Running Head: EFFECTS OF INFLUENZA AND HEPATITIS B VACCINATIONS 1

Effects of Influenza and Hepatitis B Vaccinations on Healthcare Workers and Patients

Rey X. Colon, Anthony J. DeVengencie, Jasmine M. Smith, Tramaine Tillis

04/03/2017

NURS 3947: Nursing Research

Dr. Valerie O’Dell

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Abstract

The purpose of this research was to look at the effects of influenza and hepatitis B vaccinations

on healthcare workers and their patients. Factors such as influenza and hepatitis B backgrounds,

their coinciding vaccination rates, potential patient and healthcare worker benefits, and

healthcare worker vaccination compliance rates were explored. This research was drawn from

ten references ranging from qualitative studies, textbooks, and literature reviews. It was found

that vaccinations can help reduce transmission rates between healthcare workers and their

patients in theory, but despite the strong recommendations for immunizations not all employers

mandate vaccinations upon employment. A percentage of healthcare workers abstain from

influenza and hepatitis B vaccinations resulting in a higher risk of infection transmission. There

was no definite evidence directly relating rates of vaccinations to transmission rates in the studies

analyzed. There were other benefits shown such as reduced sick days for vaccinated healthcare

workers when compared to their unvaccinated counterparts. Overall, the research showed that

despite the potential beneficial effects of influenza and hepatitis B vaccinations, not all

healthcare workers are immunized and there is risk for potential infections to occur that could be

prevented by vaccinations.
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Effects of Influenza, Hepatitis B, and Pertussis Vaccinations on Patients and Healthcare Workers

Each year, a portion of the human population acquires preventable diseases caused by

various infectious agents such as viruses or bacteria. Depending on the type of infectious agent,

these diseases can be spread from person to person through various modes of transmission. Such

modes can include direct contact with an infected individual or contaminated source, indirect

contact such as through coughing and sneezing, and some diseases can even be airborne for days

(Hinkle, Cheever, 2013). There are multiple ways to prevent the spread of diseases in the

healthcare setting, which include hand hygiene, the use of personal protective equipment, and

vaccinations. Vaccinations are used to produce immunity in the body (Hinkle, Cheever, 2013).

Healthcare professionals, such as a registered nurse (RN), practice proper hand hygiene and

personal protective equipment usage in all healthcare settings, but vaccines to preventable

diseases are not universally standard. Some studies performed on the vaccination rates of certain

preventable diseases such as influenza and hepatitis B in healthcare settings show potential

beneficial effects on both the patient and healthcare workers. Vaccinations can reduce

transmission rates to and from patients and can also reduce the amount of sick days health care

workers take. Despite these potential beneficial effects, research is conflicting on the extent of

benefits and some healthcare employers do not mandate certain vaccinations while a portion of

healthcare workers abstain from obtaining immunizations altogether. Therefore, the following

research question was addressed: How do the rates of vaccinations of influenza and hepatitis B

affect healthcare workers and their patients?

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Literature Review

Information was acquired via Ohio LINK databases, specifically CINHAL Plus and

MEDLINE. Ten sources were reviewed and analyzed in order to compare and contrast the

effects of vaccinations of influenza and hepatitis B on healthcare workers and their patients.

Backgrounds for influenza and hepatitis B will be discussed along with studies that analyzed

their coinciding vaccination rates, patient benefits, and healthcare worker vaccination

compliance rates along with other miscellaneous factors specific to each disease.

Influenza

Influenza is a viral infection that affects the respiratory system and could lead to other

complications such as pneumonia. “Each year, the influenza virus is responsible for a significant

number of hospitalizations and deaths, especially among the elderly” (Rosati et al., 2016, p.178).

The elderly populations are at an increased risk for contracting influenza due to the decreasing

efficiency of their body systems such as their respiratory and immune systems. It is important

for this demographic and others at increased risk to receive the yearly influenza vaccine in order

to prevent acute symptoms. These influenza vaccines are designed annually to defend against the

most likely strands of the virus to appear during that season.

Since healthcare settings are made up of a vast populace of employees, these staff

members serve as vehicles for modes of transmission. Nurses are at the front line of preventative

care in many healthcare settings and they typically spend the majority of their days taking care of

patients. If a staff member becomes ill, they could potentially spread the illness before they

show manifestations of the virus or bacterial infection. Vaccinations not only protect the patients

from unnecessary complications, but they also protect the nurses from acquiring the illness as

well. This is a key concept for the use of preventative vaccinations and why mandating or not
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mandating vaccinations is a nursing issue. This can lead to an epidemic within the hospital or

health care community, depending on what virus or bacteria is spread and if the patients or staff

members are vaccinated.

Unvaccinated nurses may need time off from work to recover from the illness. This could

leave the hospital short staffed for a period of time depending on the depth of the hospital staff.

“Health care workers in hospitals had the highest uptake (89.6%) of the influenza vaccine

whereas those working in LTC facilities and Home Health Agencies (HHAs) had the lowest

coverage (61%)” (Rosati et al., 2016, p.178). The statistics from this study showed that neither

facility had a 100% compliance rate. It is important to understand why some employees do not

want to receive the recommended vaccinations. Some reasons listed in the study were beliefs of

not being in a high risk group, current health status, not liking injections, and lack of education

(Rosati et al., 2016). In order to increase compliance, employers could pass out pamphlets on the

composition of the vaccine, administration method, and the risks of complications from the

immunization. This can reduce noncompliance due to misconceptions and misinformation.

Hospitals also have the option of making certain immunizations mandatory, which would cause

their rates to increase but could also influence workers to seek employment elsewhere.

The participants in the multiple research studies to be discussed were of different health

care facilities. The first study “The Benefits and Challenges of the Influenza Vaccination Among

Home Health Care Workers” focused on a Home Health Care agency in New Jersey (NJ). The

particular agency was chosen because nurses provided direct care to the patients. At the start of

the Influenza season all staff were offered free vaccinations at various locations in NJ. When the

employees were to receive the yearly vaccination it was recorded by the facilities infection

control department whether or not they had received the immunization (Rosati et al., 2016).
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Employees that did not have proper documentation of the flu shot were contacted monthly to

update their current status. Approaching the end of the flu season, the agency sent out a survey to

all employees who did not receive the immunization or did not have proper documentation

proving they were in compliance. The survey was anonymous, asking questions concerning the

staff member’s choice to forgo the vaccine for the season.

The second study “Examining the role of a decision aid in reducing decisional conflict

amongst hospital healthcare workers towards receiving the influenza vaccine” focused on

participants in two hospital settings. The study was voluntary and posted signs as well as notified

supervisors on units to spread the information by word of mouth. Once the researchers acquired

enough volunteers of various hospital staff 41 to be exact they had the participants sign waivers.

The participants were offered a reward for participating in the study (Seale et al., 2016).

In the first study the results of the research showed an uptake of the influenza vaccine

over the three flu seasons covered. The rate of flu vaccines amongst employees improved from

38% to 74% and then the following year increased to 88% (Rosati et al., 2016). This indicated

that the efforts made to increase staff influenza vaccination rates were successful. Forty Three

percent of the staff members that chose not to receive the flu shot responded to the survey. Out

of the 43%, 59% reported seeing patients daily and typically work full time. (Rosati et al., 2016).

The survey of employees that did not receive the flu vaccine concluded the following

data, when asked on a scale of strongly agree to strongly disagree 27.8% of staff members

believe that they are not in a high risk group. If compared to the other survey taken of the same

employees where they could only choose one option as the most likely reason for noncompliance

the results show, staff members feel the vaccine will make them sick. These are both

misconceptions of the staff members. Healthcare workers are at increased risk of contracting
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Influenza due to the amount of sick patients with the illness they are around. The number one

reason the home health care workers refused the vaccination is also a misconception. The flu

shot will not infect the recipient with Influenza, people tend to have this view because some flu

like manifestation can come about after receiving the vaccination but they subside within days

(Hinkle, Cheever, 2013).

In the second study the research was based on a decisional aid tool, this tool helped

workers in both hospitals in choosing to receive or not receive the flu vaccine. The decisional aid

is an online program that evaluated employees influence on importance of vaccinations. It starts

out by asking them a series of questions relating to reasons why they wouldn't or would want to

be immunized (Seale, et al., 2016). After moving on in the aid, they are given general

information about the Influenza vaccine and are asked if they wish to receive the immunization.

The study used qualitative methods to collect data on reasons employees wished not to

vaccinated, some people in the study felt the Influenza vaccine was new to the public. Other

employees were surprised to find out they are at risk of contracting the flu as well as the adults

greater than forty five and children. (Seale et al., 2016). The study ultimately proved the

decisional aid as useful because it showed a decrease in workers that were unsure about

receiving the immunization.

Hepatitis B Virus

The hepatitis B virus can be found in body fluids such as blood, saliva, semen and

vaginal secretions which can permeate through any break in the skin and infect an individual. It

is transmitted primarily through blood (percutaneous and per mucosal routes) (Hinkle, Cheever,

2013, p.1360). Healthcare workers who provide direct care to their patients use standard

precautions to prevent the potential transmission of this virus to themselves and to other patients.
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“The risk of acquired hepatitis B infection, after a single exposure to hepatitis B virus-infected

blood or body fluid, ranges from six percent to 30 percent with increased risk attributed to

repeated exposure”(Garcell et al., 2016). Proper hand hygiene along with personal protective

equipment use can reduce the rates of transmission of any communicable disease including HBV

but obtaining the HBV vaccination is also strongly recommended to reduce these rates (Hinkle,

Cheever, 2013, p.1362).

Immunization of healthcare workers against selected diseases is strongly recommended,

taking into account the high risk of exposure they have to blood, secretions or body fluids or

other potentially contaminated environmental sources by microbial agents potentially vaccine-

preventable (Garcell et al., 2016).Hepatitis B vaccination is currently recommended or mandated

for healthcare workers worldwide (Garcell et al., 2016).Despite the beneficial immunity effect

the HBV vaccination has, many healthcare employers do not mandate their workers to obtain it

upon employment. A study performed on the staff of a 75 bed community hospital based in

Dukhan, Qatar showed that HBV vaccination compliance of healthcare professionals varied

(Garcell et al., 2016). Of 705 HCWs studied, 595 (84.4%) workers received a full hepatitis B

vaccination schedule; 110 (15.6%) received a single dose out of whom, 85 (77.3%) had

incomplete vaccination schedule, while 25 (22.7%) received booster doses. The full schedule

was reported with significantly (p<0.001) higher frequency by nurses (90.2%) compared with

physicians (74.1%) and technicians (79.7%) (Garcell et al., 2016).

Abstaining from receiving the HBV vaccine for a healthcare worker may put one at risk for

infection despite proper personal protective equipment usage and hand hygiene. Accidents do

occur (needle sticks or other sharps injuries) and “Occupational exposures to hepatitis B virus

have historically accounted for as many as four and a half percent of the acute hepatitis B cases
EFFECTS OF INFLUENZA AND HEPATITIS VACCINATIONS 9

reported in the USA” (Garcell et al., 2016, p.235). Some reasoning’s surveyed healthcare

workers used for not obtaining vaccinations included the belief that one was not at risk for

infection, misinformation about the vaccine’s probability of instilling illness, and even the

avoidance of being stuck with a needle (Rosati et al., 2016). Other studies even question the

extent of benefits from employer mandated vaccination on patients themselves (De Serres et al.,

2017). Despite these potential reasons for not getting vaccinated, immunizations are strongly

recommended for the human population, especially healthcare workers.

Conclusion

Studies have shown that influenza and hepatitis B vaccination rates can affect the

transmission rates between healthcare workers and their patients. Healthcare workers benefit

from these immunizations by protecting themselves from potential infectious occupational

hazards. They also minimize the possibility of transferring these infectious agents to their

patients. Despite the benefits, not all employers mandate influenza and hepatitis B vaccines upon

employment putting some healthcare workers at risk. Dispersing educational material on

vaccinations may alert healthcare workers to possible dangers of not being vaccinated and

increase compliance rate of staff immunizations. Despite strong recommendations for

vaccinations, some studies claim that the effects of healthcare worker immunization on patient

care are exaggerated. There is little data directly correlating rates of infection with vaccination

rates in public healthcare settings. The data available concentrates mostly on rates of

vaccinations and does not factor in the effects on transmission rates of nosocomial infections

such influenza or hepatitis B inoculation. This may be because it is difficult to determine the

origin of an infection unless it is obvious as in a needle stick or sharps injury.

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