Developing an Instrument to Assess Immunization Requirements Among Utah Health Care Workers in the Outpatient Setting

by

Print Friendly, PDF & Email

Nathan Wiley and Dr. Beth Luthy, College of Nursing

The health care environment is ideal for the spread of immunization-preventable and communicable diseases (Goldstein, Kincade, Gamble, & Bearman, 2004). Communicable diseases, such as pertussis, are highly contagious and easily transmitted by health care workers (HCWs) to at-risk patients (CDC, 1997; Sandora, Gidengil, & Lee, 2008). Pediatric patients, especially those under 5 years of age, are especially vulnerable to immunization-preventable diseases since they have not yet completed all immunizations in a given series. Since 2006, the CDC has recommended the cocoon immunization strategy, a program that aims to protect newborns from pertussis by immunizing caregivers of the infant (TCH, 2010). In addition to caregivers, HCWs are also at risk for infecting infants with the disease (Wicker & Rose, 2010). While the Tetanus, Diphtheria, and Pertussis (Tdap) immunization is recommended for HCWs, the vast majority of HCWs nationwide fail to comply with this guideline (Calderon et al., 2008).

While not currently required by the Utah State Department of Health, many Utah hospitals have instituted mandatory immunization requirements of their HCWs for communicable diseases such as flu, hepatitis, chickenpox, measles, and pertussis. However, it was unknown if Utah outpatient clinics have instituted similar compulsory immunization requirements for their HCWs. Because young children have an increased risk for mortality secondary to immunization-preventable diseases, such as pertussis, it is especially important to assess the immunization statuses of Utah HCWs employed in the pediatric outpatient setting. Since a study such as this was the first of its kind, there was no established tool for use in the literature. Thus, the purpose of this project was to develop an instrument to assess immunization requirements among Utah HCWs employed in the pediatric outpatient clinic setting. We hope that developing an instrument to evaluate the immunization requirements of HCWs in pediatric outpatient settings will be of great value, not only in the State of Utah but potentially for use by health departments across the nation.

Before attempting to develop the instrument on our own, a search was conducted using the CINAHL database to review the literature regarding evaluation of immunization requirements of HCWs in any setting. The hope was that we might find a study of that nature that had already developed an evaluative instrument similar to the instrument we needed to develop. With access to such an instrument, we would be able to use it as a base blueprint and alter it to our needs, rather than building one from scratch. Two related studies were found that might have used instruments similar to the one we intended to develop. The corresponding authors of both studies were contacted via email to request a copy of their respective instruments. Permission was also obtained to use their work in developing our own instrument. The instrument used by Miller, Ahmed, Lindley and Wortley (2011) was a questionnaire much like what we planned to create. This proved to be most useful and became the main blueprint in the development of our instrument. The other used by Harris, Maurer, Black, Euler, and Kadiyala (2011) was a phone interview script that provided some ideas for other questions to include, such as demographic questions. So, the work of these two groups of authors greatly contributed to our own.

Through collaboration with Utah immunization experts to further generate instrument items, we generated an initial version of the instrument. We then had these experts check for content validity and relevancy of the items. By analyzing this feedback, we created a pretest version of the instrument. This version was then pretested in the family practice setting. With feedback from the pretest participants, we then revised, improved, and polished the instrument.

Though my ORCA project officially ended with instrument development, we have since conducted the study in the Utah outpatient pediatric setting. I presented our preliminary findings at the nursing research conference held at Utah Valley University in October. We are now in the final stages of analysis and are preparing our work to be published. We intend to submit our work to Pediatrics. We hope that, with publication of our work, other researchers will become interested in evaluating the status and requirements of HCW immunizations in other areas. We have also already made slight alterations to the instrument to be used in a future study in the outpatient family practice setting.

This ORCA project has provided me with a great learning experience and I have appreciated the opportunity to work so closely with professors that have a passion for learning and mentoring and that continually seek to improve and expand upon research in their field of interest. I also appreciate the ORCA donors that made my participation in this research possible. I have learned so much and had so many unique opportunities throughout this research experience that I would have not received in my standard nursing curriculum.

References

  • Calderon, M., Feja, K., Ford, P., Frenkel, L., Gram, A., Spector, D., & Tolan, R. (2008). Implementation of a pertussis immunization program in a teaching hospital. American Journal of Infection Control, 36, 392-398.
  • Centers for Disease Control and Prevention. (1997). Immunization of health-care workers. MMWR, 46(RR-18), 1-42.
  • Goldstein, A., Kincade, J., Gamble, G., & Bearman, R. (2004). Policies and practices for improving influenza immunization rates among healthcare workers. Infection Control and Hospital Epidemiology, 25(11), 908-911.
  • Harris, K., Maurer, J., Black, C., Euler, G., & Kadiyala, S. (2011). Workplace efforts to promote
    influenza vaccination among healthcare personnel and their association with uptake during the 2009 pandemic influenza A (H1N1). Vaccine, 29, 2978-2985. doi:10.1016/j.vaccine.2011.01.112
  • Miller, B., Ahmed, F., Lindley, M., & Wortley, P. (2011). Institutional requirements for influenza vaccination of healthcare personnel: Results from a nationally representative survey of acute care hospitals – United States, 2011. Clinical Infectious Diseases, 53(11), 1051-1059. doi:10.1093/cid/cir633
  • TCH. (2010). The cocoon strategy – Preventing severe and fatal pertussis (whooping cough) in infants through family immunization. Retrieved from http://www.texaschildrens.org/carecenters/vaccine/programs.aspx
  • Wicker, S., & Rose, M. (2010). Health care workers and pertussis: An underestimated issue. Medizinische Klini, 105, 882-886.