Healthcare-Associated Infections _ ______________________________________________________________
• More rapid disinfection than other hand- hygiene techniques • Less damaging to skin • Time savings (18 minutes compared with 56 minutes per 8-hour shift)
CDC guidelines include four Level I recommendations to help increase rates of vaccination [304]: • Offer influenza vaccine annually to all eligible healthcare workers. • Provide influenza vaccination to healthcare workers at the work site and at no cost as one component of employee health programs. Use strategies that have been demonstrated to increase influenza vaccine acceptance, including vaccination clinics, mobile carts, vaccination access during all work shifts, and modeling and support by institutional leaders. • Monitor influenza vaccination coverage and declination of healthcare workers at regular intervals during influenza season and provide feedback of ward-, unit-, and specialty-specific rates to staff and administration. • Educate healthcare workers about the benefits of influenza vaccination and the potential health consequences of influenza illness for themselves and their patients, the epidemiology and modes of transmission, diagnosis, treatment, and nonvaccine infection control strategies, in accordance with their level of responsibility in preventing healthcare- associated influenza. In addition, the Joint Commission began including vaccination programs in its accreditation standards in 2007 [305]. Note: As of January 1, 2021, the Joint Commission eliminated its requirement that select healthcare facilities set a goal toward achieving a 90% vaccination rate. However, while the goal of 90% was retired, the rest of the standard remains in effect, and organizations are encouraged to “continue to strive to increase compliance with influenza vaccinations and take action to improve vaccination rates” [306]. Despite these guidelines, not all healthcare personnel are being vaccinated for influenza. Overall, 80.7% of healthcare person- nel in acute care hospitals and 45.4% of healthcare personnel in nursing homes reported receiving influenza vaccination during the 2023–2024 season, which was slightly higher than in the prevision season in which 75.9% reported vaccination [307]. Healthcare workers have given many reasons for not being vaccinated, and the reasons vary among categories of healthcare professionals [308]. Across all categories, shortage of the vaccine is the primary reason for not being vaccinated; other reasons include concern about side effects, inconve- nience, and forgetfulness [308]. Many reasons for receiving the vaccine have also been identified, including [303; 308]: • Fear of getting influenza • Fear of transmitting influenza to patients • Belief that the vaccine is safe • Belief that the vaccine is effective • Convenience
The guidelines suggest that healthcare facilities promote compliance by making the handrub solution available in dispensers in convenient locations (such as the entrance to patients’ room or at the bedside) and provide individual pocket-sized containers [29]. The handrub solution may be used in all clinical situations except for when hands are visibly dirty or are contaminated with blood or body fluids. In such instances, soap (either antimicrobial or nonantimicrobial) and water must be used. However, there are many other reasons for lack of adherence to appropriate hand hygiene, including denial about risks, forgetfulness, and belief that gloves provide sufficient protec- tion [29; 43]. These reasons demand education for healthcare professionals to emphasize the importance of hand hygiene. Also necessary is research to determine which interventions are most likely to improve hand-hygiene practices, as no studies have demonstrated the superiority of any intervention [298; 299]. Single interventions are unlikely to be effective [298; 299]. Several single-institution studies have demonstrated that appropriate hand hygiene reduces overall rates of HAIs, including those caused by MRSA and VRE [45; 296; 297]. However, rigorous evidence linking hand hygiene alone with the prevention of HAIs is lacking, making it difficult to evalu- ate the true impact of hand hygiene alone in reducing HAIs [59]. One challenge in evaluating the impact of hand hygiene is that a variety of methodologies have been used to assess compliance (e.g., surveys, direct observation, measurement of product use), each with its own advantages and disadvantages [300]. Measuring the effect of appropriate hand hygiene alone is also difficult because the intervention is often one aspect of a multicomponent strategy to reduce infection [45]. Lastly, as noted previously, the development of HAIs is complex, with many contributing factors. Although more research is needed to assess the individual impact of appropriate hand hygiene, this basic prevention measure is the essential foundation of an effective infection control strategy and an element of every infection control guideline. INFLUENZA VACCINATION The vaccination status of healthcare workers has been found to have a direct effect on transmission of the influenza virus to patients. Outbreaks of influenza in healthcare settings have been associated with low rates of vaccination among healthcare workers, and lower rates of nosocomial influenza have been related to higher vaccination rates among healthcare workers [301; 302]. Because of these findings, several organizations have addressed the need for vaccination. The CDC and the Advisory Committee on Immunization Practices recommends annual influenza vaccination for all healthcare workers [303].
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