OBJECTIVES:To assess whether nursing homes (NHs) made organizational improvements to increase influenza vaccination rates in healthcare workers (HCWs) 1-3 In addition, it reduces the medical and non-healthcare costs related to influenza outbreaks and influenza-associated absenteeism of NH HCWs. 4,5 The Dutch association of NH physicians published a guideline in 2004 in which it recommended that all HCWs in NHs be immunized against influenza, followed by a national recommendation by the Health Council of the Netherlands in 2007.6,7 Despite these official recommendations and the efforts of institutions to increase vaccination rates, vaccination rates in HCWs remain low, less than 25% in Europe. 8,9 Persistently low vaccination rates in HCWs have led to debate between international scientists on implementing mandatory influenza vaccination. Those who favor mandatory vaccination cite the professional responsibility of HCWs not to do harm and their duty to support the collective efforts of the institution at which they work, which justifies some infringement of their personal autonomy. [10][11][12] Before the 2008/09 influenza season, a questionnaire study was conducted following a previous study. 13 It was hypothesized that NHs made organizational improvements to increase influenza vaccination rates in HCWs. In addition, the extent to which NH administrators agree with the arguments in favor of mandatory influenza vaccination for NH HCWs was quantified. METHODS Participants and MethodsIn October 2005, a questionnaire was sent to the administrators of all Dutch NHs (N 5 335). 13 The following items were assessed: influenza vaccination rates in NH residents (N 5 310). The total number of NHs was less than in 2005 because of closing and merging of 25 NHs. Reminders were sent after 2 and 4 weeks.Items concerning implementation of mandatory influenza vaccination were that influenza vaccination of NH HCWs is effective in reducing mortality and morbidity of NH residents, influenza vaccination of NH HCWs is effective in reducing the costs related to influenza, NH HCWs have a special responsibility in preventing influenza transmission to NH residents, administrators have a moral responsibility to implement voluntary influenza vaccination of NH HCWs, and mandatory influenza vaccination of NH HCWs should be implemented if voluntary vaccination fails to reach a sufficient vaccination rate. Respondents were asked to state to which extent they agreed or disagreed with these propositions on a 5-point Likert scale ranging from strongly agree to strongly disagree. Finally respondents were asked whether they had any supplementary comments. For the English translation of the questionnaire see Appendix 1. Statistical AnalysisData were analyzed using SPSS for windows (version 14.0, SPSS, Inc., Chicago, IL). The question on the current offering policy was dichotomized as active request versus employee initiative or none. The question on information offered to NH HCWs was dichotomized as any form of information versus no information of...
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