Healthcare workers experience occupational risk of infection and may transmit infections to patients. Vaccination provides an efficient means of protecting workers and patients, but uptake may be low. We sought to identify factors influencing vaccine acceptance by healthcare workers in order to obtain insights leading to more effective vaccination programs in this population.

Systematic review and meta-analysis.

We searched Medline, Embase, and CINAHL databases to identify studies published up to May 2012. Factors influencing vaccination acceptance were devised a priori. Random-effects meta-analysis was performed to generate summary estimates of effect. Heterogeneity and publication bias were explored using statistical tools.

Thirty-seven studies evaluating a variety of vaccines (against influenza, pertussis, smallpox, anthrax, and hepatitis B) were included. Homogeneous effects on vaccine acceptance were identified with desire for self-protection (odds ratio [OR], 3.42 [95% confidence interval (CI), 2.42–4.82]) and desire to protect family and friends (OR, 3.28 [95% CI, 1.10–9.75]). Concern that vaccine transmits the illness it was meant to prevent decreased acceptance (OR, 0.42 [95% CI, 0.30–0.58]). Differences in physician and nurse acceptance of immunization were seen between Asian and non-Asian studies.

Consideration of self-protection (rather than absolute disease risk or protection of patients) appears the strongest and most consistent driver of healthcare workers’ decisions to accept vaccination, though other factors may also be impactful, and reasons for between-study divergence in effects is an important area for future research. This finding has important implications for the design of programs to enhance healthcare worker vaccine uptake.

Infect Control Hosp Epidemiol 2014;35(6):699–708

Standard precautions are advocated for reducing the number of injuries caused by needles and sharp medical devices (“sharps injuries”), but the effectiveness of gloves in preventing such injuries has not been established. We evaluated factors associated with gloving practices and identified associations between gloving practices and sharps-injury risk.

Usual-frequency case-crossover study.

Thirteen medical centers in the United States and Canada.

Six hundred thirty-six healthcare workers who presented to employee health clinics after sharps injury.

Structured telephone questionnaires were administered to assess usual behaviors and circumstances at the time of injury.

Of 636 injured healthcare workers, 195 were scrubbed in an operating room or procedure suite when injured, and 441 were injured elsewhere. Nonscrubbed individuals were more commonly gloved when treating patients who were perceived to have a high risk of human immunodeficiency virus, hepatitis B virus, or hepatitis C virus infection than when treating other patients (adjusted odds ratio [aOR], 2.53 [95% confidence interval {CI}, 1.30-4.91]). Nurses (aOR, 0.11 [95% CI, 0.04-0.32]) and other employees (aOR, 0.24 [95% CI, 0.07-0.77]) were less commonly gloved at injury than were physicians and physician trainees. Gloves reduced injury risk in case-crossover analyses (incidence rate ratio [IRR], 0.33 [95% CI, 0.22-0.50]). In scrubbed individuals, involvement in an orthopedic procedure was associated with double gloving at injury (aOR, 13.7 [95% CI, 4.55-41.3]); this gloving practice was associated with decreased injury risk (IRR, 0.20 [95% CI, 0.10-0.42]).

Although the use of gloves reduces the risk of sharps injuries in health care, use among healthcare workers is inconsistent and may be influenced by risk perception and healthcare culture. Glove use should be emphasized as a key element of multimodal sharps-injury reduction programs.

To examine the impact of different acellular pertussis booster vaccination strategies on the probability of a nosocomial pertussis outbreak occurring and the distribution of outbreak sizes observed for each intervention strategy.

Neonatal intensive care unit.

We developed a stochastic, agent-based simulation model to examine the impact of booster vaccination strategies for pertussis on health care-related transmission.

Our results demonstrate that healthcare worker booster vaccination decreases the probability of secondary transmission from 49% (base case, no boosting) to 2% (if 95% of healthcare workers are boosted) and decreases final outbreak size. Boosting family caregivers did not have a clinically significant impact on nosocomial disease transmission.

The provision of booster vaccine to healthcare workers in the neonatal intensive care unit substantially reduces the risk of hospital-centered pertussis outbreaks in a manner that enhances the health of hospitalized children. A formal health economic analysis of this finding is currently under way. Policies to protect patient safety in pediatric facilities should include compliance with the United States Advisory Committee on Immunization Practices, which recommends provision of pertussis booster vaccination to healthcare workers.

Recognition of seasonal trends in hospital infections may improve diagnosis, use of empirical therapy, and infection prevention interventions. There are very few data available regarding the seasonal variability of these infections. We quantified the seasonal variation in the incidences of hospital infection caused by common bacterial pathogens and estimated the association between temperature changes and infection rates.

A cohort of all adult patients admitted to the University of Maryland Medical Center during the period from 1998 through 2005 was analyzed. Time-series analyses were used to estimate the association of the number of infections per month caused by Pseudomonas aeruginosa, Acinetobacter baumannii, Enterobacter cloacae, Escherichia coli, Staphylococcus aureus, and enterococci with season and temperature, while controlling for long-term trends.

There were 218,594 admissions to the index hospital, and analysis of 26,624 unique clinical cultures that grew the organisms of interest identified increases in the mean monthly rates of infection caused by P. aeruginosa (28% of isolates recovered; P < .01), E. cloacae (46%; P < .01), E. coli (12%; P < .01), and A. baumannii (21%; P = .06). For each 10°F increase, we observed a 17% increase in the monthly rates of infection caused by P. aeruginosa (P = .01) and A. baumanii (P = .05).

Significantly higher rates of gram-negative infection were observed during the summer months, compared with other seasons. For some pathogens, higher temperatures were associated with higher infection rates, independent of seasonality. These findings have important implications for infection prevention, such as enhanced surveillance during the warmer months, and for choice of empirical antimicrobial therapy among hospitalized adults. Future, quasi-experimental investigations of gram-negative infection prevention initiatives should control for seasonal variation.

Extreme fatigue in medical trainees likely compromises patient safety, but regulations that limit trainee work hours have been controversial. It is not known whether extreme fatigue compromises trainee safety in the healthcare workplace, but evidence of such a relationship would inform the current debate on trainee work practices. Our objective was to evaluate the relationship between fatigue and workplace injury risk among medical trainees and nontrainee healthcare workers.

Case-crossover study.

Five academic medical centers in the United States and Canada.

Healthcare workers reporting to employee healthcare clinics for evaluation of needlestick injuries and other injuries related to sharp instruments and devices (sharps injuries). Consenting workers completed a structured interview about work patterns, time at risk of injury, and frequency of fatigue.

Of 350 interviewed subjects, 109 (31%) were medical trainees. Trainees worked more hours per week (P < .001) and slept less the night before an injury (P < .001) than did other healthcare workers. Fatigue increased injury risk in the study population as a whole (incidence rate ratio [IRR], 1.40 [95% confidence interval {CI}, 1.03-1.90]), but this effect was limited to medical trainees (IRR, 2.94 [95% CI, 1.71-5.07]) and was absent for other healthcare workers (IRR, 0.97 [95% CI, 0.66-1.42]) (P = .001).

Long work hours and sleep deprivation among medical trainees result in fatigue, which is associated with a 3-fold increase in the risk of sharps injury. Efforts to reduce trainee work hours may result in reduced risk of sharps-related injuries among this group.