The global population of older adults is growing. Older adults are more vulnerable to infectious diseases compared to younger adults. Vaccines are available to protect older adults against several infectious diseases, yet their uptake remains sub-optimal. Healthcare professionals (HCP) play an important role in vaccine decisions of older adults and subsequently they could improve the vaccine uptake. This study aims to identify HCPs' awareness, attitudes and perceptions regarding older adult vaccination. Moreover, the study investigates HCPs' information needs, information seeking behaviour and factors influencing older adult vaccine communication. Semi-structured in-depth interviews were conducted with 79 HCPs involved in older adult vaccination in Hungary, Italy, the Netherlands and France. The interview guide was inspired by the Integrated Change Model (I-Change Model) and included both questions about existing vaccines and hypothetical new vaccines. All interviews were transcribed verbatim and subjected to a process of coding. Thematic analysis was performed and cross-country comparisons were made. Participants in all four countries generally shared positive views about vaccines although some reservations regarding vaccines were also shared. In case of a hypothetical new vaccine, HCPs in all countries indicated a need for information on disease and vaccine characteristics, including on efficacy, side-effects and contra-indications. The introduction of new vaccines and patient questions were drivers for information seeking among HCPs. Main sources of information used by HCPs were scientific articles and national institutes. Participants mentioned factors that could either prevent them from discussing vaccines or hamper the conversation. They expressed a desire to further develop their communication skills on vaccines. Information provision for HCPs is crucial to increase their awareness and knowledge on vaccines. However, information alone is insufficient to adequately prepare HCPs for discussing vaccines with older adults. Dedicated learning activities to acquire communication skills about vaccines are also needed.

The increase in the older adult population over the coming decades emphasizes the importance of vaccinations to prevent infectious diseases among this population. Acceptance of vaccination is crucial for a successful vaccination program and insight in the motives of acceptation is therefore important. This study explores specifically the association between experiencing influenza-like illness (ILI) and other determinants for older adults on seasonal influenza vaccination acceptance. Furthermore, differences in acceptance of pneumococcal, influenza, herpes zoster and pertussis vaccines between various age groups were studied. Three prospective observational studies (2011/2012, 2012/2013 and 2014/2015) were performed in community-dwelling older adults (≥ 60 years) to monitor ILI. During home visits, throat/nose swabs, a blood sample and a questionnaire on demographics and general health were collected. An additional questionnaire was added to the 2014/2015 study on motives and intention of older adults to accept seasonal influenza and other vaccinations, including knowledge statements on vaccination in general (n = 1647). Random Forest analyses were used to identify predictors of intention to accept seasonal influenza vaccination. Univariate analyses showed that males, persons with limited contact with children, people who have received seasonal influenza vaccination in 2014/2015, persons reporting co-morbidity, persons reporting a lower perceived health and persons with more knowledge about vaccination have a significantly higher intention to accept seasonal influenza vaccination. The univariate and prediction analyses showed no association between having experienced ILI and the intention to receive seasonal influenza vaccination. Previous influenza vaccination had by far the most predictive value; when excluding this factor, age and perceived health were the best predictors. Except for pertussis vaccination, persons aged ≥ 70 years had a higher intention to vaccinate compared to persons aged 60–69 years. Our study showed that there is no association between having experienced ILI and the intention to receive seasonal influenza vaccination. Instead, previous influenza vaccination had the highest predictive value. Therefore, efforts should be made to make vaccination a habit to ensure annual vaccination. Healthcare workers, such as general practitioners (GPs) could play an important role in this because of frequent contact between older adults and GPs and the perceived importance of the advice of the GP. NTR4818 (30-09-2014).

BACKGROUND:The growing population of vulnerable clients receiving home-based nursing care (HBNC), combined with the worldwide increase in the prevalence of multidrug-resistant organisms (MDROs), poses a new burden on nursing staff. This study explored the attitudes, perceptions, experiences, challenges, and needs of nursing staff providing HBNC for clients carrying MDROs. METHODS:Seven focus groups with home-based nursing staff (N = 34) were performed in the Netherlands between April and July 2022, using a semistructured, open-ended topic list based on the integrated-change model and seven domains of practice. Data were analyzed using thematic analysis. RESULTS:Participants experienced ambiguities in infection prevention and control recommendations in MDRO guidelines or protocols. At times, the proportionality of these measures was questioned, including the effect on compliance. Participants indicated to be influenced by perceptions and behavior of their colleagues and clients. Furthermore, participants experienced inadequate information exchange about MDRO carriage and debated about the roles and responsibilities of involved health care professionals. CONCLUSIONS:There is a need for tailored MDRO guidelines for HBNC. Expanding knowledge, sufficient resources, and improving information exchange about MDRO carriage among health care professionals, clients (including their family members), and HBNC organization boards are essential to respond to current developments in HBNC.

Background Healthcare workers (HCW) significantly influence older adults’ vaccine acceptance. This systematic review aimed to identify effective educational interventions for HCWs that could enhance their ability to engage in a dialogue with older adults on vaccination. Methods Medline, Scopus, Cochrane library and grey literature were searched for comparative studies investigating educational interventions concerning older adult vaccinations. The search encompassed all languages and publication years. Analysis was performed on the outcomes ‘vaccines offered or ordered’ and ‘vaccination rates’. Whenever feasible, a sub-analysis on publication year was conducted. Methodological limitations were assessed using the RoB 2 for RCTs and the GRADE checklist for non-randomized studies. Study outcomes were categorized according to the four-level Kirkpatrick model (1996) for effectiveness: reaction, learning, behaviour, and results. Results In total, 48 studies met all inclusion criteria. Most studies included reminder systems signalling HCWs on patients due for vaccination. Other interventions included seminars, academic detailing and peer-comparison feedback. Four articles reporting on the reaction-level indicated that most HCWs had a favourable view of the intervention. Two of the six articles reporting on the learning-level observed positive changes in attitude or knowledge due to the intervention. Seventeen studies reported on the behaviour-level. An analysis on eleven out of seventeen studies focusing on vaccines ‘ordered’ or ‘offered’ outcomes suggested that tailored reminders, particularly those implemented before 2000, were the most effective. Out of 34 studies reporting on the result-level, 24 were eligible for analysis on the outcome ‘vaccination rate’, which showed that compared to usual care, multicomponent interventions were the most effective, followed by tailored reminders, especially those predating 2000. Nonetheless, tailored reminders often fell short compared to other interventions like standing orders or patient reminders. In both the behaviour-level and result-level ‘education only’ interventions frequently underperformed relative to other interventions. Seventeen out of the 27 RCTs, and seven of the 21 non-randomized studies presented a low-to-medium risk for bias in the studies’ findings. Conclusions Tailored reminders and multicomponent interventions effectively assist HCWs in addressing vaccines with older adults. However, education-only interventions appear to be less effective compared to other interventions rates, attitude, knowledge.

AIMS:The aims of the study were to explore the impact of caring for patients carrying multi-drug resistant organisms on nursing staff and identify factors predicting their intention to use personal protective equipment and their ability to comply with advised infection prevention and control measures.BACKGROUND:Carriage of multi-drug resistant organisms and corresponding infection prevention and control measures have a major impact on patients. Limited research has been done to investigate the impact of caring for these patients on nursing staff.DESIGN:A cross-sectional design.METHODS:Online survey among Dutch nursing staff in various healthcare settings. Prediction analyses were conducted using random forest. The STROBE checklist was used preparing the manuscript.RESULTS:974 respondents were included. The majority of nursing staff reported to have experience in caring for patients carrying multi-drug resistant organisms. Relevant dilemmas in daily practice were identified. Important predictors of the intention to use protective equipment were practicing hand hygiene, usable protocols, favourable attitudes and perceptions, as well as knowledge. Important predictors of the ability to comply with advised measures were usable and findable protocols, a suitable work environment and practicing hand hygiene.CONCLUSION:We have gained comprehensive insight into experiences, attitudes, perceptions, knowledge and dilemmas in daily practice of nursing staff caring for patients carrying multi-drug resistant organisms. To enhance their intention to use protective equipment and their ability to comply with advised measures, activities should focus on improving hand hygiene and the usability of protocols. Additionally, efforts are needed to improve knowledge, provide better resources and a more supportive work environment. All of which need to be specifically tailored to each healthcare setting.RELEVANCE TO CLINICAL PRACTICE:The results can be used in the development of interventions to improve nursing care while reducing the unfavourable impact on nursing staff and supporting adherence to advised measures.

Abstract Background and objectives Healthcare professionals (HCP) have a key role in raising awareness and informing older adult patients about vaccines. However, HCPs are sometimes unaware of existing vaccines or have little knowledge on them. This study aimed to identify the information flows within HCP networks and to find out which HCPs play a key role in interprofessional information transfer. Methods An online questionnaire was distributed in Hungary (HU), Italy (IT), the Netherlands (NL) and France (FR) among HCPs, such as general practitioners (GP), medical specialists (MS), public health physicians (PHP), pharmacists, specialists elderly care (SEC) and nurses. The questionnaire included a case study in which a new vaccine for older adults was about to be made available. HCPs were asked whom they would contact for additional information and by whom they would be contacted on their turn, to reveal the information flow. Data were analyzed using social network analysis, comparing the results between countries. Results Preliminary results show the top three information providers. These were identical for NL and IT, with the MS being contacted by the highest number of different HCP-types, followed by the GP and PHP. FR and HU had GP ranked first and MS second. The PHP ranked also third in HU, but in FR it was the geriatrician instead. The main requesters of information were pharmacists (IT, HU), GPs (NL) and community nurses (FR). Hospital nurses (IT, FR), SEC (NL) and GPs (HU) ranked second on the number of HCP-types they would contact for information on a new vaccine. Conclusions In each country GPs and MS were the most important information providers in the HCP network when a new vaccine is introduced. Main information requesters varied per country and were pharmacists, GPs, nurses, and SEC. Thus, GPs were both main information providers and requesters (NL, HU). Key messages • Our study identified the HCP-(information)network regarding (new) vaccines for older adults. GPs and MS are the main providers of information, while pharmacists, nurses, and GPs are main requesters. • Identifying the HCPs in the information network makes it possible to specifically target key HCPs and to provide them with tailormade information on new vaccines.

Population Medicine considers the following types of articles:• Research Papers -reports of data from original research or secondary dataset analyses.• Review Papers -comprehensive, authoritative, reviews within the journal's scope.These include both systematic reviews and narrative reviews.• Short Reports -brief reports of data from original research.• Policy Case Studies -brief articles on policy development at a regional or national level.• Study Protocols -articles describing a research protocol of a study.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.

Population Medicine considers the following types of articles:• Research Papers -reports of data from original research or secondary dataset analyses.• Review Papers -comprehensive, authoritative, reviews within the journal's scope.These include both systematic reviews and narrative reviews.• Short Reports -brief reports of data from original research.• Policy Case Studies -brief articles on policy development at a regional or national level.• Study Protocols -articles describing a research protocol of a study.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.

Background The COVID-19 pandemic has led to an increased interest in communication with the public regarding vaccination. Our recent Cochrane qualitative evidence synthesis points to several factors that could influence the implementation and success of healthcare worker communication with older adults about vaccination. However, it is often difficult to assess whether factors identified as potentially important in qualitative studies have been considered in randomized trials because of poor trial reporting. We therefore decided to use our qualitative evidence synthesis findings to encourage better reporting of vaccination communication interventions in trials by developing an elaboration of the TIDieR (Template for Intervention Description and Replication) checklist for intervention reporting. Methods We examined the findings from our Cochrane qualitative evidence synthesis on healthcare workers’ perceptions of and experiences with communicating about vaccination with adults over the age of 50 years. We identified factors that could influence the implementation and uptake, and thereby the effectiveness, of vaccination communication interventions. We then drafted a list of the information elements we would need from trial reports to assess whether these factors had been considered in the development of the interventions evaluated in these trials. Finally, we compared our list of information elements to the TIDieR checklist items. We were able to align all of our information elements with the TIDieR items. However, for several of the TIDieR items, we developed a more detailed description to ensure that relevant information would be captured sufficiently in trial reports. Results We developed elaborations for the following TIDieR items: “Why” (item 2), “What—materials” (item 3), “Who provided” (item 5), “How” (item 6), “Where” (item 7) and “Tailoring” (item 9). Conclusions Both qualitative research and trials of intervention effectiveness are critical to furthering our understanding of what works, where, for whom and through which mechanisms. However, a key ingredient for developing this understanding is adequate reporting of intervention design, content and implementation in randomized trials. We hope that this elaboration of the TIDier checklist will improve reporting of interventions in trials focused on vaccine communication with older adults, and thereby enhance the usability of this research for developing future communication strategies.

Contact tracing (CT) is an important, but resource-intensive tool to control outbreaks of communicable diseases. Under pandemic circumstances, public health services may not have sufficient resources at their disposal to effectively facilitate CT. This may be addressed by giving cases and their contact persons more autonomy and responsibility in the execution of CT by public health professionals, through digital contact tracing support tools (DCTS-tools). However, the application of this approach has not yet been systematically investigated from the perspective of public health practice. Therefore, we investigated public health professionals’ perspectives and needs regarding involving cases and contact persons in CT for COVID-19 through DCTS-tools. Between October 2020 and February 2021, we conducted online semi-structured interviews (N = 17) with Dutch public health professionals to explore their perspectives and needs regarding the involvement of cases and contact persons in CT for COVID-19 through DCTS-tools, in the contact identification, notification, and monitoring stages of the CT-process. Interviews were audio recorded and transcribed verbatim. A thematic analysis was performed. Four main themes related to Dutch public health professionals’ perspectives and needs regarding involving cases and contact persons in CT for COVID-19 through DCTS-tools emerged from the data: ‘Distinct characteristics of CT with DCTS-tools’; ‘Anticipated benefits and challenges of CT for COVID-19 with DCTS- tools’; ‘Circumstances in CT for COVID-19 that permit or constrain the application of DCTS-tools’; and ‘Public health professionals’ needs regarding the development and application of DCTS-tools for CT’. Public health professionals seem to have a positive attitude towards involving cases and contact persons through DCTS-tools. Public health professionals’ (positive) attitudes seem conditional on the circumstances under which CT is performed, and the fulfilment of their needs in the development and application of DCTS-tools. Dutch public health professionals seem positive towards involving cases and contact persons in CT for COVID-19 through DCTS-tools. Through adequate implementation of DCTS-tools in the CT-process, anticipated challenges can be overcome. Future research should investigate the perspectives and needs of cases and contact persons regarding DCTS-tools, and the application of DCTS-tools in practice.

Background Human Papillomavirus (HPV) occurs in 80% of the sexually active population and may cause certain types of cancers among men and women. Vaccination against HPV could prevent cancers associated with HPV. The Dutch National Immunization Program (NIP) only includes HPV vaccination for girls, but the HPV vaccination for boys will be implemented in 2022. Little is known about the awareness of parents and their attitudes regarding the vaccination for boys. However, these concepts might influence the intention to vaccinate one’s child. Gaining insight in these factors could lead to more effective communication strategies. Methods This qualitative research aimed to explore parental associations and beliefs regarding the HPV vaccination for boys. In total, 16 interviews were conducted with parents. Topics discussed were primary associations with vaccinations, associations with HPV-vaccination and information needs regarding the HPV vaccination for boys. Results Most parents were unaware about HPV infections in boys as well as the possibility to vaccinate their sons. Furthermore, after hearing about the vaccine parents reported uncertainties about anticipated adverse effects of the vaccine. Other themes that emerged were difficulties with the proposed age at which boys would be offered the vaccination and low risk perception of the virus. Conclusion Public campaigns regarding (the HPV) vaccination should improve (parental) awareness about the virus and the vaccination, and increase knowledge. Moreover, it should address concerns regarding vaccination and be transparent about decision making. For example, a rationale why HPV vaccination is needed for boys who turn 10 years and its advantage to reducing risks for boys to contract HPV related cancers should be provided.

The increasing life expectancy leads to more older adults suffering from infectious diseases. Vaccines are available against diverse infections such as influenza, pneumococcal disease, herpes zoster and tetanus. However, vaccine acceptance is crucial for optimal preventive effect. The objective of the study is to perform a cross-country analysis of the perceptions and decision-making behaviour of older adults regarding vaccinations and their information needs. Focus groups with older adults were conducted in four countries: France, Hungary, Italy and the Netherlands. Data were analysed using thematic analysis. Demographic characteristics of participants were gathered with a questionnaire. Influenza and tetanus vaccines were commonly known, as was the disease influenza. On the contrary, the awareness of the vaccines against pneumococcal disease and herpes zoster were low. Participants also expressed a need for more information on vaccines, such as possible side effects, contra-indications and duration of protection, emphasizing that information is a condition for decision-making on vaccination. General practitioners were found to be the most important in information provision on vaccines. Perceptions on vaccines, such as effectiveness, side effects and safety, as well as perceptions on infectious diseases, such as severity, susceptibility and experiencing an infectious disease, played a role in the decision-making of older adults on vaccines. More awareness of the information needs among older adults with regard to vaccines should be raised among general practitioners and other healthcare providers. This requires appropriate knowledge about the vaccines among healthcare providers as well as communication skills to meet the information needs of older adults.

BACKGROUND:Multidrug-resistant organism (MDRO) carriage may have an adverse impact on the quality of life of carriers, in particular those who have experienced hospital precautionary measures. This study aims to gain a deeper understanding of how MDRO carriage has affected the daily lives of carriers with these experiences. METHODS:This was a qualitative study based on 15 semi-structured interviews with MDRO carriers or parents of carriers, which were analysed by thematic analysis. RESULTS:Three main themes were identified: (1) Feeling dirty and unworthy portrays the feelings that MDRO carriers often expressed and how these were related to the language usage describing the MDRO, the perceived avoidance by staff and those in their personal networks, and the effects of the precautionary measures implemented in the hospital. (2) MDROs are invisible, but impact is visible covers how the microbe, despite its apparent invisibility, still impacted carriers in their physical and psychological health. MDRO carriage disrupted their lives, by affecting their other unrelated medical conditions at times and by causing varying levels of fear for their own and others' health. (3) Carrying the burden on one's own shoulders describes the lingering questions, uncertainties and confusion that carriers continued to live with and the perceived burden and responsibility that lay on their own shoulders with respect to carrying and preventing the transmission of the MDRO. CONCLUSIONS:MDRO carriage can negatively influence the quality of people's lives in various ways. Improved support and sensitivity from health care providers (HCPs) are needed to address feelings of unworthiness among MDRO carriers and the fears that many experience. Clearer information and guidelines are also needed from HCPs to address the many questions and uncertainties that MDRO carriers face outside of the hospital in their daily lives.

Abstract Background The COVID-19 pandemic highlighted the significance of vaccination for older adults (OA), however, more health benefits could be gained with vaccination against influenza, pneumococcal disease, herpes zoster and tetanus as their uptake remains rather low. As healthcare professionals (HCP) play an important role in the vaccination decision making of OA, this study identifies obstacles in vaccination communication between HCP and OA. Methods 80 in-depth structured interviews have been conducted with HCPs in Hungary (HU), Italy (IT), the Netherlands (NL) and France (FR). Participants were general practitioners, medical specialists, public health physicians, occupational physicians, pharmacists, geriatricians, specialists elderly care and nurses. The interview included questions on HCPs’ perceptions regarding information provision to OA on vaccines. Data were analyzed cross-country, using thematic analysis. Results Preliminary results reveal that a factor hindering HCPs to initiate conversations with OA on vaccines was lack of time (FR, IT, HU, NL). In hospitals this was often due to (acute) clinical problems taking precedence over discussing vaccines (IT, NL). In ambulatory settings the high number of patients waiting to be seen prevented discussing vaccines with OA (HU). Moreover, HCPs sometimes forgot to discuss vaccines with OA (NL, HU, IT). Patient factors hindering the conversation of HCPs on OA vaccines were a negative attitude (IT, HU) and lack of understanding the information provided (IT, HU). Also, misinformation on vaccines (FR, HU), as well as anti-vax beliefs from patients (NL) or their relatives (FR, IT) hampered the conversation on vaccines. HCPs mentioned their need to learn communication skills to convince OA on vaccines (FR, IT, HU). Conclusions HCPs encounter various obstacles in communicating with OA about vaccines. Lack of time and not recognizing the opportunity to discuss vaccines are important barriers for initiating vaccine conversations. Key messages • Providing HCPs with communication strategies is important to support HCPs in discussing vaccines with OA. • Reminder systems are important to help HCPs remember address vaccination.

Antibiotic resistance is a growing problem worldwide. Several measures are taken when identified carriers of antibiotic resistant bacteria (such as MRSA) are admitted to a hospital: patients stay in an isolation room and healthcare workers have to put on personal protective equipment (PPE) before entering the isolation room. Previous research on experiences of isolated care shows that patients felt lonely, forgotten and stigmatized while healthcare personnel felt guilty for bundling their contact moments. Therefore, an innovation project has been set up to re-design the concept of an isolation room: the isolation room of the future. The isolation room of the future concentrates around providing enhancements for communication and interaction, comfort and accessibility and architecture and interior design, while taking into account the infection prevention regulations for isolation rooms in hospitals. The interior of the isolation room of the future consists of biophilic elements, including photo wallpaper, transparent walls, surfaces that mimic natural materials, and natural and dynamic light; creating a positive healing and working environment for patients, staff and visitors. Transparent walls also allow easy communication between patients and healthcare workers without the need for the PPE. Furthermore, a transfer hatch is installed to easily serve meals and drinks to the patient. A modular furniture set-up will ensure the most optimum use of space in the room. The isolation room of the future does not necessarily need to be built as a whole; specific elements can implemented depending on needs, finances and possibilities. We hope that these practical solutions might inspire healthcare facilities worldwide to re-think the concept of an isolation room to improve the experiences of people involved in isolated care. This approach is useful for a broader range of infections with pathogens that require isolation precautions, among which SARS-CoV-2. Key messages A change on perspective of isolated care is needed. Although based on experiences with resistant bacteria, the isolation room of the future useful for a broader range of infections with pathogens that require isolation precautions.

Background Online respondent-driven detection (RDD) is a novel method of case finding that can enhance contact tracing (CT). However, the advantages and challenges of RDD for CT have not yet been investigated from the perspective of public health professionals (PHPs). Therefore, it remains unclear if, and under what circumstances, PHPs are willing to apply RDD for CT. Methods Between March and April 2019, we conducted semi-structured interviews with Dutch PHPs responsible for CT in practice. Questions were derived from the ‘diffusion of innovations’ theory. Between May and June 2019, we distributed an online questionnaire among 260 Dutch PHPs to quantify the main qualitative findings. Using different hypothetical scenarios, we assessed anticipated advantages and challenges of RDD, and PHPs’ intention to apply RDD for CT. Results Twelve interviews were held, and 70 PHPs completed the online questionnaire. A majority of questionnaire respondents (71%) had a positive intention towards using RDD for CT. Anticipated advantages of RDD were ‘ accommodating easy and autonomous participation in CT of index cases and contact persons ’, and ‘ reaching contact persons more efficiently ’. Anticipated challenges were ‘ limited opportunities for PHPs to support, motivate, and coordinate the execution of CT ’, ‘ not being able to adequately convey measures to index cases and contact persons ’, and ‘ anticipated unrest among index cases and contact persons ’. Circumstances under which PHPs anticipated RDD applicable for CT included index cases and contact persons being reluctant to share information directly with PHPs, digitally skilled and literate persons being involved, and large scale CT. Circumstances under which PHPs anticipated RDD less applicable for CT included severe consequences of missing information or contact persons for individual or public health, involvement of complex or impactful measures for index cases and contact persons, and a disease being perceived as severe or sensitive by index cases and their contact persons. Conclusions PHPs generally perceived RDD as a potentially beneficial method for public health practice, that may help overcome challenges present in traditional CT, and could be used during outbreaks of infectious diseases that spread via close contact. The circumstances under which CT is performed, appear to strongly influence PHPs’ intention to use RDD for CT.

Background Carriers of methicillin-resistant Staphylococcus aureus (MRSA) experience a variety of personal and social consequences, despite the asymptomatic nature of carriage. Some of these consequences are inherent to the application in practice of strict infection prevention guidelines. However, the experiences of nurses carrying MRSA have not been documented. This study aimed to describe the experiences of nurses carrying MRSA to get insight into the impact of MRSA carriage on nurses in a country with a “search-and-destroy” policy for MRSA. Methods A qualitative study was conducted among eighteen nurses who experienced MRSA carriage and were working in healthcare organizations in the Netherlands (e.g. hospitals, nursing homes and home care). Semi-structured interviews were conducted using an interview guide. The interviews were audio tape recorded, transcribed and analyzed using thematic analysis. Results MRSA carriage has an impact on the life of nurses during four distinct phases: becoming aware of carrying MRSA, processing information and guidance, experiencing consequences of carriage and, when applicable, a life after eradication of MRSA. Each phase was found to be associated with negative consequences. The impact of MRSA carriage on the daily life of nurses is mostly influenced by the experience of consequences of MRSA carriage – including a ban to work with patients, eradication treatment with antibiotics, and social isolation from others – despite the asymptomatic nature of MRSA carriage itself. In addition, lack of information and guidance increased the impact of carriage. Conclusions This study shows nurses experience various consequences of MRSA carriage, despite the asymptomatic nature of carriage. The work ban, eradication treatment and social isolation influenced the nurses’ work-related future, personal health and social environment. The impact of carriage may be reduced by clear information and guidance, and support from others. Therefore, sufficient information and guidance needs to be given to MRSA carriers by healthcare organizations.

Background Infectious diseases are a major cause of illness and death among older adults. Vaccines can prevent infectious diseases, including against seasonal influenza, pneumococcal diseases, herpes zoster and COVID-19. However, the uptake of vaccination among older adults varies across settings and groups. Communication with healthcare workers can play an important role in older people's decisions to vaccinate. To support an informed decision about vaccination, healthcare workers should be able to identify the older person's knowledge gaps, needs and concerns. They should also be able to share and discuss information about the person's disease risk and disease severity; the vaccine's effectiveness and safety; and practical information about how the person can access vaccines. Therefore, healthcare workers need good communication skills and to actively keep up-to-date with the latest evidence. An understanding of their perceptions and experiences of this communication can help us train and support healthcare workers and design good communication strategies. Objectives To explore healthcare workers' perceptions and experiences of communicating with older adults about vaccination. Search methods We searched MEDLINE, CINAHL and Scopus on 21 March 2020. We also searched Epistemonikos for related reviews, searched grey literature sources, and carried out reference checking and citation searching to identify additional studies. We searched for studies in any language. Selection criteria We included qualitative studies and mixed-methods studies with an identifiable qualitative component. We included studies that explored the perceptions and experiences of healthcare workers and other health system staff towards communication with adults over the age of 50 years or their informal caregivers about vaccination. Data collection and analysis We extracted data using a data extraction form designed for this review. We assessed methodological limitations using a list of predefined criteria. We extracted and assessed data regarding study authors' motivations for carrying out their study. We used a thematic synthesis approach to analyse and synthesise the evidence. We used the GRADE-CERQuaI (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each finding. We examined each review finding to identify factors that may influence intervention implementation and we developed implications for practice. Main results We included 11 studies in our review. Most studies explored healthcare workers' views and experiences about vaccination of older adults more broadly but also mentioned communication issues specifically. All studies were from high-income countries. The studies focused on doctors, nurses, pharmacists and others working in hospitals, clinics, pharmacies and nursing homes. These healthcare workers discussed different types of vaccines, including influenza, pneumococcal and herpes zoster vaccines. The review was carried out before COVID-19 vaccines were available. We downgraded our confidence in several of the findings from high confidence to moderate, low or very low confidence. One reason for this was that some findings were based on only small amounts of data. Another reason was that the findings were based on studies from only a few countries, making us unsure about the relevance of these findings to other settings. Healthcare workers reported that older adults asked about vaccination to different extents, ranging from not asking about vaccines at all, to great demand for information (high confidence finding). When the topic of vaccination was discussed, healthcare workers described a lack of information, and presence of misinformation, fears and concerns about vaccines among older adults (moderate confidence). The ways in which healthcare workers discussed vaccines with older adults appeared to be linked to what they saw asthe aim of vaccination communication. Healthcare workers differed among themselves in their perceptions of this aim and about their own roles and the roles of older adults in vaccine decisions. Some healthcare workers thought it was important to provide information but emphasised the right and responsibility of older adults to decide for themselves. Others used information to persuade and convince older adults to vaccinate in order to increase 'compliance' and 'improve' vaccination rates, and in some cases to gain financial benefits. Other healthcare workers tailored their approach to what they believed the older adult needed or wanted (moderate confidence). Healthcare workers believed that older adults' decisions could be influenced by several factors, including the nature of the healthcare worker-patient relationship, the healthcare worker's status, and the extent to which healthcare workers led by example (low confidence). Our review also identified factors that are likely to influence how communication between healthcare workers and older adults take place. These included issues tied to healthcare workers' views and experiences regarding the diseases in question and the vaccines; as welt as their views and experiences of the organisational and practical implementation of vaccine services. Authors' conclusions There is little research focusing specifically on healthcare workers' perceptions and experiences of communication with older adults about vaccination. The studies we identified suggest that healthcare workers differed among themselves in their perceptions about the aim of this communication and about the role of older adults in vaccine decisions. Based on these findings and the other findings in our review, we have developed a set of questions or prompts that may help health system planners or programme managers when planning or implementing strategies for vaccination communication between healthcare workers and older adults.

On behalf of all members of work package 4 from the VITAL project

Background The emergence and spread of multidrug resistant microorganisms is a serious threat to transnational public health. Therefore, it is vital that cross-border outbreak response systems are constantly prepared for fast, rigorous, and efficient response. This research aims to improve transnational collaboration by identifying, visualizing, and exploring two cross-border response networks that are likely to unfold during outbreaks involving the Netherlands and Germany. Methods Quantitative methods were used to explore response networks during a cross-border outbreak of carbapenem resistant Enterobacteriaceae in healthcare settings. Eighty-six Dutch and German health professionals reflected on a fictive but realistic outbreak scenario (response rate ≈ 70%). Data were collected regarding collaborative relationships between stakeholders during outbreak response, prior working relationships, and trust in the networks. Network analysis techniques were used to analyze the networks on the network level (density, centralization, clique structures, and similarity of tie constellations between two networks) and node level (brokerage measures and degree centrality). Results Although stakeholders mainly collaborate with stakeholders belonging to the same country, transnational collaboration is present in a centralized manner. Integration of the network is reached, since several actors are beneficially positioned to coordinate transnational collaboration. However, levels of trust are moderately low and prior-existing cross-border working relationships are sparse. Conclusion Given the explored network characteristics, we conclude that the system has a promising basis to achieve effective coordination. However, future research has to determine what kind of network governance form might be most effective and efficient in coordinating the necessary cross-border response activity. Furthermore, networks identified in this study are not only crucial in times of outbreak containment, but should also be fostered in times of non-crisis.