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      Knowledge, attitude and behavior towards vaccinations among nursing- and health care students in Hesse. An observational study Translated title: Wissen, Einstellung und Verhalten zu Impfmedizin bei Auszubildenden in medizinischen Ausbildungsberufen in Hessen. Eine Beobachtungsstudie

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          Abstract

          Objective: Work-related vaccinations are recommended for employees in nursing and health care professions due to their elevated risk of infection because of job-related exposure. These vaccinations prevent work-related infections, protect patients and help to maintain the medical infrastructure. Thorough training and imparting of knowledge about vaccinations and work-related infections are essential pillars of the vaccination decision and thus for achieving a protective immune status. The present study examines the knowledge, attitudes and behavior of nursing- and health care students in Hesse regarding work-related infections and vaccinations.

          Methods: In spring 2018, seven nursing schools in Hesse took part in an anonymous survey study. A total of 690 surveys from students of various health care professions were included in the study. The content of the survey was based on the recommendations of the Standing Committee on Vaccination (STIKO), a literature review and sample questions from the World Health Organization (WHO) regarding “vaccine hesitancy”. Vaccination cards were also evaluated based on the STIKO recommendations concerning standard vaccinations and occupational vaccinations for health care workers.

          Results: The risk of acquiring a work-related infection was estimated to be quite high over all years of training. Gaps in knowledge were particularly evident in the area of vaccinations. Only three quarter of those surveyed believed that the effectiveness of vaccinations has been proven, and nearly 30% believed that the doses of the drugs used in vaccines were dangerous. Over 80% of the students had never had an influenza vaccination documented in their vaccination card.

          Conclusions: The knowledge about vaccinations imparted in the course of the education should be expanded. A special course on the subject of vaccinations and the immune system with practical elements could contribute to a better understanding of how vaccinations work and misunderstandings could be eliminated in early stages of the training through the dialog between the students and the teacher in the classroom and the occupational physician as part of preventive occupational health check-ups.

          Zusammenfassung

          Zielsetzung: Beschäftige in der Krankenpflege und medizinischen Ausbildungsberufen sind berufsbedingt einer erhöhten Infektionsgefährdung ausgesetzt, daher bestehen für sie Empfehlungen für beruflich indizierte Impfungen. Diese dienen neben der Vermeidung arbeitsbedingter Infektionen auch dem Patientenschutz, sowie der Aufrechterhaltung der medizinischen Infrastruktur. Eine profunde Ausbildung und Wissensvermittlung über Impfungen und arbeitsbedingte Infektionen sind wichtige Grundlagen der Impfentscheidung und somit zur Erlangung eines schützenden Immunstatus. Die vorliegende Studie untersucht das Wissen, die Einstellung und das Verhalten von Auszubildenden in medizinischen Ausbildungsberufen in Hessen zu arbeitsbedingten Infektionen und Impfungen.

          Methodik: Im Frühjahr 2018 nahmen sieben Pflegeschulen in Hessen an einer anonymen Fragebogenstudie teil. Insgesamt wurden 690 Fragebögen von Schülerinnen und Schülern verschiedener medizinischer Ausbildungsberufe in die Studie aufgenommen. Der Inhalt der Fragen orientierte sich an den Empfehlungen der Ständigen Impfkommission (STIKO), einer Literaturrecherche, sowie an den Beispielfragen der Weltgesundheitsorganisation (WHO) bezüglich „vaccine hesitancy“. Ebenso erfolgte die Auswertung von Impfpässen anhand der STIKO-Empfehlungen hinsichtlich Standardimpfungen, sowie den beruflich bedingten Impfungen für Beschäftigte im Gesundheitswesen.

          Ergebnisse: Das Risiko an einer arbeitsbedingten Infektion zu erkranken wurde über alle Ausbildungsjahre hinweg als ziemlich groß eingeschätzt. Wissenslücken zeigten sich vor allem im Bereich der Impfungen. Nur knapp drei Viertel der Befragten hielt die Wirksamkeit von Impfung für belegt und fast 30% waren der Meinung, dass die Dosierungen der in Impfstoffen erhaltenen Arzneistoffe gefährlich sind. Über 80% der Schülerinnen und Schüler hatten noch niemals eine Influenza-Impfung erhalten.

          Schlussfolgerung: Das im Rahmen der Ausbildung vermittelte Wissen über Impfungen sollte ausgebaut werden. Eine spezielle Unterrichtseinheit zum Thema Impfungen und Immunsystem mit praktischen Anteilen könnte zum besseren Verständnis über die Wirkungsweise von Impfungen beitragen und Missverständnisse könnten im Dialog der Schülerinnen und Schüler mit der Lehrkraft im Unterricht und dem Betriebsarzt im Rahmen der arbeitsmedizinischen Vorsorgen bereits in frühen Stadien der Ausbildung beseitigt werden.

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          Vaccine hesitancy and healthcare providers.

          While most people vaccinate according to the recommended schedule, this success is challenged by individuals and groups who delay or refuse vaccines. The aim of this article is to review studies on vaccine hesitancy among healthcare providers (HCPs), and the influences of their own vaccine confidence and vaccination behaviour on their vaccination recommendations to others. The search strategy was developed in Medline and then adapted across several multidisciplinary mainstream databases including Embase Classic & Embase, and PschInfo. All foreign language articles were included if the abstract was available in English. A total of 185 articles were included in the literature review. 66% studied the vaccine hesitancy among HCPs, 17% analysed concerns, attitudes and/or behaviour of HCPs towards vaccinating others, and 9% were about evaluating intervention(s). Overall, knowledge about particular vaccines, their efficacy and safety, helped to build HCPs own confidence in vaccines and their willingness to recommend vaccines to others. The importance of societal endorsement and support from colleagues was also reported. In the face of emerging vaccine hesitancy, HCPs still remain the most trusted advisor and influencer of vaccination decisions. The capacity and confidence of HCPs, though, are stretched as they are faced with time constraints, increased workload and limited resources, and often have inadequate information or training support to address parents' questions. Overall, HCPs need more support to manage the quickly evolving vaccine environment as well as changing public, especially those who are reluctant or refuse vaccination. Some recommended strategies included strengthening trust between HCPs, health authorities and policymakers, through more shared involvement in the establishment of vaccine recommendations.
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            Attitudes to vaccination: a critical review.

            This paper provides a consolidated overview of public and healthcare professionals' attitudes towards vaccination in Europe by bringing together for the first time evidence across various vaccines, countries and populations. The paper relies on an extensive review of empirical literature published in English after 2009, as well as an analysis of unpublished market research data from member companies of Vaccines Europe. Our synthesis suggests that hesitant attitudes to vaccination are prevalent and may be increasing since the influenza pandemic of 2009. We define hesitancy as an expression of concern or doubt about the value or safety of vaccination. This means that hesitant attitudes are not confined only to those who refuse vaccination or those who encourage others to refuse vaccination. For many people, vaccination attitudes are shaped not just by healthcare professionals but also by an array of other information sources, including online and social media sources. We find that healthcare professionals report increasing challenges to building a trustful relationship with patients, through which they might otherwise allay concerns and reassure hesitant patients. We also find a range of reasons for vaccination attitudes, only some of which can be characterised as being related to lack of awareness or misinformation. Reasons that relate to issues of mistrust are cited more commonly in the literature than reasons that relate to information deficit. The importance of trust in the institutions involved with vaccination is discussed in terms of implications for researchers and policy-makers; we suggest that rebuilding this trust is a multi-stakeholder problem requiring a co-ordinated strategy.
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              Influenza vaccination of healthcare workers: a literature review of attitudes and beliefs.

              Influenza vaccination coverage among healthcare workers (HCW) is insufficient despite health authority recommendations in many countries. Numerous vaccination campaigns encouraging HCW to be vaccinated have met with resistance. We reviewed published influenza vaccination programs in healthcare settings to understand the reasons for their success and failure, as well as the attitudes and beliefs of HCW. Relevant articles published up to June 2004 were identified in the MEDLINE/Pubmed database. Thirty-two studies performed between 1985 and 2002 reported vaccination rates of 2.1-82%. Vaccination campaigns including easy access to free vaccine and an educational program tended to obtain the highest uptake, particularly in the USA. Yet, even this type of campaign was not always successful. Two main barriers to satisfactory vaccine uptake were consistently reported: (1) misperception of influenza, its risks, the role of HCW in its transmission to patients, and the importance and risks of vaccination (2) lack of (or perceived lack of) conveniently available vaccine. To overcome these barriers and increase uptake, vaccination campaigns must be carefully designed and implemented taking account of the specific needs at each healthcare institution.
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                Author and article information

                Journal
                GMS J Med Educ
                GMS J Med Educ
                GMS J Med Educ
                GMS Journal for Medical Education
                German Medical Science GMS Publishing House
                2366-5017
                15 November 2021
                2021
                : 38
                : 7
                : Doc115
                Affiliations
                [1 ]Plant Medical Services, Wetzlar, Germany
                [2 ]University Hospital of Frankfurt, Company Medical Services, Frankfurt/M., Germany
                Author notes
                *To whom correspondence should be addressed: Timm Tristan Berg, Plant Medical Services, Uferstr. 5d, D-35576 Wetzlar, Germany, E-mail: timm-tristan.berg@ 123456t-online.de
                Article
                zma001511 Doc115 urn:nbn:de:0183-zma0015111
                10.3205/zma001511
                8675377
                34957320
                91971f9f-e1d7-43d2-8db1-78e9c07b7041
                Copyright © 2021 Berg et al.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

                History
                : 15 March 2021
                : 09 August 2021
                : 04 August 2021
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                health care workers,vaccination,occupational health,occupational physician,health education,nurses

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