Josephine van Dongen

Chapter 7 168 anomaly, need more complex care, often involving a multitude of pediatric specialists. Vaccination as a rule is only appropriate when the infant is stable which is often not the case during admission in tertiary care .” (Int. HCP1). The implementation of rotavirus vaccination protocol was adapted to local policy by each par ticipating hospital. Sometimes, additional restrictions on administration were adopted, limiting oppor tunities for vaccination for the most vulnerable infants. One of the interviewees remarked: “ This center has an in-hospital vaccination policy which stipulates not to offer vaccination to infants born under 27 weeks of gestation; not to administer vaccination in the NICU setting; to offer vaccination only at time of discharge on the infant/surgical ward or during outpatient visits .” (Int. HCP1). In addition, the variation in out-patient follow-up for these infants made it difficult to implement a vaccination program in an uniform and standardized way. As was clarified by a neonatologist: “ There is no national follow-up program for eligible infants, in-hospital administration of first dose HRV is the best way for infants born before 32 weeks of gestation... Almost all eligible infants are born in a hospital, we do see these infants.The vast majority in our hospital is however born at term. The eligible infants represent approximately 20%, prematurity is the main group, smaller group of dysmature and infants with a congenital disorder even smaller. It is complex and individual care… Rotavirus vaccination is not part of the standard thought processes, not routine .” (Int. HCP3). Awareness, belief and attitude towards rotavirus vaccination as new standard of care for infants with MRC was mentioned both as a barrier and as facilitator. An on-site research nurse said: “ The institution is proud to be a participating hospital, feels it can offer it’s patients additional care and even issued a press release once the rotavirus vaccination became available… However, the quick turnover of pediatric residents – most of the time unfamiliar with the RIVAR project – does not help the implementation process. ” (Int. HCP1). For the execution of the program hospital nurses might be the best option, suggested by a HCP: “ Nurses provide stable care for these infants. In a training hospital there is a high turnover of residents and it takes time to create awareness among new physicians...Well-baby clinic physicians can function as safety net ….“ (Int. HCP3). On the other hand, endorsement by a medical doctor can improve willingness to vaccinate: “ In the tertiary center it was often just the research nurse discussing and explaining the need for rotavirus vaccination while it was never mentioned by the pediatrician (or resident). The implicit message to parents might be that it is of inferior importance since it is not discussed as part of current practice.” (Int. HCP1).