Introduction to the Importance of Influenza Vaccination Among Healthcare Workers

Introduction

Influenza is referred to the viral infection which attacks and infects the respiratory system of the body that is lungs, nose and throat making individuals develop symptoms such as sore throat, cough, sneeze, headache and others (Grohskopf et al. 2019). The influenza flu is of different types and is found to more intricately affect the healthcare workers that make them face hindered health condition. However, effective vaccination for influenza is present which allows protection to individuals from getting affected by the disease. In this research study, the factors which influence uptake of vaccine for influenza among the healthcare workers are to be discussed. This is to understand the aspects responsible for making influenza vaccination important for healthcare workers. For this purpose, methodology is to be discussed where explanation of information regarding the way related to the study topic is to be collected. The way ethical considerations are to be ensured in the study is to be discussed.

Rationale of Study

Influenza is able to cause a spectrum of illness ranging from mild to severe among people and it does not allow protection to people who have already suffered from the illness. This means that people are able to get reinfected with influenza even after coping from the disease (Petrova and Russell, 2018). In the winter months, the frontline workers are prone to get more exposed to influenza virus as during this phase increased numbers of infected patients are required to be managed by them. It is reported that 1 in 4 healthcare workers are prone to get infected as a result of influenza during a mild season (NHS, 2019). This is considered a greater incidence than expected in the general population ensuring healthcare workers are to be adversely affected without vaccination.

The reports of 2019 inform that nearly 70.3% of the frontline healthcare workers have received seasonal influenza vaccine compared to 68.7% of healthcare workers in 2018 and 63.2% in 2016 (assets.publishing.service.gov.uk, 2019). In regard to staff groups, it is seen that 72.5% of general practice nurses and 72% of supportive clinical staffs have taken influenza vaccine in 2017-18. This is compared to 63.1% general practice nurses who have taken influenza vaccine in 2016-17 (assets.publishing.service.gov.uk, 2019). Thus, the statistics inform that there is increase in uptake of influenza vaccine among the healthcare workers and different staffs in the UK.

The aggregate of seasonal influenza flu vaccine taken by healthcare workers of all trust in 2018-19 was reported to be 64-82.2% and among them, NHS England team reported an aggregate of 75% and over to be the key trust where the highest number of health professional are vaccinated (assets.publishing.service.gov.uk, 2019). The seasonal influenza vaccine uptake among acute trust is referred to be 64-76.9% and the highest vaccine was mentioned to be received by North West PHE centre and lowest by the London PHE centres which are similar in the previous year (Edelstein and Pebody, 2014). This indicates that vaccine uptake was higher compared to the earlier years among the healthcare trust where healthcare workers mainly provide care to different service users.

In contrast, the study by Kassianos (2015) informed that the willingness to avail influenza vaccine by the healthcare professionals in overall Europe is quite low. Moreover, the study by Jorgensen et al. (2018) mentioned that from 2009 to 2015, very few countries reported having met the 75% goal of vaccination for healthcare workers and individuals set by WHO. Therefore, it is necessary to understand the key factors that influenced the UK trusts and healthcare workers in taking vaccine for influenza which has led to lower incidence of the disease among the healthcare staffs. Thus, this study is essential to be developed so that the key factors can be explored which can be considered by healthcare trusts over Europe and other countries to increase vaccination of healthcare staffs. It would ensure protecting them from getting infected or spreading the infection while offering care to the service users.

Aim

The study aims to determine the responsible factors that influence uptake of influenza vaccine among the healthcare workers in the UK.

Objectives

Literature Review

The research conducted mentions that there are mainly four types of influenza viruses present which are A, B, C and D. The Human Influenza A and B viruses are considered to be seasonal which spreads to wide number of people mainly during the winter months. The Influenza A virus is the only type that has the ability to cause flu pandemics in which globally huge number of individuals are adversely affected and may face death due to complications (Suarez, 2016). This is because Influenza A viruses are able to actively spread through human contact. The Influenza C infected people and results in mild illness making it lack viability to cause pandemic. The Influenza D viruses are mainly spread among cattle and animals and are not known to infect humans (Ferguson et al. 2016). The spread of Influenza A and B viruses are considered to be risky for certain individuals who are suffering from chronic diseases such as chronic lung diseases, morbid obesity, diabetes, heart diseases, anaemia and others (Jones et al. 2020). This is because the chronic condition often leads the people unable to have strengthened and effective body functioning to fight with the virus making them experience deteriorated health condition and mortality.

Influenza is considered to be able to spread by airborne transmission through droplets (particles of ≥5µm and has settled within 3-6 feet) but the airborne route is identified as implication to spread influenza viruses under special situations such as aerosol-generation procedures (Xue e al. 2018). In the study of Bischoff et al. (2013), it is mentioned that aerosolised influenza virus was present in 26 out of 61 patients who are diagnosed for the disease. This indicates that these patients have the ability to infect other persons with influenza by spreading the virus through air. As argued by Safan (2019), people with influenza can spread the virus to healthy individuals who are within 6 feet from them. This is because it is considered that the virus is able to spread by droplets created through coughing and sneezing or during talking from one per to another within 6 feet. The droplets are considered to land on the mouth or face that can be inhaled into the lungs (Leung et al. 2016). As criticised by Mirzaei and Abdi (2020), the influenza virus is considered to be less likely to be spread by coming in contact with an infected surface. This is because the life of the virus varies according to the nature of surface and its viability is often reduced to infect healthy individuals when healthy individuals touch infected surfaces and place their hands on mouth, nose, eyes or other areas.

The Influenza vaccine is considered to protect individuals from getting infected by the virus and avoid facing hindered health condition. The vaccine is viable to be administered to people who are 6 months and older. The vaccine is required to be taken each year because the immune response of the body to influenza virus reduce over time and the receiving vaccine for each year ensures effective protection in continuous manner (Volling et al. 2019). The influenza vaccine mainly contains deactivated viruses of the diseases which are administered into the body for training the immune system of the body to recognise as well as combat the viruses through the production of antibodies. The production of these antibodies leads the body to fight against active viruses when they enter the body to avoid negative impact on the health of the individuals (Edmond, 2019). There are no serious side-effects of influenza vaccine except a mild fever or aching muscles for some days to be faced after being injected with vaccine (Haridi et al. 2017).

The influenza vaccination is essential for all age group of people and mainly for the healthcare workers. In the study by Dolan et al. (2013), it is mentioned that 20% of the health professionals have tested positive for serology confirmed influenza virus during epidemics. The individuals are often seen to remain asymptomatic in 50% cases, in turn, acting as potential source of infection carrier in the healthcare environment for patients, co-workers and others. In similar to the article, the study by Amodio et al. (2014) mentioned that after encompassing 7 influenza seasons and managing 62,000 hospitalised patients it is seen that vaccination of healthcare professional regarding influenza is directly related with lowering frequency of influenza-like illness among patients. It is evident as fall in vaccination coverage of healthcare workers from 13.2% to 2.1% lead to influenza-like illness among patients to be raised from 1.1% to 5.7%. The healthcare workers are required to take influenza vaccine to protect their families from getting infected by the virus through them. This is because with vaccination the healthcare workers would not be infected by influenza making them unable to spread the illness among their family members (Pereira et al. 2017). As argued by Lytras et al. (2016), vaccination for influenza is essential for healthcare workers because they are the individuals who work in close contact with infected influenza patients. It makes the healthcare workers have higher chances of getting infected by influenza making them unable to provide effective care to the patients.

The healthcare workers infected with influenza have high ability to widely transmit influenza to many patients and healthy individuals. This is because they work in close vicinity to provide care to elderly, vulnerable patients, infants and others making them responsible to cause life-threatening situation for chronically-ill patients due to spread of the virus. As asserted by Maltezou et al. (2018), lack of presence of healthcare workers due to sickness leads to create shortage of staff in the care environment which causes deteriorated care support to be delivered to patients. This is because staff shortage leads to care increased workload on the existing individuals and lower nurse-patient ratio. The extra workload leads healthcare staffs to create error in delivering care and lower their quality of care support to the service users, in turn, making the patients avail unsatisfactory care (Tai et al. 2018). Thus, vaccination of healthcare workers from influenza is required to ensure their full functionality in participating in the healthcare program and protecting patients during pandemic.

There are barriers which act to demotivate healthcare workers from taking up influenza vaccine. In the study by Sundaram et al. (2018), it is mentioned that lack of consideration among the healthcare workers to perceive influenza as life-threatening risk has contributed them to avoid taking vaccine. This is because they believe that since influenza cannot cause much harm to them and others thus vaccination is unnecessary. As argued by Schmid et al. (2017), wrong perception among the healthcare workers regarding increased side-effects of influenza vaccine leads to its lower uptake. This is because the healthcare workers fear the vaccine would affect their health adversely making them unable to lead quality life. As criticised by Haridi et al. (2017), safety of vaccination is one of the potential barriers among healthcare workers for not accessing the influenza vaccine. This is because lack of safe use of needle and hygienic environment for vaccine administration makes healthcare workers fear to get infected by additional disease. Thus, lower efficacy and safety are potential reason behind avoidance of vaccination by healthcare workers.

The study by Boey et al. (2018) mentions that lack of effective access to vaccination often leads the healthcare workers to avoid influenza vaccine. This is evident as difficulties like lack of resources to administer vaccine, lower amount of presence of influenza vaccine per individual and others makes healthcare workers avoid getting vaccinated. As commented by Schmid et al. (2017), lack of effective education regarding the importance of vaccination among the healthcare workers leads them avoid take vaccine for influenza. This is because without awareness the healthcare workers are unable to overcome hindered attitude and fears regarding vaccination, in turn, making them avoid taking it. The study by Pereira et al. (2018), informed that there was higher chances of taking influenza vaccine by healthcare workers who have already received the vaccine more than once. This is because they are able to overcome their fears and understand the importance of influenza vaccination in turn motivating them to accept the vaccine.

The existing literature is seen to provide information regarding the importance of influenza vaccine uptake among healthcare workers. However, the existing literature does not provide detailed information regarding the key factors that support uptake of vaccination among the healthcare workers. Moreover, the existing study lack in-depth information about the degree of misconception present in healthcare workers that are making them avoid taking influenza vaccine and the factors that could influence in resolving the condition. The understanding of key factors which influences influenza vaccine uptake among healthcare workers is essential to be known to develop effective plan and educational program for motivation among healthcare workers who are still avoiding to getting vaccinated. Thus, to focus on this the study is being developed and essential to be executed.

Methodology

The development of well-structured research methodology is required so that a systematic plan is present that mentions the appropriate chosen techniques and methods to be used by the researcher in executing the study. There are mainly two types of methodological research which are primary research and secondary research. As commented by Petek and Kamnik-Jug (2018), primary research is the methodology in which researchers gather data directly from the participants related with the study. They execute it through the use of interview, survey, observation and others making them avoid depending on presence of existing data. As criticised by Song et al. (2017), secondary research is the methodology in which information is collected by the research through analysis of existing evidence related to the topic. The researchers mainly take a narrative approach in explaining the data in-depth regarding the study so that the raised issues in the research are effectively resolved. In this study, the secondary research methodology will be used in gathering data. This is because it allows easier gathering of scientifically approved data by previous researchers ensuring information from experts to be presented regarding the topic that in turn enhances its validity and reliability (Alenazi et al. 2018). The primary research will not be used in executing the study. This is because it is expensive and requires increased amount of time in collecting data that may be scientifically approved with effective observations (Ma et al. 2019). The limitation of secondary research is that it allows influence of personal beliefs and attitudes in representation of information (Moyle et al. 2016). The issue will be resolved in this researcher by allowing the data to be reviewed and analysed by more than one researcher to ensure no personal belief is influenced in gathering or presentation of the information.

Research Question

The development of an effective research question is required so that the key issues are highlighted and the focus of the topic is identified for which information is to be gathered. In this study, the PEO framework will be used in developing the research question. This is because the framework provides opportunity to the researcher to analyse the clinical problem that has occurred in the existing condition (Amodio et al. 2017). The PEO framework stands for population, exposure and outcome. The population that will be focussed in the study are healthcare workers who involved in delivering wide amount of care to sick individuals. The exposure is referred to the problem in the research which in this study is the influenza vaccination uptake. The outcome is referred to the results of the study which in this research is factors that influence influenza vaccination uptake among healthcare workers in the UK. Thus, the research question is: What are the factors that influence influenza vaccination uptake among healthcare workers in the UK?

Table 1: PEO Framework

Population	Exposure	Outcome
Healthcare Workers	Influenza Vaccination	Factors that influence influenza vaccination uptake among healthcare workers in the UK

Literature Search

In this research, the literature search will be executed by use of electronic databases. This is because electronic database allows huge amount of data regarding the topic to be gathered by exploring wide number of resources without any barriers (Huerta et al. 2016). It is helpful as it improves the capability of the researcher in presenting wide amount of narrative information regarding the topic which in turn ensures in-depth presentation of knowledge to meet the study objectives and overcoming raised issues in the study. The electronic database used in gathering data helps to critically compare wide amount of information from various geographic locations regarding a single topic. This leads to allow increased facts and figures regarding the study topic to be gathered (Hsieh et al. 2019). The electronic databases that will be used in gathering information regarding the study are Goggle Scholar, CINHAL, MEDLINE and others. The following databases will be used because they contains wide amount of journals and articles regarding different medical and clinical topic that provide intricate information regarding the study topic.

Keywords and Boolean Operators

The keywords in research are required to be used as it allows easier searching for information regarding the topic as it reveals relatable information from the pool of data (Gu et al. 2017). In this study, the keywords that will be used are “influenza vaccine”, “factors influence influenza vaccine”, “healthcare workers”, “healthcare workers avail influenza vaccine” and others. The Boolean operators are referred to the conjunctions used for combining or excluding keywords during search to develop more focussed research in gathering productive results. The Boolean operators that will be used include AND and OR in combining the keywords to develop well-structured research.

Inclusion and Exclusion Criteria

The inclusion criteria are the characteristics to be included in executing the study so that definitive information can be gathered. The exclusion criteria are the characteristics rejected for the study as it would create unnecessary error leading to compromise the quality of outcome for the research (Budrionis and Bellika, 2016). The inclusion criteria for the study will be articles published in the English language, articles published on and after 2013, fully-accessible and contains information about the factors that influence influenza vaccination among healthcare workers. However, the exclusion criteria will be articles published before 2013, written in language other than English, abstract available and contains information of factors that influence influenza vaccination among patients and normal individuals.

The articles published in English language will be included in the study and others to be excluded because the study is organised for the UK where the official language is English. Thus, using information from articles that are published in language other than English would lead the readers unable to understand the results present when references are made to the existing studies. Moreover, the researchers are only knowledgeable about English as the language and thus use of articles written in other languages is avoided as they would be unable to interpret the data to present valid findings and results in the study.

The articles published on and after 2013 will be included and other excluded because they would provide most current information regarding the study topic avoiding error to be raised out of use of backdated information. The fully accessible articles will be used in the study as they provide opportunity to the researcher in understanding and analysing detailed account of the presented results. However, partially available information in studies where only abstracts are present leads the researcher unable to provide appropriate argument and evidence regarding results to be presented in the current study. The articles that focussed on factors of influenza vaccine uptake among healthcare workers will be used in the study and others to be excluded as it provides opportunity to researcher in present appropriate results that are relevant to the study topic.

Critical Appraisal Tool

The critical appraisal helps to lower the burden from the researchers in selecting articles by allowing them to effectively focus on studies that are relevant to the study topic and which can reliably support or refute claims for high-quality evidence (Shea et al. 2017). In this study, for critical analysis of the articles the Critical Appraisal Skills Programme (CASP) tool will be used. The CASP tool is the framework which assists researchers in following set of questions to be answered to evaluate collected evidence regarding the topic (Backman et al. 2017). The CASP tool will be used because it is going to help the researcher in gathering effective evidence regarding the factors responsible to influence influenza vaccine uptake among UK healthcare workers.

Ethical Considerations

The ethical considerations are the aspects to be controlled in the study t avoid legal issues to be raised and breach in privacy of participants in the study (Carter and Yentis, 2018). For this purpose, the evidence to be shared from the previous studies will be referenced in adequate manner by mentioning the name and year of publication of the data. This will be executed to avoid the work from plagiarism which leads to academic misconduct. In order to avoid manipulation in data presentation, the two researchers will be involved in analysing the existing evidence so that judgement-free information without influence of beliefs of others are mentioned in the study. In order to maintain confidentiality, no name or personal details of any healthcare workers from the previous studies will be mentioned.

Timetable

(Refer to Appendix 1)

Conclusion

The above discussion informs that influenza vaccine uptake is essential for healthcare workers to ensure protection from the disease. The existing literature informs that vaccination of healthcare workers from influenza lower the chances of infection transmission to patients, protect the family members of service providers, avoid absentees from illness and others. The rationale informs that there is current increased uptake of influenza vaccine among healthcare workers in the UK compared to overall Europe and other parts of the work. Thus, the factors responsible for influencing the increased uptake of vaccine will be identified so that the information can be used in promoting vaccination among healthcare workers within Europe.

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Appendix

Appendix 1

Table 1: Research Timetable

Main activities and stages	Week 1-3	Week 4-8	Week 9-13	Week 14-17	Week 18-21	Week 22-25	Week 26
Identifying topic for research	➔
Selecting the secondary sources	➔	➔
Research planning organisation and plan		➔	➔
Identifying research question			➔
Study background			➔
Identifying research methods			➔
Gathering secondary sources				➔	➔
Determining data analysis method					➔	➔
Conclusion							➔