NHS staff who refuse flu vaccine this winter will have to give reasons

NHS staff who refuse to have the flu vaccine this winter will have to give reasons to their employer, as leaders make efforts to improve take-up rates|  BMJ 2017359 

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Image source: Daniel Dionne – Flickr // CC BY-SA 2.0

 NHS leaders are to write to all NHS staff urging them to be vaccinated against flu as soon as possible. The letter will make it clear that staff who refuse the vaccine will have to give reasons to their employing NHS trust, which will then be recorded.

The heads of NHS England, Public Health England, the Department of Health for England, and NHS Improvement said that they were writing to remind staff of their “professional duty to protect their patients.” Trusts are also being urged to make the flu vaccine “readily available” to staff.

Although last year saw record take-up of the vaccine among staff, more than a third of NHS staff members did not take up the offer, with just a fifth being vaccinated in some trusts.

Hospitals and GP surgeries are being warned by NHS England to be prepared for a big increase in cases of flu this winter after a heavy season in the southern hemisphere.

Full story via BMJ 2017359 doi: https://doi.org/10.1136/bmj.j4766

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Exposure to information and seasonal influenza vaccination uptake in nurses

Coverage of annual influenza vaccination of healthcare workers (HCWs) varies and remains at a sub-optimal level in many countries | Journal of Hospital Infection

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As HCWs are often exposed to a variety of information on vaccination, their pattern of exposure may impact their decision, which deserves further investigation.

Practising nurses in Hong Kong were invited to participate in an anonymous online survey in February 2015, after the winter seasonal peak. The questionnaire covered demographics, work nature and experiences, vaccination uptake history and reasons for vaccination decisions. Two categories of behaviors with regards to information access were defined – (A) passive exposure to information, and (B) active information-seeking, as differentiated by the source, type and nature of information accessed. Chi-square test, Mann-Whitney U test, logistic regression were performed to compare between vaccinated and unvaccinated nurses.

A total of 1177 valid returns were received from nurses who had a median age of 32, of whom 86% were female. The overall vaccination rate was 33%. Passive exposure to information from workplace, professional body and social network did not predict vaccination decision, while mass media did (OR:1.78). Active information-seeking involving consulting seniors (OR:2.46), having organized promotion activities (OR:2.85) and performing information search (OR:2.43) were significantly associated with increased vaccination uptake. Cumulative effect could be demonstrated for active information seeking (OR:1.86) but not passive exposure to information.

Current strategy of promotions and campaigns for seasonal influenza vaccination in HCWs may not be effective in increasing vaccination coverage. Measures targeting information-seeking behaviors may serve as an alternative approach.

Full reference: Cheung, E.K.H. et al. (2017) Pattern of exposure to information and its impacts on seasonal influenza vaccination uptake in nurses. Journal of Hospital Infection. Published online: 11 August 2017

Disinfection of gloved hands for multiple activities with indicated glove use on the same patient

Most hand hygiene guidelines recommend that gloves should be changed during patient care when an indication for hand disinfection occurs | The Journal of Hospital Infection

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Observational studies indicate that the majority of healthcare workers (HCWs) do not disinfect their hands at all during continued glove wear. The aim of this narrative review is to assess the potential benefits and risks for disinfecting gloved hands during patient care for multiple activities with indicated glove use on the same patient.

Continued glove wear for multiple activities on the same patient often results in performing procedures, including aseptic procedures with contaminated gloves, especially in a setting where there are many indications in a short time, e.g. anaesthetics or accident and emergency departments. Of further note is that hand hygiene compliance is often lower when gloves are worn. To date, three independent studies have shown that decontamination is at least as effective on gloved hands as on bare hands and that puncture rates are usually not higher after up to 10 disinfections. One study on a neonatal intensive care unit showed that promotion of disinfecting gloved hands during care on the same patient resulted in a significant reduction in the incidence of late-onset infections and of necrotizing enterocolitis.

We conclude that disinfection of gloved hands by HCWs can substantially reduce the risk of transmission when gloves are indicated for the entire episode of patient care and when performed during multiple activities on the same patient.

Full reference: Kampf, G. & Lemmen, S. (2017) Disinfection of gloved hands for multiple activities with indicated glove use on the same patient. The Journal of Hospital Infection. Published online: June 22 2017

Reducing the Risk of Mouth to Mouth Transmission of Pathogens Via Parking Tickets.

In the initial phase of our study 598 staff members were observed entering the carpark. 21.6% of them put their parking ticket in their mouth | Journal of Hospital Infection

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Using UV dye we successfully demonstrated card-to-card cross-contamination. Swabs of the ticket machine yielded commensal bacteria: coagulase negative staphylococci and a Bacillus species.

After placing a poster on the ticket-reading machine highlighting this potential infection risk, a further 1366 observations resulted in a statistically significant and persistent decline in the proportion of staff putting their carpark tickets in their mouths (p<0.001).

Full reference: Groves, J. et al. (2017) Reducing the Risk of Mouth to Mouth Transmission of Pathogens Via Reusable, Machine-read, Parking Tickets. An observational cohort study. Journal of Hospital Infection. Published online: June 08, 2017

Transmission of Staphylococcus aureus between health-care workers, the environment, and patients in an intensive care unit

Price, J.R. et al. (2017) The Lancet Infectious Diseases. 17(2) pp. 207–214

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Background: Health-care workers have been implicated in nosocomial outbreaks of Staphylococcus aureus, but the dearth of evidence from non-outbreak situations means that routine health-care worker screening and S aureus eradication are controversial. We aimed to determine how often S aureus is transmitted from health-care workers or the environment to patients in an intensive care unit (ICU) and a high-dependency unit (HDU) where standard infection control measures were in place.

Interpretation: In the presence of standard infection control measures, health-care workers were infrequently sources of transmission to patients. S aureus epidemiology in the ICU and HDU is characterised by continuous ingress of distinct subtypes rather than transmission of genetically related strains.

Read the full abstract here

Smartphone text message service to foster hand hygiene compliance in health care workers

Kerbaj, J. et al. American Journal of Infection Control. Published online 9 December 2016

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Background: Health care-associated infections are a major worldwide public health issue. Hand hygiene is a major component in the prevention of pathogen transmission in hospitals, and hand hygiene adherence by health care workers is low in many studies. We report an intervention using text messages as reminders and feedback to improve hand hygiene adherence.

Conclusions: Text message feedback should be incorporated into multimodal approaches for improving hand hygiene compliance.

Read the full abstract here

Utilizing the Surgical “Time-out” and Hand-off Protocols to Deter High-Risk Needlesticks

Katsevman, G.V. et al. Journal of Hospital InfectionPublished online: November 3 2016

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About 35.7 million healthcare workers face sustaining a needlestick injury worldwide and an estimated 384,000 percutaneous injuries occur annually in United States hospitals alone.1,2 Although needlestick injuries continue to pose a major occupational hazard for healthcare workers, underreporting and a “culture of silence” persist.3 Few papers suggest solutions. We propose a novel solution that will help deter high-risk (i.e., history of human immunodeficiency virus (HIV), bloodborne hepatitis virus, or intravenous (IV) drug abuse) needlesticks in the operating room (OR) and the wards.

Read the abstract here