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Background Recent cases of laboratory-acquired vaccinia virus (VV) infection highlight the need for laboratory safety.

Aims To determine laboratory worker adherence to the Advisory Committee for Immunization Practices smallpox vaccination recommendations, assess potential barriers to vaccination and determine the influence of training on laboratory worker attitudes.

Methods Ninety-two laboratory workers in Pennsylvania were contacted and asked to complete an online survey about VV usage; 45 responded.

Results Eighty-seven per cent had received a smallpox vaccination in their lifetime; 73% received vaccination in the past 10 years. More workers had been given training regarding the potential risks, versus the potential benefits of vaccination, and most perceived that adverse outcomes were more likely to occur following vaccination versus accidental infection.

Conclusions The results of this study suggest that the main barrier to vaccination may be fear associated with possible vaccine adverse effects and a willingness to risk accidental infection rather than be vaccinated. More information and training about the potential benefits of vaccination, as well as the potential adverse outcomes associated with accidental infection, is therefore warranted.

The risk of acquiring hepatitis associated with work in a moderate-sized acute-care teaching hospital was determined by a seroepidemiologic survey of hepatitis B surface antigen and antibody. A blood specimen and a completed questionnaire were obtained from 76 percent of the staff members involved in patient care activities and all preemployment applicants (a total of 767 persons).

One employee was found to have transiently positive tests for hepatitis B surface antigen, whereas 94 (12.2 percent) were found to have hepatitis B surface antibodies. Using the national incidence rate for volunteer blood donors of 4.4 percent as a norm, significantly higher antibody incidence was seen in nursing personnel (16.9 percent), laboratory workers (14.0 percent), surgeons (37.5 percent) and dental workers (40.0 percent). Rates were not significantly raised among house officers, internists, respiratory therapists or housekeeping employees. Increased incidence was statistically related to age and known history of hepatitis, but not to sex, known needle-stick exposure, contact with patients having hepatitis, prior blood transfusion, blood handling or nonhospital exposure to hepatitis. In persons whose tests were positive for antibodies there was a 4 percent increment per decade of age among long-term employees; duration of employment approached significance as a risk factor. Of those with hepatitis B antibody, only 16 percent were aware of a prior bout of hepatitis.

Occupational hepatic disorders are classified into toxic hepatitis, viral hepatitis, and chemical-induced malignancy in Korea. Toxic hepatitis cases were reported in workers who were exposed to dimethylformamide, dimethylacetamide, or trichloroethylene. Pre-placement medical examination and regular follow-up are necessary to prevent the development of toxic hepatitis. Viral hepatitis was chiefly reported among health care workers such as doctors, nurses and clinical pathology technicians who could easily be exposed to blood. Preventive measures for these groups therefore include vaccination and serum monitoring programs. Hepatic angiosarcoma caused by vinyl chloride monomer (VCM) exposure is a very well known occupational disease and it has not been officially reported in Korea yet. Some cases of hepatocellular carcinoma were legally approved for compensation as an occupational disease largely by overwork and stress, but not supported by enough scientific evidence. Effort to find the evidence of its causal relationship is needed.

Background: Healthcare workers (HCWs) pose a potential risk of transmitting communicable diseases in the hospital settings where they usually work. This study aims to determine the current influenza vaccination rates among HCWs in three Middle East countries namely United Arab Emirates (UAE), Kuwait and Oman, and also to identify the different variables associated with the noncompliance of HCWs to the recommendations of the Advisory Committee on Immunization Practices (ACIP) set in those countries. Methods: 1500 questionnaires were distributed to health care workers in the three countries during the period of July-October 2009. Results: Among 993 respondents, the vaccination rate was 24.7%, 67.2% and 46.4% in UAE, Kuwait and Oman, respectively. The different motivating factors that influenced the health care workers to take the vaccine was assessed and found that the most common factor that influenced their decision to take the vaccine was for their self protection (59%). On the other hand, the most common reason that discouraged HCWs to take the vaccine was “lack of time” as reported by 31.8% of the respondents. Other reasons for not taking the vaccine were unawareness of vaccine availability (29.4%), unavailability of vaccine (25.4%), doubts about vaccine efficacy (24.9%), lack of information about importance (20.1%) and concerns about its side effects (17.3%). Conclusions: influenza immunization by healthcare workers in the studied countries was suboptimal which could be improved by setting different interventions and educational programs to increase vaccination acceptance among HCWs.

In order to determine the status of Coronary Care Unit activity in California hospitals, especially as it pertains to nurse training, a survery was conducted by the California State Department of Public Health. More than 95 percent of hospitals that were questioned responded. Only one-third of the hospitals reported they neither had a unit nor plans to build one. All units in operation were either directed by an individual medical director or by a Coronary Care Unit Committee.

The survey indicated that in some hospitals with operational units, nurses were not permitted to perform life-saving resuscitative procedures. All operational units reported in-service education programs of some type. Many hospitals indicated they would like to have Coronary Care Unit training programs to which they could send nurses. The reasons why nurses may not perform important resuscitative procedures are discussed as well as the need for Coronary Care Unit training programs for both physicians and nurses in California.

Background

Most cases of hepatitis B virus (HBV) infection and subsequent liver diseases can be prevented with universal newborn HBV vaccination. The attitudes of health care workers about HBV vaccination and their willingness to recommend vaccine have been shown to impact HBV vaccination coverage and the prevention of vertical transmission of HBV. The purpose of this study was to ascertain the factors associated with health care worker recommendations regarding newborn HBV vaccination.

Methods

A cross-sectional study of prevalence and awareness of hepatitis B and hepatitis B vaccine was conducted among randomly selected physicians and nurses employed in seven hospitals in Georgia in 2006 and 2007. Self-administered questionnaires included a module on recommendations for HBV, HCV and HIV.

Results

Of the 1328 participants included in this analysis, 36% reported recommending against hepatitis B vaccination for children, including 33% of paediatricians. Among the 70.6% who provided a reason for not recommending HBV vaccine, the most common concern was an adverse vaccine event. Unvaccinated physicians and nurses were more likely to recommend against HBV vaccine (40.4% vs 11.4%, PR 3.54; 95% CI: 2.38, 5.29). Additionally, health care worker age was inversely correlated with recommendations for HBV vaccine with older workers less likely to recommend it.

Conclusion

Vaccinating health care workers against HBV may provide a dual benefit by boosting occupational safety as well as strengthening universal coverage programs for newborns.

Background

There was a low adherence to influenza A (H1N1) vaccination program among university students and health care workers during the pandemic influenza in many parts of the world. Vaccination of high risk individuals is one of the recommendations of World Health Organization during the post-pandemic period. It is not documented about the student's knowledge, attitude and willingness to accept H1N1 vaccination during the post-pandemic period. We aimed to analyze the student's knowledge, attitude and willingness to accept H1N1 vaccination during the post-pandemic period in India.

Methods

Vaccine against H1N1 was made available to the students of Vellore Institute of Technology, India from September 2010. The data are based on a cross-sectional study conducted during October 2010 to January 2011 using a self-administered questionnaire with a representative sample of the student population (N = 802).

Results

Of the 802 respondents, only 102/802 (12.7%) had been vaccinated and 105/802 (13%) planned to do so in the future, while 595/802 (74%) would probably or definitely not get vaccinated in the future. The highest coverage was among the female (65/102, 63.7%) and non-compliance was higher among men in the group (384/595; 64.5%) (p < 0.0001). The representation of students from school of Bio-sciences and Bio-technology among vaccinees is significantly higher than that of other schools. Majority of the study population from the three groups perceived vaccine against H1N1 as the effective preventive measure when compared to other preventive measures. 250/595 (42%) of the responders argued of not being in the risk group. The risk perception was significantly higher among female (p < 0.0001). With in the study group, 453/802 (56.4%) said that they got the information, mostly from media.

Conclusions

Our study shows that the vaccination coverage among university students remains very low in the post-pandemic period and doubts about the safety and effectiveness of the vaccine are key elements in their rejection. Our results indicate a need to provide accessible information about the vaccine safety by scientific authorities and fill gaps and confusions in this regard.

Exposure to hepatitis B virus (HBV) infection is a potentially serious occupational hazard for health care workers. Data indicate an increased risk of HBV infection in health care workers. This risk appears to be related to the frequency of contact with patients' blood and exposure to high risk patient populations. Strategies available for preventing HBV infection in the health care setting include HBV vaccine, which is the most efficacious and practical strategy. In view of the potential consequences of HBV infection, health care employers have a responsibility to provide education, serological testing and vaccination. Health care workers have a responsibility to use these programs, and to assess their own risk of infection.

Background

The objective of this study was to assess the compliance of health care workers (HCWs) employed in Hajj in receiving the meningococcal, influenza, and hepatitis B vaccines.

Methods

A cross-sectional survey of doctors and nurses working in all Mena and Arafat hospitals and primary health care centers who attended Hajj-medicine training programs immediately before the beginning of Hajj of the lunar Islamic year 1423 (2003) using self-administered structured questionnaire which included demographic data and data on vaccination history.

Results

A total of 392 HCWs were studied including 215 (54.8%) nurses and 177 (45.2%) doctors. One hundred and sixty four (41.8%) HCWs were from Makkah and the rest were recruited from other regions in Saudi Arabia. Three hundred and twenty three (82.4%) HCWs received the quadrivalent (ACYW135) meningococcal meningitis vaccine with 271 (83.9%) HCWs receiving it at least 2 weeks before coming to Hajj, whereas the remaining 52 (16.1%) HCWs received it within < 2 weeks. Only 23 (5.9%) HCWs received the current year's influenza virus vaccine. Two hundred and sixty (66.3%) of HCWs received the three-dose hepatitis B vaccine series, 19.3% received one or two doses, and 14.3% did not receive any dose. There was no statistically significant difference in compliance with the three vaccines between doctors and nurses.

Conclusion

The meningococcal and hepatitis B vaccination coverage level among HCWs in Hajj was suboptimal and the influenza vaccination level was notably low. Strategies to improve vaccination coverage among HCWs should be adopted by all health care facilities in Saudi Arabia.

A random sample of 232 U.S. hospitals was surveyed. Of those hospitals, 75 percent had hepatitis B vaccination programs. The presence of a program was associated with hospital size (60 percent of those with 100 beds, 75 percent with 100-499 beds, 90 percent with 500 or more beds; P = 0.0013) and hospital location (urban 86 percent; rural 57 percent; P less than 0.001). The frequency of needlestick exposures per month among hospital personnel and hospital location were directly related to and best predicted the existence of hepatitis B vaccination programs. All hospitals with programs offered vaccine to high-risk personnel (as defined by the hospital). Seventy-seven percent of hospitals paid all costs for vaccinating high-risk personnel; 19 percent paid for any employee to be vaccinated regardless of risk status. Forty-six percent of hospitals with programs were estimated to have vaccinated more than 10 percent of all eligible personnel, and 13 percent to have vaccinated more than 25 percent of eligible personnel. The highest compliance rates were associated with hospitals paying for the vaccine and requiring vaccination of high-risk personnel. Fifty-four percent of hospitals attributed noncompliance to concern regarding vaccine safety and effectiveness. The reasons why there was no vaccination program in 58 hospitals were (a) low incidence of hepatitis B virus infections among personnel, (b) cost of vaccine, and (c) vaccination being offered as part of a needlestick protocol. Full utilization of hepatitis B vaccine could eliminate the occupational hazard that hepatitis B virus presents to health care personnel.

Background: The risk of occupational exposure to blood borne pathogens (including hepatitis B, hepatitis C and HIV) via sharp injuries such as needle stick injuries (NSIs) among health care workers, especially dental, nursing and midwifery students is a challenging issue. Inadequate staff, lack of experience, insufficient training, duty overload and fatigue may lead to occupational sharp injuries. The aim of this prospective cross-sectional study was to evaluate the frequency of NSIs in Iranian dental, nursing, and midwifery students and their knowledge, attitude and practices regarding prevention of NSIs.

Methods: A questionnaire was provided to 264 dental and 435 nursing and midwifery students during their under graduate clinical training. 52% of dental students and 48% of nursing and midwifery students responded to the questionnaire. The questionnaire was pre-tested for reliability on 9.2% of the 55 sample population and found to have a high (r=0.812) test-retest reliability.

Results: 73% of students reported at least one NSI during the past year. Activities most frequently associated with injuries involved use of a hollow-bore needle during venous sampling or IV injection in both groups, followed by wound suturing in nursing and midwifery students and recapping in dental students. NSIs and non-reporting of NSIs were highly prevalent in these participants. The reason for not reporting injuries included not knowing the reporting mechanism or not knowing to whom to report.

Conclusion: Education about transmission of blood borne infections, standard precaution and increasing availability of protective strategies must be enforced. Furthermore, an optimization of the management for reporting is warranted.

Health and safety in clinical laboratories is becoming an increasingly important subject as a result of emergence of highly infectious diseases such as Hepatitis and HIV. A cross sectional study was carried out to study the safety measures being adopted in clinical laboratories of India. Heads of laboratories of teaching hospitals of India were subjected to a standardized, pretested questionnaire. Response rate was 44.8%. only 60% of laboratories had person in-charge of safety in laboratory. Seventy three percent of laboratories had safety education program regarding hazards. In 91% of laboratories staff is using protective clothing while working in laboratories. Hazardous material regulations are followed in 78% of laboratories. Regular health check ups are carried among laboratory staff in 43.4% of laboratories.

Safety manual is available in 56.5% of laboratories. 73.9% of laboratories are equipped with fire extinguishers. Fume cupboards are provided in 34.7% of laboratories and they are regularly checked in 87.5% of these laboratories. In 78.26% of laboratories suitable measures are taken to minimize formation of aerosols.

In 95.6% of laboratories waste is disposed off as per bio-medical waste management handling rules. Laboratory of one private medical college was accredited with NABL and safety parameters were better in that laboratory. Installing safety engineered devices apparently contributes to significant decrease in injuries in laboratories; laboratory safety has to be a part of overall quality assurance programme in hospitals. Accreditation has to be made necessary for all laboratories.

Background

Canada's National Advisory Committee on Immunization recommends that both staff and residents of long-term care facilities be vaccinated against influenza. This paper describes the influenza vaccination policies and programs, as well as vaccination rates, for staff and residents of long-term care institutions in Alberta. Such data have not previously been reported.

Methods

Data were collected by means of an anonymous mail survey (with 2 reminders) sent to Alberta nursing homes and auxiliary hospitals in spring 1999.

Results

Of 160 facilities providing long-term care during the study period, 136 responded to the survey (85%). Of these, only 85 provided data on staff vaccination rates, whereas 118 provided data on resident vaccination rates. For institutions reporting this information, the median proportion of staff vaccinated was 29.9% and the median proportion of residents vaccinated was 91.0%. Only 2 facilities reported that staff vaccination was mandatory; however, only one of these had a written policy consistent with the self-report period. Using a travelling vaccination cart, offering vaccination on night shift, and monitoring and providing feedback about staff vaccination rates were infrequently employed as elements of staff vaccination programs, although all were positively correlated with staff vaccination rates. Standing orders for resident vaccination were reported by only 84 facilities. Fourteen institutions required written consent for vaccination from the resident or a relative. Facility requirements for consent to vaccinate from the resident or a relative were significantly associated with mean vaccine coverage: 90.5% coverage for institutions requiring verbal consent, 86.5% coverage for institutions requiring written consent and 95.0% for institutions not requiring written or verbal consent.

Interpretation

Staff vaccination rates in Alberta long-term care facilities are unacceptably low. Changes in staff vaccination programs may improve the situation even in the absence of mandatory vaccination or work exclusion rules. Requirements for written consent for vaccination of residents of long-term care facilities may be a barrier to immunization.

PROBLEM BEING ADDRESSED: School staff are anxious about the demands on their time associated with a perceived increase in health problems among their students. OBJECTIVE OF PROGRAM: To respond to these concerns by developing a health committee in two elementary schools and one high school. The health committee could perform needs assessments and, with the results of these assessments and a careful literature review, could develop health policies and procedures appropriate to the school environment and to evolving community expectations. MAIN COMPONENTS OF PROGRAM: A committee of four family physicians (nonremunerated parents of students), one of whom served as Chair, four school administrators, and one part-time remunerated nurse practitioner explored aspects of illness in the schools. They studied approaches to acute and chronic student illness; emergency response; management of children with special needs; environmental safety; health promotion; and the availability and quality of resources for learning about health for teachers, administrators, parents, and students. CONCLUSION: Opportunities exist for family physicians to expand their involvement in child and adolescent health in schools. Involvement should be collaborative and multidisciplinary and reflect community interests and needs.

Occupational hepatitis B remains a threat to healthcare workers (HCWs) worldwide, even with availability of an effective vaccine. Despite limited resources for public health, the Czech Republic instituted a mandatory vaccination program for HCWs in 1983. Annual incidence rates of acute hepatitis B were followed prospectively through 1995. Despite giving vaccine intradermally from 1983 to 1989 and intramuscularly as half dose from 1990 to 1995, rates of occupational hepatitis B decreased dramatically, from 177 cases per 100,000 workers in 1982 (before program initiated) to 17 cases per 100,000 in 1995. Among high-risk workers, the effect was even more dramatic (from 587 to 23 per 100,000). We conclude that strong public-health leadership led to control of occupational hepatitis B among HCWs in the Czech Republic, despite limited resources that precluded administering full-dose intramuscular vaccine for much of the program. Application of a similar program should be considered for other countries in regions that currently do not have a hepatitis B vaccination program.

OBJECTIVE: To determine the policies of Canadian medical schools concerning immunization of students and the methods used to promote these policies. DESIGN: Mail survey with the use of a 12-item, self-administered questionnaire; telephone follow-up to ensure response. SETTING: All 16 medical schools in Canada. PARTICIPANTS: Deans of Canada's 16 medical schools or their designates. All of them responded to the questionnaire. MAIN OUTCOME MEASURES: Policies on vaccination of students against diphtheria, hepatitis B, influenza, measles, mumps, poliomyelitis, rubella, tetanus and typhoid fever; recommended or required timing of such vaccination; methods for making students aware of immunization policies and for making vaccinations available to students; responsibility for payment for vaccination; compliance rates; methods used to monitor compliance; problems associated with noncompliance; policies for compensating students infected with hepatitis B or other vaccine-preventable diseases; and future plans for vaccination of medical students. RESULTS: Vaccination against rubella was required in 11 (69%) of the 16 medical schools, and vaccination against tetanus, diphtheria and hepatitis B was required in 10 (63%). Nine schools (56%) required vaccination against measles and poliomyelitis, and eight (50%) required mumps vaccination. Only three schools (19%) required or recommended influenza vaccination, and only one recommended vaccination against typhoid fever. The authors identified various methods used to promote student awareness of immunization policies, make vaccinations available, pay for vaccinations and monitor compliance. CONCLUSIONS: Each medical school has a unique set of requirements and recommendations for the vaccination of medical students. National guidelines on immunization for medical students and a comprehensive and nationally coordinated vaccination program would help to ensure that students receive proper protection from disease.

In the Fall 2009, the University of Pittsburgh Models of Infectious Disease Agent Study (MIDAS) team employed an agent-based computer simulation model (ABM) of the greater Washington, DC, metropolitan region to assist the Office of the Assistant Secretary of Public Preparedness and Response, Department of Health and Human Services, to address several key questions regarding vaccine allocation during the 2009 H1N1 influenza pandemic, including comparing a vaccinating children (i.e., highest transmitters)-first policy versus the Advisory Committee on Immunization Practices (ACIP)-recommended vaccinating at-risk individuals-first policy. Our study supported adherence to the ACIP (instead of a children-first policy) prioritization recommendations for the H1N1 influenza vaccine when vaccine is in limited supply and that within the ACIP groups, children should receive highest priority.

A survey of nurse associate training programs in the United States and its territories was made in 1972. Data were obtained by questionnaires mailed to program directors, with mail and telephone followup, for 60 operating programs and 9 programs being planned. The response rate was 79 percent of an estimated 87 programs in existence. The survey data indicated that the "typical" nurse associate training program lasts 4 to 6 months, began instruction in 1971, and is sponsored solely by a university or a 4-year college. The most frequently mentioned sources of financial support are the sponsoring institutions or the National Institutes of Health, or both. The typical program receives about 24 trainee applications a year and can accommodate 16 new students annually; 12 students graduate each year at a cost of about $3,536 per graduate. Most students in nurse associate training are white women who have either a diploma or bachelor's nursing degree. In addition to a substantial amount of nursing experience, they are likely to have a guarantee of employment on graduation. Nurse associates are expected to exercise a significant amount of independent judgment in tasks performed, and they are likely to work with primary care physicians in a wide range of settings, including rural and remote areas. They are likely to perform a variety of tasks and activities, including giving physical examinations, ordering tests and medications (under standing order), instructing, counseling, and monitoring patients, and management of disease.

Background. Hepatitis B virus (HBV) infection is a well recognised occupational health hazard preventable by vaccination. Objectives. To determine the knowledge of operating room personnel (ORP) in Nigeria about the Hepatitis B vaccine, their perception of Hepatitis B vaccination and vaccination status against HBV. Methods. Four university hospitals were selected by simple random sampling. A structured questionnaire was administered to 228 ORP after obtaining consent. Result. Only 26.8% of ORP were vaccinated against HBV. The primary reason for not being vaccinated or for defaulting from vaccination was lack of time. Differences in age, sex, duration of practice and respondent's institution between vaccinated and unvaccinated ORP were not significant (P > 0.05). The majority (86.8%) had the awareness of the existence of Hepatitis B vaccine. 83.8% of respondents believed that the vaccine should be given to the ORP as part of work place safety measures. The majority were aware of the modes of transmission of HBV infection. 78.9% of respondents believed that Hepatitis B vaccine is safe and 81.1% would recommend it to another staff. Conclusion. Despite a good knowledge about HBV infection and vaccine, most of ORP are still not vaccinated. Hepatitis B vaccination should be a prerequisite for working in the theatre, hence putting surgical patients at reduced risk.

Factors associated with awareness and acceptance of hepatitis B vaccine were identified among 150 homosexual male clients of a Boston community health center. Five percent of the subjects were unaware of hepatitis B and 25 percent had a history of hepatitis. Among the remaining 106 men, 68 percent were aware of the vaccine, and 25 percent of these had been vaccinated. Awareness of vaccine was associated with education beyond the baccalaureate level. Factors associated with vaccination included at least one prior visit to the health center, having health insurance, and extent of knowledge of the effects of hepatitis B. Among those not vaccinated, 68 percent would like to be but were deterred by the perceived high cost of the vaccine. The predominant reason given by the 31 percent who have decided not to be vaccinated was the perception that they were not at risk because of monogamous sexual relationships, or "safer" sexual practices. Strategies for maximizing vaccine use among homosexually active men should focus on increasing both awareness of the vaccine and appropriate perceptions of risk.

Varicela Biken [Live varicella Biken vaccine (strain Oka)] is an effective and safe vaccine for the prevention of varicella infection. Although the recommended schedule in all age groups (children, adolescents and adults) is a single dose, physicians in some countries follow the 2007 recommendation of the US Advisory Committee on Immunization Practices (ACIP) which recommends “implementation of a routine 2-dose varicella vaccination program for children, with the first dose administered at age 12–15 months and the second dose at age 4–6 years.”1 Therefore, cases can arise when two doses of Varicela Biken are given even though the ACIP guidelines are a response to the US epidemiological situation and for US licensed products based on the Oka/Merck and the Oka-RIT strains (Varicela Biken is not registered in US). The aim of this study is to ascertain the safety of a second dose of Varicela Biken in children who have been previously vaccinated with the same vaccine.

In this study, children, 4–6 years of age who had been previously vaccinated with Varicela Biken, received a single 0.5 mL dose of live attenuated varicella virus vaccine containing at least 1,000 Plaque Forming Units (PFU) attenuated live Varicella-zoster virus (Oka strain). Participants were monitored for 30 minutes after vaccination. Predefined injection site and systemic reactions were solicited during the subsequent seven days. Unsolicited injection site reactions and unsolicited systemic events were collected throughout the study. Any serious adverse events occurring throughout the study were reported to the sponsor's pharmacovigilance department.

One hundred and twenty two children were recruited and all provided safety data. There were no immediate adverse events or injection site reactions. Forty three percent of participants reported injection site reactions and 22.1% reported systemic reactions on solicitation during the seven days after vaccination. During the 30 day monitoring period, 43 participants reported a total of 66 adverse events. Seven participants reported a total of eight unsolicited events that were assessed as related to the vaccine or where the relationship to vaccination was unknown. Five of these eight events were injection site reactions and all were mild, systemic reactions included mild rash (1 case) and fever (2 cases). There was a single serious adverse event that was not related to the study medication (subject was a passenger in a motor vehicle accident). A second dose of Varicela Biken was well tolerated and showed no significant safety issues in this population of previously vaccinated children.

Objectives

To review estimates of U.S. nurse supply and demand, document trends in nurse immigration to the United States and their impact on nursing shortage, and consider strategies for resolving the shortage of nurses in the United States without adversely affecting health care in lower-income countries.

Principal Findings

Production capacity of nursing schools is lagging current and estimated future needs, suggesting a worsening shortage and creating a demand for foreign-educated nurses. About 8 percent of U.S. registered nurses (RNs), numbering around 219,000, are estimated to be foreign educated. Eighty percent are from lower-income countries. The Philippines is the major source country, accounting for more than 30 percent of U.S. foreign-educated nurses. Nurse immigration to the United States has tripled since 1994, to close to 15,000 entrants annually. Foreign-educated nurses are located primarily in urban areas, most likely to be employed by hospitals, and somewhat more likely to have a baccalaureate degree than native-born nurses. There is little evidence that foreign-educated nurses locate in areas of medical need in any greater proportion than native-born nurses. Although foreign-educated nurses are ethnically more diverse than native-born nurses, relatively small proportions are black or Hispanic. Job growth for RNs in the United States is producing mounting pressure by commercial recruiters and employers to ease restrictions on nurse immigration at the same time that American nursing schools are turning away large numbers of native applicants because of capacity limitations.

Conclusions

Increased reliance on immigration may adversely affect health care in lower-income countries without solving the U.S. shortage. The current focus on facilitating nurse immigration detracts from the need for the United States to move toward greater self-sufficiency in its nurse workforce. Expanding nursing school capacity to accommodate qualified native applicants and implementing evidence-based initiatives to improve nurse retention and productivity could prevent future nurse shortages.

To help resolve the conflicting demands of primary and secondary care in hospital medical clinics, a program was developed whereby, with the physicians' agreement, nurses would select and vaccinate clinic patients eligible for influenza vaccination. In a controlled trial the nurses offered vaccination to half of the eligible patients attending morning sessions and vaccinated 35% of them. In contrast, physicians in the afternoon sessions, who were unaware of the program, vaccinated only 2% of similar patients. These results show that, although these physicians agree with guidelines for influenza vaccination, they are not currently providing the service. The use of nursing personnel to provide this and other types of primary medical care for clinic patients is a reasonable alternative.

The study describes the smoking habits of student nurses and determines the correlates of smoking initiation, continuation, and cessation. The sample included 1,163 students attending 10 nursing schools in Buffalo, NY. Data were gathered by means of a self-administered questionnaire. Approximately 30 percent of the students were current smokers, 25 percent were exsmokers, and 45 percent had never smoked. More than half of the smokers (57 percent) expressed the desire to quit, and 81 percent had tried to do so in the past. Major reasons for trying to quit were to protect future health, save money, self-discipline, and pressure from significant others. Most (90 percent) of the students who had tried to quit had attempted to do so on their own and all at once. Knowledge of the health consequences of smoking was not significantly related to smoking behavior. These data suggest the need for health educators to promote personal health practices among their students that are congruent with the goals of the nursing profession of health promotion and disease prevention.

Background

The Advisory Committee on Immunization Practices advocates that influenza immunization is the most effective method for prevention of illness due to influenza. Recommendations for vaccination of children against influenza have been revised several times since 2002, and as of 2008 include all children 6 months to 18 years of age. Nevertheless, influenza immunization rates have remained low.

Methods

We surveyed practicing pediatricians in Maryland in the spring of 2007 to determine their attitudes and practices toward childhood influenza immunization.

Results

The overall response to the survey was 21%. A total of 61% of respondents reported that immunization either is cost neutral or produces a loss, and 36.6% noted it was minimally profitable. Eighty-six percent of respondents were receptive to supporting school-based immunization programs, and 61% indicated that they would participate in such programs. Respondents reported higher rates of immunization of select patient groups than those noted by the Centers for Disease Control and Prevention

Conclusion

Vaccination was reported to occur at multiple types of patient encounters, as recommended. Survey respondents stated that practice-based immunization was not a profitable service. Pediatricians were supportive of school-based immunization programs, and more than half stated they would be actively involved in such programs. School-based programs may be critical to achieving high vaccination coverage in the school-aged population.