- Email: [email protected]
Inclusion of social media-based strategies in a health care worker influenza immunization campaign
902
Letters to the Editor / American Journal of Infection Control 43 (2015) 900-3
Thomas Diller, MD, MM CHRISTUS Health, Irving, TX *
Address correspondence to J. William Kelly, MD Greenville Health System Infectious Disease Associates 890 W Faris Rd, Ste 520, Greenville, SC 29605. E-mail address: [email protected] (J.W. Kelly). http://dx.doi.org/10.1016/j.ajic.2015.02.032
Response to the Letter to the Editor regarding Comparison of hand hygiene monitoring using the My 5 Moments for Hand Hygiene method versus the Wash In-Wash Out method
and 3 combined was actually greater than compliance with moments 1 and 4 combined (79% vs 52%; P ¼ .03). Finally, although nonintrusive automated systems for monitoring all 5 moments offer advantages over current monitoring methods, it is likely that many facilities will continue to rely on human observers for some or all monitoring of hand hygiene behavior. All methods that rely on human observers have limitations. We have pointed out several important caveats to consider if the Wash In-Wash Out method is used. Although the Wash In-Wash Out and My 5 Moments for Hand Hygiene monitoring methods resulted in similar overall rates of hand hygiene compliance in our facility, additional studies are needed in other settings. Conflicts of interest: None to report.
Venkata C.K. Sunkesula, MD, MS Infectious Diseases Division, Department of Medicine Case Western Reserve University School of Medicine Cleveland, OH Center for Proteomics and Bioinformatics Case Western Reserve University School of Medicine Cleveland, OH Sirisha Kundrapu, MD, MS Infectious Diseases Division, Department of Medicine Case Western Reserve University School of Medicine Cleveland, OH
To the Editor: We appreciate the interest in our study and would like to respond to the issues raised regarding the generalizability of the findings. First, we agree with the concern that underrepresentation of nurses in our study population could have affected our conclusions. We therefore reexamined the data to determine whether there were important differences between findings for nurses and physicians. For both groups, the major finding of our study was the same: the Wash In-Wash Out and My 5 Moments for Hand Hygiene monitoring methods resulted in similar overall rates of hand hygiene compliance (Table 1). Second, we agree with the concern that there is the potential for reduced adherence to hand hygiene in moment 2 and moment 3 if monitoring focuses only on hand hygiene upon room entry and exit. To address this concern, we recommended in our article that facilities using the Wash In-Wash Out method should provide ongoing education based on the My 5 Moments for Hand Hygiene approach and conduct intermittent assessments of hand hygiene before clean procedures and after body fluid exposure in patient rooms. This is the current practice in our facility and we found that compliance with moments 2 and 3 combined was similar to overall hand hygiene compliance. For nurses, compliance with moments 2
Table 1 Comparison of hand hygiene compliance using the Wash In-Wash Out versus My 5 Moments for Hand Hygiene monitoring methods, by provider type Physicians My 5 Moments for Hand Hygiene Moment 1 79/94 (84) Moment 2 22/29 (76) Moment 3 28/39 (72) Moment 4 82/96 (85) Moment 5 15/17 (88) Overall 226/275 (82) Wash In-Wash Out Wash In 131/170 (77) Wash Out 147/170 (86) Overall 278/340 (82)
Nurses 47/82 5/7 10/12 38/82 3/5 103/188
(57) (71) (83) (46) (60) (55)
47/82 (57) 49/91 (54) 96/173 (55)
Total 126/176 27/36 38/51 120/178 18/22 329/463
(72) (75) (75) (67) (82) (71)
178/252 (71) 196/261 (75) 374/513 (73)
NOTE. Values are presented as number of compliant hand hygiene episodes/number of hand hygiene opportunities (%).
Curtis J. Donskey, MD* Infectious Diseases Division, Department of Medicine Case Western Reserve University School of Medicine Cleveland, OH Geriatric Research, Education, and Clinical Center Cleveland VA Medical Center Cleveland, OH * Address correspondence to Curtis J. Donskey, MD, Cleveland VA Medical Center, Geriatric Research, Education, and Clinical Center 1110W, 10701 East Blvd, Cleveland, OH 44106. E-mail address: [email protected] (C.J. Donskey).
http://dx.doi.org/10.1016/j.ajic.2015.04.205
Inclusion of social media-based strategies in a health care worker influenza immunization campaign To the Editor: We developed an influenza immunization campaign utilizing social media as a tool to potentially increase vaccination rates for health care workers (HCWs) at our hospital. The hypothesis was that social media sites would help to create awareness and education. Common misconceptions reported among HCWs include the belief that one can develop influenza from the vaccine, the belief that one is not at risk for influenza, and skepticism about vaccine effectiveness and safety.1,2 Employees typically make up the biggest audience for hospital social media.3 In general, adults aged 18-34 years are most likely to use social media, and adults aged 35-40 years are also avid users.4 Given that these age groups make
Letters to the Editor / American Journal of Infection Control 43 (2015) 900-3
up the largest segment of unvaccinated HCWs, we postulated that use of social media in an HCW vaccination campaign could increase vaccination rates. Our influenza campaign was conducted September 2010-April 2011 at our 530-bed teaching hospital. The campaign was led by the Employee Health Department and Pharmacy Department. The social media sites Facebook and Twitter were used to disseminate information to employees about influenza, vaccination, and times when HCWs could be immunized. The social media sites appeared on large monitors throughout the hospital and through direct posts to individual “followers.” These sites were also linked to the hospital intranet site, the Centers for Disease Control and Prevention web site, and The American Society of Health-System Pharmacists Stop the Flu web site. Central facets of the existing influenza campaign included intranet announcements and a kick-off event to vaccinate mass numbers of HCWs. The social media and web sites also provided information through Ask a Pharmacist links. An electronic general questionnaire was distributed via hospital e-mail to all employees to characterize HCW knowledge, attitudes, and behaviors regarding influenza and vaccination and to assess use of social media. A second questionnaire was offered at point-of-vaccination with similar questions. Our institutional HCW vaccination rate increased from 60% during 2009-2010 to 64% during 2010-2011 (P ¼ .0001). The mean age of HCW vaccination recipients was younger during the 20102011 campaign: 37.8 10.3 years versus 40.0 12.2 in 2009-2010 (P ¼ .007). The electronic questionnaire garnered 920 responses (14.2%) from hospital employees. The point-of-vaccination questionnaire was completed by 1,917 (46.7%) of 4,109 vaccines. From the general electronic survey, individuals who had previously received the influenza vaccination did so primarily “to protect myself” (80.7%); the primary reason cited for not previously receiving the influenza vaccination was “I am worried about side effects” (36.4%). Reasons for getting or avoiding the vaccine and HCW knowledge and attitudes paralleled results found in previous studies.1,2 Primary motivators for HCWs receiving vaccination during 2010-2011 but who did not in 2009-2010 (n ¼ 172) were assessed in the point-of-vaccination questionnaire. “Friends or co-workers” (28%) and the “hospital intranet” reminders (25%) were cited the most as motivators. Only 1% of this group responded as having used the social media campaign pages directly. Unfortunately, due to institution firewall issues, the program was not able to solicit followers for Facebook and Twitter by employee e-mail. This could have reduced the direct influence of the social media sites. Therefore, it is difficult to assess the specific influence of social media on the slight increase in employee vaccination rates. The social media outlets may have influenced HCWs indirectly. Almost one-third of vaccine recipients were motivated by their friends/ coworkers, some of whom may have been influenced by the social media. Despite a lack of certainty about the influence of social media tools in this influenza vaccination program, we believe that the combined efforts of social media, intranet, employee health professionals, and pharmacist involvement can be useful parts of an influenza immunization campaign. Our case can be helpful to programs that plan to use social media in employee vaccination programs because it highlights the hospital firewall-related
903
restrictions. Planners will need to address these issues with their hospital administration. References 1. Hollmeyer HG, Hayden F, Poland G, Buchholz U. Influenza vaccination of healthcare workers in hospitals: a review of studies on attitudes and predictors. Vaccine 2009;27:3935-44. 2. Heimberger T, Chang HG, Shaikh M, Crotty L, Morse D, Birkhead G. Knowledge and attitudes of healthcare workers about influenza: why are they not getting vaccinated? Infect Control Hosp Epidemiol 1995;16:412-4. 3. Sweetland W, Thomson SC. Social media: New tools boost marketing, education, community. Health Prog 2010;91:30-6. 4. Nielsen Reports. State of the Media: social Media Report, Q3 9/11/2011 Available from: http://www.nielsen.com/us/en/reports/2011/social-media-report-q3.html. Accessed March 24, 2015. This work was funded by a grant from the American Society of Health-System Pharmacists Research and Education Foundation (1005028R). Conflicts of interest: None to report.
Diana P. Venci, PharmD, BCPS The Ohio State University Wexner Medical Center Columbus, OH Douglas Slain, PharmD, BCPS* Department of Clinical Pharmacy and Section of Infectious Diseases West Virginia University School of Pharmacy Morgantown, WV Betsy M. Elswick, PharmD Department of Clinical Pharmacy West Virginia University School of Pharmacy Morgantown, WV Arif R. Sarwari, MD, MBA Section of Infectious Diseases West Virginia University School of Medicine Morgantown, WV Ashley L. Ross, PharmD, BCPS Jewish Hospital and Sts Mary & Elizabeth Hospital (Kentucky One Health) Louisville, KY Ann Smithmyer, MSN, FNP-BC Employee Health WVU Healthcare Morgantown, WV Justin T. Hare, PharmD Department of Pharmacy WVU Healthcare Morgantown, WV Frank Briggs, PharmD, MPH Administration WVU Healthcare Morgantown, WV * Address correspondence to Douglas Slain, PharmD, BCPS, FCCP, FASHP, West Virginia University, 1124 Health Sciences N, PO Box 9520, Morgantown, WV 26506-9520. E-mail address: [email protected] (D. Slain).
http://dx.doi.org/10.1016/j.ajic.2015.04.185
Letters to the Editor / American Journal of Infection Control 43 (2015) 900-3
Thomas Diller, MD, MM CHRISTUS Health, Irving, TX *
Address correspondence to J. William Kelly, MD Greenville Health System Infectious Disease Associates 890 W Faris Rd, Ste 520, Greenville, SC 29605. E-mail address: [email protected] (J.W. Kelly). http://dx.doi.org/10.1016/j.ajic.2015.02.032
Response to the Letter to the Editor regarding Comparison of hand hygiene monitoring using the My 5 Moments for Hand Hygiene method versus the Wash In-Wash Out method
and 3 combined was actually greater than compliance with moments 1 and 4 combined (79% vs 52%; P ¼ .03). Finally, although nonintrusive automated systems for monitoring all 5 moments offer advantages over current monitoring methods, it is likely that many facilities will continue to rely on human observers for some or all monitoring of hand hygiene behavior. All methods that rely on human observers have limitations. We have pointed out several important caveats to consider if the Wash In-Wash Out method is used. Although the Wash In-Wash Out and My 5 Moments for Hand Hygiene monitoring methods resulted in similar overall rates of hand hygiene compliance in our facility, additional studies are needed in other settings. Conflicts of interest: None to report.
Venkata C.K. Sunkesula, MD, MS Infectious Diseases Division, Department of Medicine Case Western Reserve University School of Medicine Cleveland, OH Center for Proteomics and Bioinformatics Case Western Reserve University School of Medicine Cleveland, OH Sirisha Kundrapu, MD, MS Infectious Diseases Division, Department of Medicine Case Western Reserve University School of Medicine Cleveland, OH
To the Editor: We appreciate the interest in our study and would like to respond to the issues raised regarding the generalizability of the findings. First, we agree with the concern that underrepresentation of nurses in our study population could have affected our conclusions. We therefore reexamined the data to determine whether there were important differences between findings for nurses and physicians. For both groups, the major finding of our study was the same: the Wash In-Wash Out and My 5 Moments for Hand Hygiene monitoring methods resulted in similar overall rates of hand hygiene compliance (Table 1). Second, we agree with the concern that there is the potential for reduced adherence to hand hygiene in moment 2 and moment 3 if monitoring focuses only on hand hygiene upon room entry and exit. To address this concern, we recommended in our article that facilities using the Wash In-Wash Out method should provide ongoing education based on the My 5 Moments for Hand Hygiene approach and conduct intermittent assessments of hand hygiene before clean procedures and after body fluid exposure in patient rooms. This is the current practice in our facility and we found that compliance with moments 2 and 3 combined was similar to overall hand hygiene compliance. For nurses, compliance with moments 2
Table 1 Comparison of hand hygiene compliance using the Wash In-Wash Out versus My 5 Moments for Hand Hygiene monitoring methods, by provider type Physicians My 5 Moments for Hand Hygiene Moment 1 79/94 (84) Moment 2 22/29 (76) Moment 3 28/39 (72) Moment 4 82/96 (85) Moment 5 15/17 (88) Overall 226/275 (82) Wash In-Wash Out Wash In 131/170 (77) Wash Out 147/170 (86) Overall 278/340 (82)
Nurses 47/82 5/7 10/12 38/82 3/5 103/188
(57) (71) (83) (46) (60) (55)
47/82 (57) 49/91 (54) 96/173 (55)
Total 126/176 27/36 38/51 120/178 18/22 329/463
(72) (75) (75) (67) (82) (71)
178/252 (71) 196/261 (75) 374/513 (73)
NOTE. Values are presented as number of compliant hand hygiene episodes/number of hand hygiene opportunities (%).
Curtis J. Donskey, MD* Infectious Diseases Division, Department of Medicine Case Western Reserve University School of Medicine Cleveland, OH Geriatric Research, Education, and Clinical Center Cleveland VA Medical Center Cleveland, OH * Address correspondence to Curtis J. Donskey, MD, Cleveland VA Medical Center, Geriatric Research, Education, and Clinical Center 1110W, 10701 East Blvd, Cleveland, OH 44106. E-mail address: [email protected] (C.J. Donskey).
http://dx.doi.org/10.1016/j.ajic.2015.04.205
Inclusion of social media-based strategies in a health care worker influenza immunization campaign To the Editor: We developed an influenza immunization campaign utilizing social media as a tool to potentially increase vaccination rates for health care workers (HCWs) at our hospital. The hypothesis was that social media sites would help to create awareness and education. Common misconceptions reported among HCWs include the belief that one can develop influenza from the vaccine, the belief that one is not at risk for influenza, and skepticism about vaccine effectiveness and safety.1,2 Employees typically make up the biggest audience for hospital social media.3 In general, adults aged 18-34 years are most likely to use social media, and adults aged 35-40 years are also avid users.4 Given that these age groups make
Letters to the Editor / American Journal of Infection Control 43 (2015) 900-3
up the largest segment of unvaccinated HCWs, we postulated that use of social media in an HCW vaccination campaign could increase vaccination rates. Our influenza campaign was conducted September 2010-April 2011 at our 530-bed teaching hospital. The campaign was led by the Employee Health Department and Pharmacy Department. The social media sites Facebook and Twitter were used to disseminate information to employees about influenza, vaccination, and times when HCWs could be immunized. The social media sites appeared on large monitors throughout the hospital and through direct posts to individual “followers.” These sites were also linked to the hospital intranet site, the Centers for Disease Control and Prevention web site, and The American Society of Health-System Pharmacists Stop the Flu web site. Central facets of the existing influenza campaign included intranet announcements and a kick-off event to vaccinate mass numbers of HCWs. The social media and web sites also provided information through Ask a Pharmacist links. An electronic general questionnaire was distributed via hospital e-mail to all employees to characterize HCW knowledge, attitudes, and behaviors regarding influenza and vaccination and to assess use of social media. A second questionnaire was offered at point-of-vaccination with similar questions. Our institutional HCW vaccination rate increased from 60% during 2009-2010 to 64% during 2010-2011 (P ¼ .0001). The mean age of HCW vaccination recipients was younger during the 20102011 campaign: 37.8 10.3 years versus 40.0 12.2 in 2009-2010 (P ¼ .007). The electronic questionnaire garnered 920 responses (14.2%) from hospital employees. The point-of-vaccination questionnaire was completed by 1,917 (46.7%) of 4,109 vaccines. From the general electronic survey, individuals who had previously received the influenza vaccination did so primarily “to protect myself” (80.7%); the primary reason cited for not previously receiving the influenza vaccination was “I am worried about side effects” (36.4%). Reasons for getting or avoiding the vaccine and HCW knowledge and attitudes paralleled results found in previous studies.1,2 Primary motivators for HCWs receiving vaccination during 2010-2011 but who did not in 2009-2010 (n ¼ 172) were assessed in the point-of-vaccination questionnaire. “Friends or co-workers” (28%) and the “hospital intranet” reminders (25%) were cited the most as motivators. Only 1% of this group responded as having used the social media campaign pages directly. Unfortunately, due to institution firewall issues, the program was not able to solicit followers for Facebook and Twitter by employee e-mail. This could have reduced the direct influence of the social media sites. Therefore, it is difficult to assess the specific influence of social media on the slight increase in employee vaccination rates. The social media outlets may have influenced HCWs indirectly. Almost one-third of vaccine recipients were motivated by their friends/ coworkers, some of whom may have been influenced by the social media. Despite a lack of certainty about the influence of social media tools in this influenza vaccination program, we believe that the combined efforts of social media, intranet, employee health professionals, and pharmacist involvement can be useful parts of an influenza immunization campaign. Our case can be helpful to programs that plan to use social media in employee vaccination programs because it highlights the hospital firewall-related
903
restrictions. Planners will need to address these issues with their hospital administration. References 1. Hollmeyer HG, Hayden F, Poland G, Buchholz U. Influenza vaccination of healthcare workers in hospitals: a review of studies on attitudes and predictors. Vaccine 2009;27:3935-44. 2. Heimberger T, Chang HG, Shaikh M, Crotty L, Morse D, Birkhead G. Knowledge and attitudes of healthcare workers about influenza: why are they not getting vaccinated? Infect Control Hosp Epidemiol 1995;16:412-4. 3. Sweetland W, Thomson SC. Social media: New tools boost marketing, education, community. Health Prog 2010;91:30-6. 4. Nielsen Reports. State of the Media: social Media Report, Q3 9/11/2011 Available from: http://www.nielsen.com/us/en/reports/2011/social-media-report-q3.html. Accessed March 24, 2015. This work was funded by a grant from the American Society of Health-System Pharmacists Research and Education Foundation (1005028R). Conflicts of interest: None to report.
Diana P. Venci, PharmD, BCPS The Ohio State University Wexner Medical Center Columbus, OH Douglas Slain, PharmD, BCPS* Department of Clinical Pharmacy and Section of Infectious Diseases West Virginia University School of Pharmacy Morgantown, WV Betsy M. Elswick, PharmD Department of Clinical Pharmacy West Virginia University School of Pharmacy Morgantown, WV Arif R. Sarwari, MD, MBA Section of Infectious Diseases West Virginia University School of Medicine Morgantown, WV Ashley L. Ross, PharmD, BCPS Jewish Hospital and Sts Mary & Elizabeth Hospital (Kentucky One Health) Louisville, KY Ann Smithmyer, MSN, FNP-BC Employee Health WVU Healthcare Morgantown, WV Justin T. Hare, PharmD Department of Pharmacy WVU Healthcare Morgantown, WV Frank Briggs, PharmD, MPH Administration WVU Healthcare Morgantown, WV * Address correspondence to Douglas Slain, PharmD, BCPS, FCCP, FASHP, West Virginia University, 1124 Health Sciences N, PO Box 9520, Morgantown, WV 26506-9520. E-mail address: [email protected] (D. Slain).
http://dx.doi.org/10.1016/j.ajic.2015.04.185