强制性职业健康检查外文文献

Obligatory occupational health check increases vaccination rates among medical students K Schmid K Merkl K Hiddemann Koca H Drexler Institute and Outpatient Clinic of Occupational Social and Environmental Medicine University of Erlangen Nuremberg Erlangen Germany Received 19 February 2008 accepted 16 May 2008 Available online 14 July 2008 KEYWORDS Medical students Vaccination Vaccination coverage Hepatitis B Occupational health check Effi cacy SummaryIn October 2002 an obligatory occupational health check for all preclinical students at the University of Erlangen Nuremberg was intro duced Over the period 2005 to 2007 medical students started their clinical year either with or without a health check during their preclinical years The aim of the study was to evaluate the effi cacy of health checks for preclinical students with respect to vaccination rates At the beginning of the clinical year we examined 242consecutive students 121 with and121 withouta pre ceding preclinical occupational health check The immunisation rate against hepatitisBincreasedduringmedicaleducationfrom50 to96 inwomenand from 58 to 96 in men In medical students without an initial occupational health check vaccination rates were signifi cantly lower 85 in women and 81 in men A signifi cant benefi t from the preclinical check was seen in men regarding immunisation status for hepatitis B tetanus diphtheria po lio rubella and mumps and in women for hepatitis B and rubella This study demonstrates that it is possible to signifi cantly increase vaccination rates particularlyformen Eveninmedical students startingtheirclinicaltraining an individual occupational health check is necessary to optimise immunisa tion against infectious diseases Routine occupational health checks could make an important contribution to closing gaps in vaccination coverage 2008 The Hospital Infection Society Published by Elsevier Ltd All rights reserved Parts of this paper have been included in the medical thesis in preparation of Kerstin Merkl at the Medical Faculty of the University of Erlangen Nuremberg Parts of this paper have been presented at the annual congress of the German Society for Occu pational and Environmental Medicine Hamburg Germany 12e15 March 2008 Corresponding author Address Institute and Outpatient Clinic of Occupational Social and Environmental Medicine University of Erlangen Nuremberg Schillerstrasse 25 29 D 91054 Erlangen Germany Tel fax 49 9131 852 6777 E mail address klaus schmid rzmail uni erlangen de 0195 6701 see front matter 2008 The Hospital Infection Society Published by Elsevier Ltd All rights reserved doi 10 1016 j jhin 2008 05 010 Journal of Hospital Infection 2008 70 71e75 Available online at Introduction Healthcare workers HCWs are at increased risk of occupationally acquired infections 1Medical stu dents come into contact with infectious material early in their medical education and many studies have demonstrated that needlestick injuries are common in medical students 2e6Therefore we in troduced an obligatory occupational health check for all preclinical students at the University of Er langen Nuremberg in October 2002 7This included checking vaccination certifi cates and serological tests for hepatitis B hepatitis C and on request human immunodefi ciency virus HIV Voluntary vaccination against hepatitis B was offered free of charge Before October 2002 an obligatory occupa tional health check had been performed only at the end of clinical education before starting the clinical year which consists of a full time job at a teaching hospital Voluntary vaccination against hepatitis B free of charge was offered to all studentswhohadsuccessfullypassedtheir preclinical education An obligatory occupational health check for medical students is controversial and of question able necessity For example is it suffi cient to offer only vaccination against hepatitis B as medical students should receive enough informa tion during their education to be aware of the importance of vaccinations Methods of evidence based practice have been applied to occupational health risks and interventions only in a very limited way 8 9Systematic evaluation of the bene fi t of a preventive measure is essential for evi dence based prevention This should improve the quality of prevention and optimise the use of fi nancialresources Thereforewedecidedto evaluate the effectiveness of health checks for preclinical students For the period 2005 to 2007 medical students started their clinical year either with or without a health check during their preclinical years Duringahealthcheckatthebeginningof the clinical year we evaluated whether there was a benefi t in those students who had had a preclinical check Methods Since October 2002 regulations of the University Erlangen Nuremberg have required that all fi rst year students of the medical faculty have a docu mented occupational health check In the period 2005 to 2007 about half the students started their clinical year having had a health check during their preclinical years At the health check at the beginning of the clinical year we examined 242 consecutive clinical students 121 with CS and 121 without CS a preclinical occupational health check Data from the 121 preclinical health checks were available The students average age was 26 5 3 3 years with 62 8 female in the CS group and 27 2 3 8 years with 48 8 females in the CS group As the proportion of females differed signifi cantly in both groups men and women were analysed separately The median time interval from the initial occupa tional health check to the one required to enter the clinical year was 3 9 years The students vaccination status against teta nus diphtheria poliomyelitis pertussis measles mumps rubella and hepatitis B was checked by a physician Suffi cient protection against tetanus diphtheria poliomyelitis and pertussis was as sumed if a booster dose had been given within the past 10 years Students with two documented vaccinations against measles mumps and rubella were classifi ed as adequately immunised Persons without certifi cates of vaccination were classifi ed as not being immunised A blood sample was taken from each student and antibodies against hepatitis B hepatitis C and on request HIV were examined enzyme linked immunosorbent assay In students already vacci nated against hepatitis B response to the vaccine was confi rmed anti HBs Vaccination against hepatitis B was offered free of charge to all medical students Students with inadequate immunity to tetanus diphtheria poliomyelitis measles mumps rubella and per tussis were informed and asked to consult their family doctor to complete their immunisations If necessary students who chose to specialise in paediatrics had the opportunity to be vaccinated against measles mumps rubella varicella and pertussis Participationinvaccinationswas voluntary The occupational health check was performed as an obligatory preventive medical check in accordance with the German Biological Agents Ordinance 10The data collected were made anon ymous in accordance with legal requirements regardingdataprotectionandmedical confi dentiality Data were entered into a database and analysed using SPSS for Windows 15 0 A statistical evalua tion was performed using descriptive analysis the Chi squaredtestandManneWhitneyU test P 0 05 was considered signifi cant 72K Schmid et al Results Hepatitis B The proportion of students who were immunised against hepatitis B increased during medical edu cation from 50 0 to 96 1 in women and from 57 8 to 95 6 in men with no signifi cant differ ences between men and women Nevertheless in CS students vaccination rates were signifi cantly lower in both men and women Figure 1 When testing vaccine response in those already immunised we detected anti HBs in 98 3 of the CS group median anti HBs 857 IU L and in 93 0 of the CS group median anti HBs 694 IU L Vaccination against hepatitis B either as a pri mary immunisation or as a booster dose was neces sary in 13 2 of the CS group and in 23 3 of the CS group Other vaccinations Immunisation rates against other vaccine preventable diseases in men and women at the preclinical medical check and CS and CS groups are shown in Table I When comparing the data of the preclinical occupational health checks and the data of the CS group the proportion of students who were ad equately immunised increased during medical edu cation with the exception of tetanus vaccination in women Signifi cant increases were seen both in men and women in immunisation against hepatitis A rubella measles and mumps Chi squared test When comparing CS and CS students vaccina tion rates were generally higher in the CS group with the exception of mumps vaccination in women A signifi cant benefi t from the preclinical check was seen in men regarding immunisation against tetanus diphtheria polio rubella and mumps and in women against rubella Chi squared test Discussion Data from the literature indicate important cov erage gaps for certain vaccines and the often incomplete vaccination status of adults 7 11 12Lud wig et al analysed the immune status of 1134 trav ellers comparingactualwithrecommended vaccinations They demonstrated serious gaps in polio diphtheria and tetanus immunisation Over all women had better immunisation rates than men 13Vaccination gaps also exist in HCWs Bader and Egler reported 73 6 vaccination against teta nus in employees and an 80 3 vaccination preva lence in HCWs age cohort 20e29 years 12 In 2000 Seibt et al investigated the vaccination status of general practitioners internal specialists and pharmacists in Germany The best vaccine pro tection was documented against tetanus at 79 4 of physicians and 63 3 of pharmacists For other infectious diseases such as hepatitis B 73 4 diphtheria 54 1 polio 50 8 measles 17 7 mumps 14 2 and rubella 14 3 physi cians immunisation rates were low in comparison with our medical students 14 In 2001 Radon et al reported that the vaccina tion status of students of the medical school in Mu nich Germany was unsatisfactory 15Schmid et al alsoconfi rmedrelevantvaccination gaps inmedical students at the University of Erlangen Nuremberg 7 0 20 40 60 80 100 women509685 men589681 PreCS CS Figure 1Immunisation rates in men and women against hepatitis B at the preceding initial medical check Pre and in clinical students with CS and without CS the initial medical check Asterisks indicate signif icant differences P80 although the preclinical medical check was shown to have signifi cant benefi t improving vaccination rates to w96 in the CS group In our opinion these results demonstrate that personalised medical advice given during an occupational health check is a superior way to mo tivate students in preventive measures especially immunisations Health policies concerning the immunisation of HCWs and medical students vary in different countries 17e22Studies from other countries have demonstrated poor compliance with hepatitis B vaccination and have suggested that it should be made mandatory 23In our experience a clear offer of vaccination at an individualised occupational health check is an effective way to achieve satis factory immunisation rates In our study we found that men in particular require doctors advice such as that given during an occupational health check in order to close immunisation gaps Our results are in accordance with others reporting that women have better immunisation rates than men They indicate that concern for health might be greater in women than in men Nevertheless we were able to show that men can be motivated by a personal occupational health check For reasons of economy we were only able to offervaccinationagainsthepatitisBfreeof charge Medical students with inadequate immu nity to other infectious diseases are informed and asked to consult their family doctor to complete their immunisations Even with this approach we were able to see signifi cant positive effects on vaccination status One might speculate that the effect would have been greater if all vaccines were offered free of charge at the occupational health check Occupational health checks are meaningful pre ventive measures able to signifi cantly increase vaccination rates particularly for men Even in medical students starting their clinical training individualised advice is necessary for optimising immunisation against infectious diseases Routine occupationalhealthchecksinmedicalstudents and also in practising doctors could make an important contributiontoclosinggapsinvaccinationcoverage Acknowledgements Theauthorsthankallparticipantsfortheir co operation Confl ict of interest statement None declared Funding sources None References 1 Rapiti E Pru ss U stin A Hutin Y Sharp injuries assessing the burden of disease from sharps injuries to health care workers at national and local levels In WHO Environmen tal Burden of Disease Series No 11 Geneva World Health Organization 2005 2 Schmid K 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evidence based practicetooccupationalhealth OccupMed2000 50 231e236 9 Verbeek JH van Dijk FJ Malmivaara A et al Evidence based medicine for occupational health Scand J Work Environ Health 2002 28 197e204 10 Ordinance on safety and health protection at work involving biological agents Biological Agents Ordinance e Biostoff verordnung Federal Gazette 29 January 1999 Part I no 4 Bonn Germany 11 Reiter S Vaccination coverage in Germany Bundesgesund heitsblGesundheitsforschGesundheitsschutz2004 47 1144e1150 74K Schmid et al 12 Bader HM Egler P Immunization coverage in the adult workforce 2003 Utilisation of ro