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array:23 [ "pii" => "S2445146020300194" "issn" => "24451460" "doi" => "10.1016/j.vacune.2020.10.002" "estado" => "S300" "fechaPublicacion" => "2020-07-01" "aid" => "152" "copyrightAnyo" => "2020" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Vacunas. 2020;21:90-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S1576988720300315" "issn" => "15769887" "doi" => "10.1016/j.vacun.2020.06.001" "estado" => "S300" "fechaPublicacion" => "2020-07-01" "aid" => "152" "copyright" => "Elsevier España, S.L.U." 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Borràs, P. Estany, M. Canals, M. Rabanal, L. Urbiztondo" "autores" => array:7 [ 0 => array:2 [ "nombre" => "G." "apellidos" => "Mirada" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Torres" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Borràs" ] 3 => array:2 [ "nombre" => "P." "apellidos" => "Estany" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "Canals" ] 5 => array:2 [ "nombre" => "M." "apellidos" => "Rabanal" ] 6 => array:2 [ "nombre" => "L." "apellidos" => "Urbiztondo" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2445146020300194" "doi" => "10.1016/j.vacune.2020.10.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2445146020300194?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1576988720300315?idApp=UINPBA00004N" "url" => "/15769887/0000002100000002/v2_202010210933/S1576988720300315/v2_202010210933/es/main.assets" ] ] "itemSiguiente" => array:17 [ "pii" => "S244514602030025X" "issn" => "24451460" "doi" => "10.1016/j.vacune.2020.10.008" "estado" => "S300" "fechaPublicacion" => "2020-07-01" "aid" => "150" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Vacunas. 2020;21:95-104" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Confidence toward vaccination as reported by parents of children admitted to a tertiary care hospital in Riyadh, Saudi Arabia: A cross sectional study" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "95" "paginaFinal" => "104" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Confianza en la vacunación reportada por los padres de niños ingresados en un hospital de atención terciaria en Riad, Arabia Saudí: estudio transversal" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Y.M. AlGoraini, N.N. AlDujayn, M.A. AlRasheed, Y.E. Bashawri, S.S. Alsubaie, D.A. AlShahrani" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Y.M." "apellidos" => "AlGoraini" ] 1 => array:2 [ "nombre" => "N.N." "apellidos" => "AlDujayn" ] 2 => array:2 [ "nombre" => "M.A." "apellidos" => "AlRasheed" ] 3 => array:2 [ "nombre" => "Y.E." "apellidos" => "Bashawri" ] 4 => array:2 [ "nombre" => "S.S." "apellidos" => "Alsubaie" ] 5 => array:2 [ "nombre" => "D.A." "apellidos" => "AlShahrani" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S244514602030025X?idApp=UINPBA00004N" "url" => "/24451460/0000002100000002/v1_202011280950/S244514602030025X/v1_202011280950/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2445146020300200" "issn" => "24451460" "doi" => "10.1016/j.vacune.2020.10.003" "estado" => "S300" "fechaPublicacion" => "2020-07-01" "aid" => "156" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Vacunas. 2020;21:82-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Purification of the human papillomavirus 16 L1 protein from <span class="elsevierStyleItalic">E. coli</span> SHuffle® T7" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:3 [ 0 => "en" 1 => "en" 2 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "82" "paginaFinal" => "89" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Purificación de la proteína L1 del virus del papiloma humano tipo 16 a partir <span class="elsevierStyleItalic">E.</span> <span class="elsevierStyleItalic">coli</span> SHuffle® T7" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 916 "Ancho" => 1341 "Tamanyo" => 71750 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Production of HPV-16 L1-His protein by <span class="elsevierStyleItalic">E.</span> <span class="elsevierStyleItalic">coli</span> SHuffle® T7/pETHPV16L1myc-His under autoinduction conditions. A) SDS-PAGE at 10% acrylamide. B) Western Blotting with anti-His antibody. Cellular lysates of <span class="elsevierStyleItalic">E.</span> <span class="elsevierStyleItalic">coli</span> SHuffle® T7 with: lane 1: pET-28a (C-); lanes 2-4: pETHPV16L1myc-His. PM, Broad Range Protein Molecular Weight Marker (Promega, U.S.A.). The arrows indicate the band corresponding to HPV-16 L1-His.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S.M. Brito Molina, Y. Serrano Rivero, A. Falero Morejón, E. Pimienta Rodríguez, S. Rodríguez Salgueiro, O. Ancheta Niebla, K. Marro Domínguez" "autores" => array:7 [ 0 => array:2 [ "nombre" => "S.M." "apellidos" => "Brito Molina" ] 1 => array:2 [ "nombre" => "Y." "apellidos" => "Serrano Rivero" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Falero Morejón" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "Pimienta Rodríguez" ] 4 => array:2 [ "nombre" => "S." "apellidos" => "Rodríguez Salgueiro" ] 5 => array:2 [ "nombre" => "O." "apellidos" => "Ancheta Niebla" ] 6 => array:2 [ "nombre" => "K." "apellidos" => "Marro Domínguez" ] ] ] ] "resumen" => array:1 [ 0 => array:3 [ "titulo" => "Highlights" "clase" => "author-highlights" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0005" class="elsevierStylePara elsevierViewall">HPV-16 L1-His protein represented ∼ 12% of total proteins.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0010" class="elsevierStylePara elsevierViewall">It was purified to a purity of ∼ 90% by means of Ni<span class="elsevierStyleSup">2+</span> ion affinity chromatography.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0015" class="elsevierStylePara elsevierViewall">9 mg de pentamers of cultured L1-His/L was obtained after renaturalisation.</p></li></ul></p></span>" ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1576988720300376" "doi" => "10.1016/j.vacun.2020.06.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1576988720300376?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2445146020300200?idApp=UINPBA00004N" "url" => "/24451460/0000002100000002/v1_202011280950/S2445146020300200/v1_202011280950/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Vaccination error perception in Catalonia: A cross-sectional study" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "90" "paginaFinal" => "94" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "G. Mirada, J. Torres, E. Borràs, P. Estany, M. Canals, M. Rabanal, L. Urbiztondo" "autores" => array:7 [ 0 => array:4 [ "nombre" => "G." "apellidos" => "Mirada" "email" => array:1 [ 0 => "gloria.mirada@gencat.cat" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J." "apellidos" => "Torres" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "E." "apellidos" => "Borràs" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 3 => array:3 [ "nombre" => "P." "apellidos" => "Estany" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] 4 => array:3 [ "nombre" => "M." "apellidos" => "Canals" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] 5 => array:3 [ "nombre" => "M." "apellidos" => "Rabanal" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff0030" ] ] ] 6 => array:3 [ "nombre" => "L." "apellidos" => "Urbiztondo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:6 [ 0 => array:3 [ "entidad" => "Agència de Salut Pública de Catalunya, Departament de Salut, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Universitat de Lleida, Lleida, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "CIBER Epidemiología y Salud Pública CIBERESP, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Universitat de Barcelona, Barcelona, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Institut Català de la Salut, Barcelona, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Direcció General d’Ordenació i Regulació Sanitària, Departament de Salut, Catalnya, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Percepción de los errores en la vacunación en Cataluña: un estudio transversal" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Immunisation is one of the most beneficial public health interventions. However, advances in disease control and vaccination are not free of controversy, in spite of the development of safe vaccines. Moreover, as occurs with any medication, vaccines are not 100% safe and the vaccination process can be affected by errors and could be improved.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Errors in medication (EM) are defined as “any preventable (unintentional) incident that may cause harm to a patient or which gives rise to inappropriate use of medication, when it is under control by medical professionals or a patient or consumer”.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Based on this definition, an error in vaccination is an EM in connection with the use of vaccines and the vaccination process. It is important to establish preventive measures to avoid errors and to know what to do if they arise, all conjointly with patient safety within the framework of the Patient Safety Strategy of the Spanish National Health Service.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">One of the measures that make it possible to increase patient safety within the vaccination process lies in the systems for notifying incidents and errors in the same. Although these systems do not make it possible to estimate the incidence of errors, they create opportunities for improvements and, by identifying safety risks, permit the identification of system weaknesses and prevent accidents in the future. They make it possible to learn more things and change our approach, applying measures to correct mistakes.</p><p id="par0020" class="elsevierStylePara elsevierViewall">According to the World Health Organisation (WHO) these errors are common and, although they often have no immediate consequences, they may reduce the efficacy of a vaccine and leave patients unprotected against severe infectious diseases.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Several sources indicate that based on a review of clinical histories, an error of some type was committed in 27 %–35 % of vaccinations.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">These data suggest that different moments of vaccination may be considered critical, and that it would be necessary for medical professionals to be aware of them so that they could be minimised. It has to be added that adverse reactions may be triggered by a certain proportion of the said errors. Some authors<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> determined that in 25% of documented errors the patient had suffered an adverse reaction, and that 8% of these cases had involved a serious error.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Among the causes of adverse reactions following immunisation,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> the WHO recognises reactions associated with vaccination errors — which used to be known as “program errors”—. These are by definition the result of inappropriate manipulation of the vaccine, while other errors are associated with prescribing or failure to comply with recommendations for use or administration. These errors can therefore be prevented and avoided.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Apart from the EM<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9–12</span></a> notification systems and more specifically those connected with vaccine administration,<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13,14</span></a> another previous aspect is what medical professionals think about errors. Two different professionals may hold different opinions about the same situation, as to whether or not an error occurred or the degree to which it materialised. It is therefore necessary to know what medical professionals think about different situations in which vaccination errors may arise, and it is also essential to learn what they know about how to prevent errors and what to do if they occur. A policy of training in vaccination error prevention means that prior information is required about these aspects. The aim of this study was to learn the degree to which errors are perceived to occur in vaccination and how often this happens.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0040" class="elsevierStylePara elsevierViewall">A cross-sectional study was undertaken using an online survey of medical professionals who had administered vaccines in the 12 previous months. The survey took place from April to November 2017. The vaccination centres that took part were registered in the <span class="elsevierStyleItalic">Departamento de Salut</span> of the <span class="elsevierStyleItalic">Generalitat de Catalunya</span> for primary care (CAP), or centres with the same functions in the <span class="elsevierStyleItalic">Región Sanitaria Camp</span>, <span class="elsevierStyleItalic">Tarragona, Lleida and Alt Pirineu i Aran</span>.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The main variable was the perception of the presence, absence or doubt about a vaccination error in a series of 25 hypothetical situations, in some of which errors occurred (20 situations) while others were free of error (5 situations). These hypothetical situations were described by 3 professionals with experience in the field of vaccinations, after which they were evaluated using the Delphi method by a group of 7 experts. The “vaccination errors” included situations —”Before the vaccination process”, “During the vaccination process” and “After the vaccination process”—, which are based on the recommendations of the Catalonian Department of Health Vaccination Manual and everyday praxis.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The following aspects were included as secondary variables: “Being aware that I had caused these hypothetical situations at some time” —this has never happened to me, I am not aware that it has happened to me, I am aware that it happened to me once—; “Profession” —nursing, doctor, paediatrician, midwife; “Being or having been in connection with vaccines” —never, beforehand but not now, currently—; “Type of work contract” —fixed, intern, discontinuous or substitute—; “Years in the profession” —< 1, 1–4, 5–10, > 20—; “Attended vaccination courses during the last 5 years” —yes, no—; “Attended vaccination conference during the last 5 years” —yes, no—; “Have received training on vaccination errors” —yes, no—, and “Number of vaccinations administered during the last week”.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The information was recorded using a self-administered questionnaire in Google Docs, with multiple response questions. It was obligatory to answer every question in the questionnaire. A pilot test took place in February and March 2017 with 60 medical professionals, and this was reviewed by the same group of experts. The study was publicised in writing and through presentation sessions to hospital managers, reference centres for vaccinations and medical professionals who were invited to take part. The project was approved by the Research Ethics Committee of the Jordi Gol I Gurina Foundation. The participants were asked to give their informed consent to take part in the study, and data was collected in a completely anonymous way.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Qualitative variables were described as percentages, while quantitative variables are shown as an arithmetic average and standard deviation. The comparison of groups of qualitative variables was analysed using the Chi-squared test. The level of concordance between the perception of errors and the reality assigned by the experts was measured using the kappa index and corresponding confidence interval of 95% (CI 95%). Opinions regarding the item “Have you ever been in this situation?” were expressed as percentages accompanied by their CI of 95%. The accepted degree of statistical significance was <span class="elsevierStyleItalic">P</span> <.05. V.22® of the IBM SPSS Statistics program by IBM Software Group was used for statistical analysis.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">The scope of the study included 141 vaccination centres with a total of 740 medical professionals who fulfilled the inclusion criteria, of whom 232 (31.4%) answered the questionnaire. 92.7% (215) of the participants were nursing staff. Within this group, 35.8% (83) had been or were at the time in charge of vaccinations; 94.4% (219) had a fixed work contract or were interns, and more than half had been working in the profession for more than 20 years. 81.1% (188) had been administering vaccinations for more than 4 years. During the previous week they had administered an average of 17.3 doses (17.3 ± 23.7).</p><p id="par0070" class="elsevierStylePara elsevierViewall">In the previous 5 years 60.8% (141) had received training in conferences and 54.3% (126) had taken courses, and 39.2% (91) had received training on vaccination errors.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The medical professionals evaluated a total of 5800 (25 × 232) hypothetical situations. Of these, 4640 were errors (20 × 232) and 1160 were not errors (5 × 232). 5.2% (304/5800) had doubts when deciding whether a situation was erroneous or not. In the case when the situation was not an error, 7.5% doubted (87/1160) and in the case of errors, 4.7% (217/ 4640) doubted, and this difference in proportions was significant (<span class="elsevierStyleItalic">P</span> = .0001).</p><p id="par0080" class="elsevierStylePara elsevierViewall">Errors were perceived as such in 68.7% of the hypothetical situations (3039/4423), with a CI of 95% (67.3% of 69.4%), and those which were not erroneous were perceived as such in 68.2% (732/1073) of cases, with a CI of 95%, 65.4% of 71.0%. Significant statistical differences were detected, <span class="elsevierStyleItalic">P</span> = .0000. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the analysis of the level of concordance between the perception of vaccination errors and reality. The level of concordance was weak, with a kappa index of 0.2763 and a CI of 95%, 0.2421 to 0.3015.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Respecting personal experience of real errors (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>), fewer than a quarter of the participants were aware that they had committed an error at some time (22.2%).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Of the errors classified by the group of experts as ones with greater impact (frequency, effect reduction and adverse effects) or as of special interest in terms of vaccination training, the following aspects were found.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Level of concordance between perceived vaccination errors and reality:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0100" class="elsevierStylePara elsevierViewall">78% of the participants stated that it was an error to administer a vaccine against varicella to a pregnant woman.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0105" class="elsevierStylePara elsevierViewall">63.8% of the participants stated that it was an error to administer a vaccine which had passed its use-by date the day before; 64.7% stated that this had never happened to them.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0110" class="elsevierStylePara elsevierViewall">92.2% of the participants stated that it was an error not to check the batch and use-by date of a vaccine before administering it, although only 43.1% of them stated that this had never happened to them.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">•</span><p id="par0115" class="elsevierStylePara elsevierViewall">56.9% of the participants stated that it was an error to administer the Td vaccine to an adult who had not been vaccinated with the 0.1 and 5 month prescription, and 63.4% of them stated that this had never happened to them.</p></li></ul></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0120" class="elsevierStylePara elsevierViewall">The results of this study show that healthcare professionals hardly doubted when evaluating the hypothetical situations, especially when they really did involve errors. They also show that there is room for improvement in how they perceive errors and non-errors in comparison with reality, as this was detected in our study by a weak level of concordance. A low level of awareness was also detected of having committed the errors in question, and this could be improved by vaccination training, especially regarding vaccination errors, as has also been observed in other studies.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Vaccination programs must do everything possible to ensure that vaccination involves no risks other than those which may be expected. The complexity of programs, the high number of vaccines and the range of vaccines that are administered in our context favour the appearance of preventable adverse effects due to what are known as “vaccination errors”. These errors occur at some moment of the vaccination process, and they are basically human in origin, deriving from errors in the system as a result of existing routines.</p><p id="par0130" class="elsevierStylePara elsevierViewall">Vaccination errors have an impact in terms of additional costs<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> (giving unnecessary doses, incorrect intervals or minimum ages, incomplete courses or invalid doses).<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17–20</span></a> They affect the immunological protocol and are causes of inconvenience for parents and those who are vaccinated, leading to loss of confidence in medical workers and the healthcare system.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Although the proportion of those who responded to the questionnaire was low, those who did take part represent the healthcare professionals who are the most involved with vaccines and who have the most responsibility of them, with a long professional history of working with vaccines. However, although the study was not undertaken in all healthcare regions, the type of hospitals, medical professionals and training staff, as well as application of the Catalonian vaccination Program, are all quite homogeneous throughout the territory. Respecting the measurement instrument, it is not an easy task in some hypothetical situations to decide whether something is an error or not, and this is why a panel of experts decided on this.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusions</span><p id="par0140" class="elsevierStylePara elsevierViewall">Medical professionals have to be aware of vaccination errors. It is only possible to design strategies to avoid and minimise these errors and definitively to ensure that the process of vaccination is safe, if the errors that arise are known and analysed.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> Risks have to be identified and communication must be open rather than punitive between medical professionals and institutions.</p><p id="par0145" class="elsevierStylePara elsevierViewall">A route was found towards the potential improvement in terms of appropriate perception of errors. This route should be favoured by complete training in vaccination and more specifically in vaccination errors.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflict of interests</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1423027" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1300929" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1423026" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1300930" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interests" ] 10 => array:2 [ "identificador" => "xack496786" "titulo" => "Acknowledgements" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-04-05" "fechaAceptado" => "2020-05-25" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1300929" "palabras" => array:5 [ 0 => "Vaccines" 1 => "Vaccination" 2 => "Medication errors" 3 => "Vaccination errors" 4 => "Error perception" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1300930" "palabras" => array:5 [ 0 => "Vacunas" 1 => "Vacunación" 2 => "Errores de medicación" 3 => "Errores de vacunación" 4 => "Percepción de errores" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Vaccination errors can give rise, among others, to adverse effects and to diminished immune response. The objective of this study was to assess the degree of perceived vaccination errors and the frequency at which they occur.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In 2017, a cross-sectional survey (based on a 20 error and 5 non-error assumption) was made to healthcare workers involved in vaccination in the Tarragona, Lleida and Alt Pirineu-Aran health regions of Catalonia.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The response rate was 31.4% (232/740), 92.7% (215) of whom were nursing staff and 81.1% (188) of them had been administering vaccines for more than four years. 5800 assumptions (25 × 232) were rated, being 4640 errors (20 × 232) and 1160 non-errors (5 × 232). There was 5.2% (304/5 800) of doubt when perceiving them as errors or non-errors. Errors were perceived in 68.7% of the cases (3039/4423) and non-errors in 68.2% (732/1073). The concordance between perception and reality was weak (Kappa = 0.2763). Twenty-one percent of respondents were aware that they had committed a vaccination error at least once.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Error perception and related training can be improved and should be strengthened.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Los errores en vacunación pueden provocar efectos adversos y disminución de la respuesta inmunitaria. El objetivo de este estudio fue conocer el grado de percepción de errores en la vacunación y su frecuencia.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">En 2017, se aplicó una encuesta transversal -basada en 20 supuestos de errores y 5 de no errores<span class="elsevierStyleGlyphsbnd"></span> al personal sanitario implicado en vacunaciones en la Región Sanitaria Camp de Tarragona, Lleida y Alt Pirineu-Aran, para valorar la percepción y la frecuencia de los supuestos.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Respondió el 31,4% (232/740) de los encuestados. El 92,7% (215) era personal de enfermería, 81,1% (188) con más de cuatro años administrando vacunas. Se valoraron 5.800 supuestos (25 × 232): 4.640 errores (20 × 232) y 1.160 no lo eran (5 × 232). El 5,2% (304/5800) dudaron al decidir entre si era un error o no. Los errores eran percibidos en un 68,7% de los supuestos (3.039/4.423) y los no errores, en un 68,2% (732/1.073). La concordancia entre percepción y realidad fue débil (Kappa = 0,2763). El 21,0% eran conscientes de que habían cometido un error alguna vez.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">La percepción de los errores en la vacunación y la formación en relación con esta cuestión son mejorables y habría que incrementarse.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as: Mirada G, Torres J, Borràs E, Estany P, Canals M, Rabanal M, et al. Percepción de los errores en la vacunación en Cataluña: un estudio transversal. Vacunas. 2020;21:90–94.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Reality as defined by the group of experts<span class="elsevierStyleSup">a</span></th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Error [n (%)] \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Non-error [n (%)] \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Perception \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Error \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3039 (55.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">341 (6.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Opinion of the respondents about whether something is an error or not<a class="elsevierStyleCrossRefs" href="#tblfn0005"><span class="elsevierStyleSup">a,b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not an error \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1384 (27.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">732 (13.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2440582.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">K = 0.2763 (95% CI: 0.2421−0.3015); <span class="elsevierStyleItalic">P</span> = .0000.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">304 perceptions of the 5800 evaluations which were undecided between error and non-error were excluded.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Level of concordance between perceived vaccination errors and reality.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Experience of errors \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95% CI \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Has never happened to me \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2482 (53.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52.1%-54.9% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">I am not aware that it has happened to me \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1128 (24.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23.1%-25.5% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">I am aware that it has happened to me at some time \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1030 (22.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21.0%-23.4% \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2440581.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Personal experience respecting errors.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:21 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP). 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