LaVela Sherri L, Hill Jennifer N, Smith Bridget M, Evans Charlesnika T, Goldstein Barry, Martinello Richard
Department of Veterans Affairs, Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines Jr. VA Hospital, Hines, IL; Center for Healthcare Studies, General Internal Medicine and Geriatrics, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Department of Veterans Affairs, Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines Jr. VA Hospital, Hines, IL.
Am J Infect Control. 2015 Jun;43(6):624-8. doi: 10.1016/j.ajic.2015.02.013. Epub 2015 Mar 19.
Health care worker (HCW) vaccination rates have been low for many years (approximately 50%). Our goal was to implement an influenza declination form program (DFP) to assess feasibility, participation, HCW vaccination, and costs.
This was a prospective interventional pilot study using mixed methods to evaluate the DFP implementation processes and outcomes. We conducted a formative evaluation and interviews; data were transcribed and coded into themes. Secondary outcomes included self-reported HCW influenza vaccine uptake (pre-/postsurvey) and program costs; data were evaluated using descriptive and bivariate analyses.
The DFP was compatible with ongoing strategies and unit culture. Barriers included multiple hospital shifts and competing demands. Facilitators included complementary ongoing strategies and leadership engagement. HCW vaccination rates were higher post- versus preimplementation (77.4% vs 53.5%, P =.01). To implement the DFP at site 1, using a mobile flu cart, 100% of declination forms were completed in 42.5 staff hours over <2 months. At site 2, using a vaccination table on all staff meeting days, 49% of forms were completed in 26.5 staff hours over 4.5 months. Average cost of staff time was $2,093 per site.
DFP implementation required limited resources and resulted in increased HCW influenza vaccine rates; this may have positive clinical implications for influenza infection control/prevention.
多年来医护人员（HCW）的疫苗接种率一直较低（约50%）。我们的目标是实施一项流感拒绝接种表格计划（DFP），以评估其可行性、参与度、医护人员疫苗接种情况和成本。
这是一项前瞻性干预性试点研究，采用混合方法评估DFP的实施过程和结果。我们进行了形成性评估和访谈；数据被转录并编码成主题。次要结果包括自我报告的医护人员流感疫苗接种率（调查前/后）和项目成本；数据使用描述性和双变量分析进行评估。
DFP与现行策略和科室文化相兼容。障碍包括医院多班次工作和相互竞争的需求。促进因素包括互补的现行策略和领导层的参与。实施后医护人员的疫苗接种率高于实施前（77.4%对53.5%，P = 0.01）。在1号地点，使用移动流感疫苗接种推车实施DFP，在不到2个月的时间里，42.5个工作人员工时内100%的拒绝接种表格填写完毕。在2号地点，在所有员工会议日使用疫苗接种台，在4.5个月内，26.5个工作人员工时内完成了49%的表格填写。每个地点工作人员时间的平均成本为2093美元。
DFP的实施需要有限的资源，并提高了医护人员的流感疫苗接种率；这可能对流感感染控制/预防具有积极的临床意义。
