Niedrige Influenzaimpfquoten bei Mitarbeitern im Gesundheitswesen

Zeit für einen neuen Ansatz
  • S. Wicker
  • H,F. Rabenau
  • R. Gottschalk
  • G. Krause
  • S. McLennan
In der Diskussion

Zusammenfassung

Trotz jahrzehntelanger Bemühungen, die Influenzaimpfquoten des medizinischen Personals zu verbessern, verbleiben diese auf einem unzureichenden Niveau. Lediglich jeder fünfte medizinisch Beschäftigte lässt sich in Deutschland impfen. Um nosokomiale Influenzaausbrüche zu vermeiden und den Schutz der Patienten sowie des medizinischen Personals sicherzustellen, sollten neue Konzepte zur Steigerung der Impfquoten erarbeitet werden. Erfahrungen aus den USA zeigen, dass die Einführung unterschriebener Impfablehnungen die Impfquoten erhöht. Ein möglicher Ansatz für Deutschland wäre eine Kombination aus unterschriebener Impfablehnung und dem ausschließlichen Einsatz geimpften Personals in definierten Bereichen. Hierdurch könnte auf der einen Seite die freie Entscheidung des medizinischen Personals über die Ablehnung einer medizinischen Behandlung respektiert werden, auf der anderen Seite würde dem Schutz der vulnerablen Patienten Rechnung getragen. In Deutschland sollten die Influenzadurchimpfungsquoten des medizinischen Personals erfasst werden, um die Umsetzung des Impfkonzeptes bewerten zu können. Analog zu den angestrebten Durchimpfungsquoten bei chronisch Kranken, sollte ein konkretes Impfziel für medizinisches Personal festgelegt werden.

Schüsselwörter

Impfquoten Influenza Mitarbeiter im Gesundheitswesen Unterschriebene Impfablehnung Verpflichtende Impfung 

Low influenza vaccination rates among healthcare workers

Time to take a different approach

Abstract

Despite decades of effort to encourage healthcare workers (HCWs) to be immunized against influenza, vaccination levels remain insufficient in Germany, with only one in five HCWs receiving the annual influenza vaccination. To prevent nosocomial influenza outbreaks and to ensure the protection of patients and HCWs, new approaches to increase vaccination rates are needed. The experience in the USA has shown that declination forms have increased vaccination coverage. One possible approach for Germany would be a combination of declination forms with the exclusive use of vaccinated staff in defined areas. This approach would respect a HCWs decision to refuse medical treatment, while at the same time protecting vulnerable patients. In addition, the influenza vaccination rates of HCWs should be collected in order to evaluate the implementation of vaccination policies. Similar to the setting of desired vaccination coverage for the chronically ill, a clearly defined vaccination goal should be established for HCWs.

Keywords

Vaccination rate Influenza Healthcare worker Declination form Mandatory vaccination 

Literatur

  1. 1.
    Robert Koch-Institut (2010) RKI-Ratgeber Infektionskrankheiten – Merkblätter für Ärzte: Influenza (Saisonale Influenza, Neue (pandemische) Influenza A/H1N1, Aviäre Influenza). Stand 23.08.2010, ladbar unter: http://www.rki.de/cln_160/nn_200120/DE/Content/Infekt/EpidBull/Merkblaetter/Ratgeber__Mbl__Influenza.htmlGoogle Scholar
  2. 2.
    WHO (2009) Fact sheet 211: Influenza. Ladbar unter: http://www.who.int/mediacentre/factsheets/fs211/en/index.htmlGoogle Scholar
  3. 3.
    Talbot TR, Babcock H, Caplan AL et al (2010) Revised SHEA position paper: influenza vaccination of healthcare personnel. Infect Control Hosp Epidemiol 31:987–995CrossRefPubMedGoogle Scholar
  4. 4.
    Hayward AC, Harling R, Wetten S et al (2006) Effectiveness of an influenza vaccine programme for home staff to prevent death, morbidity, and health service use among residents: cluster randomised controlled trial. BMJ 333(7581):1241CrossRefPubMedGoogle Scholar
  5. 5.
    Lemaitre M, Meret T, Rothan-Tondeur M et al (2009) Effect of influenza vaccination of nursing home staff on mortality of residents: a cluster-randomized trial. J Am Geriatr Soc 57:1580–1586CrossRefPubMedGoogle Scholar
  6. 6.
    Sullivan SJ, Jacobson R, Poland GA (2009) Mandating influenza vaccination for healthcare workers. Expert Rev Vaccines 8:1469–1474CrossRefPubMedGoogle Scholar
  7. 7.
    Dool C van den, Bonten MJM, Hak E et al (2008) The effects of influenza vaccination of health care workers in nursing homes: insights from a mathematical model. PLoS Med 5(10):e200. doi:10.1371/journal.pmed.0050200CrossRefPubMedGoogle Scholar
  8. 8.
    Salgado CD, Giannetta ET, Hayden FG, Farr BM (2004) Preventing nosocomial influenza by improving the vaccine acceptance rate of clinicians. Infect Control Hosp Epidemiol 25:923–928CrossRefPubMedGoogle Scholar
  9. 9.
    Potter J, Stott DJ, Roberts MA et al (1997) Influenza vaccination of health care workers in long-term-care hospitals reduces the mortality of elderly patients. J Infect Dis 175:1–6PubMedGoogle Scholar
  10. 10.
    Carman WF, Elder AG, Wallace LA et al. (2000) Effects of influenza vaccination of health-care workers on mortality of elderly people in long-term care: a randomised controlled trial. Lancet 355:93–97CrossRefPubMedGoogle Scholar
  11. 11.
    Robert Koch-Institut (2010) Empfehlungen der Ständigen Impfkommission (STIKO) am Robert Koch-Institut/Stand: Juli 2010. Epidemiol Bull 30:279–298Google Scholar
  12. 12.
    Gilbert GL, Kerridge I, Cheung P (2010) Mandatory influenza immunisation of health-care workers. Lancet Infect Dis 10:3–5CrossRefPubMedGoogle Scholar
  13. 13.
    Robert Koch-Institut (2010) Unberechenbare Grippe: Zeit für die Influenza-Schutzimpfung. Stand 13.09.2010, ladbar unter: http://www.rki.de/cln_160/nn_205760/DE/Content/Service/Presse/Pressemitteilungen/2010/16__2010.htmlGoogle Scholar
  14. 14.
    Blank PR, Schwenkglenks M, Szucs (2008) Influenza vaccination coverage rates in five European countries during season 2006/07 and trends over six consecutives seasons. BMC Public Health 8:272CrossRefPubMedGoogle Scholar
  15. 15.
    Blank PR, Schwenkglenks M, Szucs TD (2009) Disparities in influenza vaccination coverage rates by target group in five European countries: trends over seven consecutive seasons. Infection 37:390–400CrossRefPubMedGoogle Scholar
  16. 16.
    Müller D, Wutzler P, Szucs TD (2005) Influenza vaccination coverage rates in Germany. Med Klin 100:6–13CrossRefGoogle Scholar
  17. 17.
    Wicker S, Doerr HW, Gottschalk R et al (2007) Influenza: Akzeptanz der Schutzimpfung bei medizinischem Personal – Auswertung zur Influenzasaison 2006/2007. Dtsch Med Wochenschr 132:1683–1687CrossRefPubMedGoogle Scholar
  18. 18.
    Wicker S, Rabenau HF, Doerr HW, Allwinn R (2009) Influenza vaccination compliance among health care workers in a German university hospital. Infection 37:197–202PubMedGoogle Scholar
  19. 19.
    Anoymous (1982) Bekanntmachungen des Bundesgesundheitsamtes: 19. Sitzung der Ständigen Impfkommission des Bundesgesundheitsamtes. Bundesgesundheitsblatt 25:170–171Google Scholar
  20. 20.
    Becker MH (1974) The health belief model and personal health behaviour. Health Education Monographs 2:324–473Google Scholar
  21. 21.
    Hollmeyer HG, Hayden F, Poland G, Buchholz U (2009) Influenza vaccination of health care workers in hospitals – a review of studies on attitudes and predictors. Vaccine 27:3935–3944CrossRefPubMedGoogle Scholar
  22. 22.
    Poland GA (2010) Mandating influenza vaccination for health care workers: putting patients and professional ethics over personal preference. Vaccine 28:5757–5759CrossRefPubMedGoogle Scholar
  23. 23.
    Lam PP, Chambers LW, Pierrynowski MacDougall DM, McCarthy AE (2010) Seasonal influenza vaccination campaigns for health care personnel: systematic review. CMAJ 182:E542–E548PubMedGoogle Scholar
  24. 24.
    Gemmill I (2006) Mandatory immunization of health care providers: the time has come. Can J Public Health 97:86–89PubMedGoogle Scholar
  25. 25.
    Lambert SB (2008) Mandatory flu vaccination – patient care drives mandatory vaccination. BMJ 337:1188CrossRefGoogle Scholar
  26. 26.
    Lindley MC, Horlick GA, Shefer AM et al (2007) Assessing state immunization requirements for healthcare workers and patients. Am J Prev Med 32:459–465CrossRefPubMedGoogle Scholar
  27. 27.
    Poland GA, Jacobson RM (2007) Protecting patients from harm – legislating vaccinations for healthcare workers. Am J Prev Med 32:544–546CrossRefPubMedGoogle Scholar
  28. 28.
    Wicker S, Rabenau HF, Marckmann G et al (2009) Argumente für eine verpflichtende Influenza-Impfung. Dtsch Med Wochenschr 134:1650–1652CrossRefPubMedGoogle Scholar
  29. 29.
    Polgreen PM, Septismus EJ, Parry et al (2008) Relationship of influenza vaccination declination statements and influenza vaccination rates for healthcare workers in 22 US hospitals. Infect Control Hosp Epidemiol 29:675–677CrossRefPubMedGoogle Scholar
  30. 30.
    Talbot TR (2009) Do declination statements increase health care worker influenza vaccination rates? Clin Infect Dis 49:773–779CrossRefPubMedGoogle Scholar
  31. 31.
    Ribner BS, Hall C, Steinberg JP et al (2008) Use of a mandatory declination form in a program for influenza vaccination of healthcare workers. Infect Control Hosp Epidemiol 29:302–308CrossRefPubMedGoogle Scholar
  32. 32.
    Rakita RM, Hagar BA, Crome P, Lammert JK (2010) Mandatory influenza vaccination of healthcare workers: a 5-year study. Infect Control Hosp Epidemiol 31:881–888CrossRefPubMedGoogle Scholar
  33. 33.
    Talbot TR, Schaffner W (2010) On being the first: Virginia Mason Medical Center and mandatory influenza vaccination of healthcare workers. Infect Control Hosp Epidemiol 31:889–892CrossRefPubMedGoogle Scholar
  34. 34.
    Babcock HM, Gemeinhart N, Jones M et al (2010) Mandatory influenza vaccination of healthcare workers: translating policy to practice. Clin Infect Dis 50:459–464CrossRefPubMedGoogle Scholar
  35. 35.
    Sante JE de, Caplan A, Shofer F, Behrmann AJ (2010) Physicians attitudes towards influenza immunization and vaccine mandates. Vaccine 28:2517–2521CrossRefGoogle Scholar
  36. 36.
    Poland GA, Ofstead CL, Tucker SJ, Beebe TJ (2008) Receptivity to mandatory influenza vaccination policies for healthcare workers among registered nurses working on inpatient units. Infect Control Hosp Epidemiol 29:170–173CrossRefPubMedGoogle Scholar
  37. 37.
    Douville LE, Myers A, Jackson MA, Lantos JD (2010) Health care worker knowledge, attitudes, and beliefs regarding mandatory influenza vaccination. Arch Pediatr Adolesc Med 164:33–37CrossRefPubMedGoogle Scholar
  38. 38.
    Wicker S, Marckmann G, Poland GA, Rabenau HF (2010) Health care workers‘ perceptions of mandatory vaccination: results of an anonymous survey in a German university hospital. Infect Control Hosp Epidemiol 31:1066–1069CrossRefPubMedGoogle Scholar
  39. 39.
    Stewart AM (2009) Mandatory vaccination of health care workers. N Engl J Med 361:2015–2017CrossRefPubMedGoogle Scholar
  40. 40.
    Stewart AM, Rosenbaum S (2010) Vaccinating the health-care workforce: state law vs. institutional requirements. Public Health Rep 125:615–618PubMedGoogle Scholar
  41. 41.
    McLennan S, Wicker S (2010) Reflections on the influenza vaccination of healthcare workers. Vaccine Oct 21 [Epub ahead of print]Google Scholar
  42. 42.
    McLennan S, Gillett G, Ceil LA (2008) Healer, heal thyself: health care workers and the influenza vaccination. Am J Infect Control 36:1–4CrossRefPubMedGoogle Scholar
  43. 43.
    McLennan S, Vollweiler M, Celi LA (2009) How can nurses‘ flu vaccination rates be boosted? Nurs NZ 15:12–14Google Scholar
  44. 44.
    Tilburt JC, Mueller PS, Ottenberg AL et al (2008) Facing the challenges of influenza in healthcare settings: the ethical rationale for mandatory seasonal influenza vaccination and its implications for future pandemics. Vaccine 26:D27–D30CrossRefPubMedGoogle Scholar
  45. 45.
    Van Delden JJ, Ashcroft R, Dawson A et al (2008) The ethics of mandatory vaccination against influenza for health care workers. Vaccine 26:5562–5566CrossRefGoogle Scholar
  46. 46.
    Poland GA, Tosh P, Jacobson RM (2005) Requiring influenza vaccination for health care workers: seven truths we must accept. Vaccine 23:2251–2255CrossRefPubMedGoogle Scholar
  47. 47.
    Marckmann G (2008) Impfprogramme im Spannungsfeld zwischen individueller Autonomie und allgemeinem Wohl. Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 51:175–183CrossRefGoogle Scholar
  48. 48.
    Gavazzi G (2009) Influenza vaccination for healthcare workers: From a simple concept to a resistant issue? Aging Clin Exp Res 21:216–221PubMedGoogle Scholar
  49. 49.
    Rea E, Upshur R (2002) Mandatory vaccination of health care workers. CMAJ 166:301–302Google Scholar
  50. 50.
    Talbot TR, Bradley SE, Cosgrove SE et al (2005) Influenza vaccination of healthcare workers and vaccine allocation for healthcare workers during vaccine shortages. Infect Control Hosp Epidemiol 26:882–890CrossRefPubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag 2010

Authors and Affiliations

  • S. Wicker
    • 1
  • H,F. Rabenau
    • 2
  • R. Gottschalk
    • 3
  • G. Krause
    • 4
  • S. McLennan
    • 5
  1. 1.Betriebsärztlicher DienstKlinikum der Johann Wolfgang Goethe-Universität FrankfurtFrankfurt am MainDeutschland
  2. 2.Institut für Med. VirologieKlinikum der Johann Wolfgang Goethe-Universität FrankfurtFrankfurt am MainDeutschland
  3. 3.Amt für GesundheitFrankfurt am MainDeutschland
  4. 4.Robert Koch-InstitutBerlinDeutschland
  5. 5.Institut für Medizinische Ethik und Geschichte der MedizinRuhr-UniversitätBochumDeutschland

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