Hepatitis B vaccination coverage levels among healthcare workers in the United States, 2002-2003

Background. Hepatitis B virus ( HBV) infection is a well recognized risk for healthcare workers ( HCWs), and routine vaccination of HCWs has been recommended since 1982. By 1995, the level of vaccination coverage among HCWs was only 67%. Objective. To obtain an accurate estimate of hepatitis B vaccination coverage levels among HCWs and to describe the hospital characteristics and hepatitis B vaccination policies associated with various coverage levels. Design. Cross- sectional survey. Methods. A representative sample of 425 of 6,116 American Hospital Association member hospitals was selected to participate, using probability- proportional- to- size methods during 2002- 2003. The data collected included information regarding each hospital's hepatitis B vaccination policies. Vaccination coverage levels were estimated from a systematic sample of 25 HCWs from each hospital whose medical records were reviewed for demographic and vaccination data. The main outcome measure was hepatitis B vaccination coverage levels. Results. Among at- risk HCWs, 75% had received 3 or more doses of the hepatitis B vaccine, corresponding to an estimated 2.5 million vaccinated hospital- based HCWs. The coverage level was 81% among staff physicians and nurses. Compared with nurses, coverage was significantly lower among phlebotomists ( 71.1%) and nurses' aides and/or other patient care staff ( 70.9%;). Hepatitis B vaccination P <.05 coverage was highest among white HCWs ( 79.5%) and lowest among black HCWs ( 67.6%;). Compared with HCWs who worked P <.05 in hospitals that required vaccination only of HCWs with identified risk for exposure to blood or other potentially infectious material, hepatitis B vaccination coverage was significantly lower among HCWs who worked in hospitals that required vaccination of HCWs without identified risk for exposure to blood or other potentially infectious material ( 76.6% vs 62.4%;). P <.05. Conclusions. In the United States, an estimated 75% of HCWs have been vaccinated against hepatitis B. Important differences in coverage levels exist among various demographic groups. Hospitals need to identify methods to improve hepatitis B vaccination coverage levels and should consider developing targeted vaccination programs directed at unvaccinated, at- risk HCWs who have frequent or potential exposure to blood or other potentially infectious material.