title: Promotion of influenza vaccination among health care workers: findings from a tertiary care children's hospital in Italy.
abstract: BACKGROUND
  The aims of this study were: a) to evaluate attitudes and practices of health care workers (HCWs) towards influenza vaccination and their opinion regarding a vaccination promotion toolkit; b) to estimate hospital HCWs' influenza vaccination coverage rates (VC).
  
  
  METHODS
  The Bambino Gesù Children's Hospital (OPBG) is an academic hospital in Italy. Since 2009, free influenza vaccination is offered to HCWs during working hours. In October-December 2013, a communication campaign based on a standardized toolkit was conducted. In December 2013, we performed a cross-sectional survey in a sample of hospital wards, based on a self-administered questionnaire including participants' characteristics; self-reported influenza vaccination history; reasons for vaccination or missed vaccination; opinion regarding the toolkit. Multivariable logistic analysis was used to assess independent predictors of influenza vaccination status. Annual VC for years 2009-2013 was estimated by using the number of seasonal influenza vaccine doses administered to HCWs as numerator, and the number of hospital HCWs as denominator.
  
  
  RESULTS
  Out of 191 HCWs who participated in the survey, 35.6% reported at least one influenza vaccination during their life; 6.8% adhered to annual revaccination. Years of service and professional category were significantly and independently associated with vaccination (adjusted-OR: 2.4 for > 10 years of service, compared to < 5 years of service; adjusted-OR: 2.6 for physicians compared to nurses). Patient protection was the main reported reason for vaccination (34.3%); considering influenza a mild disease was the main reason for non-vaccination (36.9%); poor vaccine effectiveness was the main reason for missed annual revaccination (28.8%). Overall, 75% of respondents saw at least one promotion tool; 65.6% of them found the information useful. Hospital VC decreased from 30% in 2009, to 5% in 2012. In 2013, VC was 14%.
  
  
  CONCLUSIONS
  Satisfactory influenza VC in HCWs is hard to achieve. In 2013, along with the toolkit implementation, we observed an increase in HCWs' vaccination coverage, nevertheless, it remained unsatisfactory. Tailored information strategies targeting nurses and recently employed HCWs should be implemented. Institution of declination statements, adding influenza vaccination to financial incentive systems, or vaccination requirements should also be considered to increase influenza VC among HCWs.
authors.affiliation: Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy. cozza.vanessa@unifg.it.|Medical Direction, Bambino Gesù Children's Hospital, Rome, Italy. cozza.vanessa@unifg.it.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Cozza
authors.affiliation: Istituto Superiore di Sanità (ISS), National Centre for Epidemiology Surveillance and Health Promotion, Rome, Italy. valeria.alfonsi@iss.it.
authors.forename: Valeria
authors.initials: V
authors.lastname: Alfonsi
authors.affiliation: Istituto Superiore di Sanità (ISS), National Centre for Epidemiology Surveillance and Health Promotion, Rome, Italy. mariacristina.rota@iss.it.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Rota
authors.affiliation: Medical Direction, Bambino Gesù Children's Hospital, Rome, Italy. valerio.paolini@opbg.net.
authors.forename: Valerio
authors.initials: V
authors.lastname: Paolini
authors.affiliation: Clinical Epidemiology Unit, Medical Direction, Bambino Gesù Children's Hospital, Piazza Sant'Onofrio, 4, Rome, 00165, Italy. marta.ciofidegliatti@opbg.net.
authors.forename: Marta Luisa
authors.initials: ML
authors.lastname: Ciofi degli Atti
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D006282:Health Personnel / Q000706:statistics & numerical data*; D006293:Health Promotion / Q000458:organization & administration*; D006776:Hospitals, Pediatric; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000517:prevention & control*; D007558:Italy; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires; D063128:Tertiary Health Care
chemical_list: D007252:Influenza Vaccines