuals completed the survey (97% response rate); 46% of respondents were nurses, 28% were residents, and 26% were attending physicians. The three groups did not differ significantly on gender distribution, age, or number of years of clinical practice (Table 1).

Overall, 69% of respondents reported that they were very or extremely likely to be vaccinated before the coming influenza season (Table 2). Residents (94%) and attending physicians (82%) were significantly more

Discussion

In this study of hospital ED staff, two-thirds of respondents reported they were very or extremely likely to be vaccinated. Resident and attending physicians were more likely than nurses to be vaccinated. Factors associated with increased likelihood of vaccination included the belief that the vaccination is effective, and having been vaccinated in the previous year. Factors associated with decreased likelihood of vaccination included the belief that the side effects were common, and having

Conclusions

Barriers to influenza vaccination among ED staff are similar to those among HCWs in other settings. Providing regular education on the efficacy of preventive vaccination therapy and dispelling misconceptions regarding adverse effects may reduce these barriers. An influenza vaccine educational initiative may result in widespread acceptance of influenza vaccination by ED providers themselves, which could result in increased support for an influenza vaccination program for ED patients.

References (31)

  • M.L. Pearson et al.

    Influenza vaccination of health-care personnel: recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Advisory Committee on Immunization Practices (ACIP)

    MMWR Recomm Rep

    (2006)
  • S.L. LaVela et al.

    Attitudes and practices regarding influenza vaccination among healthcare workers providing services to individuals with spinal cord injuries and disorders

    Infect Control Hosp Epidemiol

    (2004)
  • A. Yassi et al.

    Influenza immunization: knowledge, attitude and behaviour of health care workers

    Can J Infect Control

    (1994)
  • C.A. Winston et al.

    Factors associated with vaccination of medicare beneficiaries in five U.S. communities: results from the racial and ethnic adult disparities in immunization initiative survey, 2003

    J Am Geriatr Soc

    (2006)
  • F.J. Walker et al.

    Influenza vaccination of healthcare workers in the United States 1989-2002

    Infect Control Hosp Epidemiol

    (2006)
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