| Popis: |
Background: Rates of healthcare worker (HCW) influenza vaccination remain suboptimal, however the most effective way to increase uptake is controversial. We conducted a systematic review of the literature of interventions to increase influenza vaccine coverage in HCWs. Methods: An expert librarian searched the following databases to July 9, 2013: MEDLINE, EMBASE, CENTRAL, Web of Science, Scopus, and CINAHL. References and conference abstracts were also searched. Interventions were classified into 9 categories (see results). Two reviewers independently extracted data and classified risk of bias. Primary outcomes were 1) reduction in number of unvaccinated HCWs, and 2) interventions that achieved 95% vaccination rates; each at 1 year (early) and 3 ±1 years (late) after intervention implementation. Results: 9193 titles/abstracts were reviewed, and 121 were included (Fig 1). Of 174 comparisons, 78 were low risk of bias (RoB), 30 were moderate RoB, and 66 were high RoB. There were 132 before/ after studies, 23 randomized trials, 12 surveys, 7 cohort studies, and 1 case-control study. All interventions were significantly associated with a reduction in unvaccinated HCWs (listed from largest to smallest effect size): condition of service [12 studies; 357,560 HCWs; 93% reduction in unvaccinated HCWs, (95%CI 91-95%); I2=99%], vaccine-or-mask [12 studies; 581,926 HCWs; 74% (61-88%); 100%], declination forms [14 studies; 209,290 HCWs; 41% (35–46%); 98%], audit-and-feedback [15 studies; 545,403 HCWs; 35% (29–40%); 99%], increased vaccine access [46 studies; 764,570 HCWs; 32% (27–36%); 100%], role models [18 studies; 204,514 HCWs; 30% (24–36%); 99%], peer-vaccination [7 studies; 120,670 HCWs; 29% (10–45%); 100%], incentives [17 studies; 188,933 HCWs; 28% (21– 33%); 99%], and education/promotion only [16 studies; 554,706 HCWs; 11% (7–16%); 99%]. The interventions that achieved 95% HCW vaccination rates were: condition of service (13/13 early; 4/4 late), vaccine-or-mask (3/15 early; 0/2 late), and role models (1/19 early; 1/10 late). Conclusion: All interventions examined increased HCW influenza vaccine uptake to various degrees. However, only condition of service policies appear to result in sustained HCW vaccination rates of >95%. |
