Improving Your Influenza Vaccination Program

H1N1 & Seasonal Influenza:Improving Your Vaccination Program The Joint Commission and Centers for Disease Control and Prevention

Purpose of Presentation: • Protect your patients • Improve your influenza vaccination program • Special challenges • H1N1 and seasonal influenza

Carol Friedman, D.O. Captain, US PHS Associate Director for Adult Immunization Centers for Disease Control and Prevention Robert Wise, M.D.Vice PresidentDivision of Standards and Survey MethodsThe Joint Commission

Transmissibility of Influenza Virus • Contagious viral infection of the respiratory tract • Easily spread from person to person via respiratory droplets when an infected person coughs or sneezes • Also spread when someone touches a surface contaminated with the virus • Airborne transmission of the virus is possible, when an infected person is talking Continued …

Transmissibility (continued) • Adults shed the infectious influenza virus at least 1 day before any symptoms appear

Why Health Care Workers (HCWs) Should Be Vaccinated • Immunized HCWs minimize the risk of transmission • To patients, coworkers, and family members • Adults shed the infectious influenza virus at least 1 day before any symptoms appear • Continue to shed for 5 to 10 days after symptoms begin Continued …

HCWs Should Be Vaccinated (cont.) • Approximately 50% of influenza infections can be asymptomatic • Both symptomatic and asymptomatic individuals can shed the virus and be a source of infection to others, especially patients

Many HCWs Do Not Recall Being Sick • Results from a serosurvey of HCW in which 23% had documented serologic evidence of having had an influenza infection during a mild influenza season • More than 50% did not recall having had influenza • More than 25% could not recall having had any respiratory infection Wilde JA,. et al (1999) Effectiveness of influenza vaccine in health care professionals: A randomized trial. JAMA 281:908-913.

Flu Activity Update • Influenza activity elevated in US • Level of influenza-like illness activity (visits to doctors) is very unusual for this time of year Continued …

Flu Activity Update (continued) • Total influenza hospitalization rates for laboratory-confirmed influenza are higher than expected for this time of year for adults and children • For children 5-17 and adults 18-49, hospitalization rates from April – September 2009 exceed average flu season rates (for October through April) Continued …

Flu Activity Update (continued) • Almost all of the influenza viruses identified so far are 2009 H1N1 influenza A viruses • Since September 28, 2008, CDC has received 147 reports of laboratory-confirmed influenza-associated pediatric deaths that occurred during the 2008-09 influenza season • 76 of these deaths were due to 2009 H1N1 influenza virus infections

CDC Key Public Health Messages CDC recommends a three-step approach to fighting the flu • Vaccination • Everyday preventive actions, including covering coughs, frequent hand washing, and staying home when sick • Correct use of antiviral drugs if your doctor recommends them • HCW taking antivirals doesn’t protect your patients

Remember … • You could be contagious for a day before your symptoms appear • About one-half of infected individuals never develop symptoms Protect the patients – get vaccinated!

“The Canadian Controversy” • Reports in the Canadian media that research conducted in Canada suggests that getting a seasonal flu vaccine may increase a person’s risk for getting 2009 H1N1 influenza • Research thus far is non-peer reviewed and not published • Consensus from World Health Organization teleconference on October 2nd regarding the data seemed to be that the Canadian findings are likely due to some confounding factor or factors in the data and may not reflect a real increased risk Continued …

“The Canadian Controversy” (cont.) • Data collected in Australia and published in Eurosurveillance journal does not suggest that receipt of seasonal influenza vaccine influences the risk of 2009 H1N1 infection • CDC continues to recommend seasonal flu vaccination

Safety of 2009 H1N1 Vaccine • The U.S. Food and Drug Administration has approved 2009 H1N1 influenza vaccines made by four different manufacturers • All four manufacturers are using the same processes that they use for making the seasonal flu vaccines, which have a long record of producing safe seasonal influenza vaccines Continued …

Safety of 2009 H1N1 Vaccine (cont.) • Based on clinical trials, the 2009 H1N1 influenza vaccine has a similar safety profile as seasonal flu vaccines, which have very good safety track records • CDC expects that any serious side effects following vaccination with the 2009 H1N1 influenza vaccine would be rare

“What about the influenza vaccine that’s a nasal mist?” • Cannot be administered to anyone who will have close contact with immunosuppressed person requiring a protected environment (e.g. hematopoietic stem cell transplant recipient) • Can be administered to anyone who may have contact with persons at high risk for complications from influenza but is not severely immunosuppressed – there's no waiting period after administration

Seasonal and H1N1 Influenza Vaccines • There is a separate H1N1 vaccine that is new this year, in addition to the seasonal influenza vaccine • Seasonal influenza vaccine available now • Seasonal influenza vaccine will not protect against H1N1 influenza virus infection • Waiting increases the risk of needless exposure for your patients Continued …

Seasonal & H1N1 Vaccines (cont.) • Health care workers should get vaccinated for seasonal influenza now and not wait for H1N1 influenza vaccine • Once H1N1 influenza vaccine becomes available, health care workers should get vaccinated • Currently, limited amount of vaccine released (nasal spray) • More vaccine will be released mid-late October

Health Care Personnel Influenza Vaccination Coverage—NHIS 2004-2008(National Health Interview Survey) Source: CDC, unpublished www.cdc.gov/nchs

Improve Influenza Vaccination Program • How’s your HCW vaccination program? • Overcoming challenges

Please Note … • Purpose of presentation is to help all organizations increase HCW influenza vaccination rate • Although these strategies are above and beyond Joint Commission requirements, they are consistent with requirements • Consult your Joint Commission accreditation manual, Infection Prevention and Control Chapter, for applicable standards

Decrease Risks to Patients • Do no harm • 36,000 people die and 200,000 people are hospitalized annually from influenza in US • Influenza is a serious disease, especially for susceptible patients

Improve Effectiveness of Your Program Goal: • Every HCW receives both vaccinations • H1N1 • Seasonal influenza

Annual HCW Influenza Program (CDC) • Educate health care workers • influenza vaccines (H1N1 and seasonal) • prevention measures – hand hygiene, stay home when ill, cough & sneeze etiquette • diagnosis, transmission, and impact of influenza Continued …

HCW Influenza Program (CDC) (cont.) • Easy access, all HCW & all shifts • Annually evaluate vaccination rates including reasons for declining • Takes steps to increase HCW vaccination

Typical Challenges • These may not be the same in all organizations • Focus your program on HCW concerns

“I’ve had the flu, it’s not that bad” • Your influenza may be mild, but for your patients it could be fatal • Protect the ones you serve • It’s not about you – it’s about patients

“The flu shot does not work” • Overall, up to 80% effective • Getting vaccine, best available protection

“I’ll wait a little longer” • Vaccine takes two weeks before fully effective • People exposed during that window may become sick • High amount of infected asymptomatic HCWs • Waiting results in needless exposures

Other Reasons HCWs Decline • Uses only on homeopathic remedies • Lack of physician recommendation • Fear of needles • Lack of free vaccine • Insufficient time, inconvenience, or forgetting to get the vaccinations

What’s Different This Year? • 2 types of influenza • H1N1 & seasonal and • 2 separate vaccinations • This may be your biggest challenge

Use Monograph to Enhance Program • Providing a Safer Environment for Health Care Personnel and Patients Through Immunization Vaccination: Strategies for Research and Practice (free) • http://www.jointcommission.org/PatientSafety/InfectionControl/flu_monograph.htm • Next 6 slides are highlights

1. Reasons HCWs Accept Vaccination • Desire to protect patients • Desire for self-protection or to protect family members • Perceived effectiveness of the vaccine • Desire to avoid missing work • Previous receipt of the vaccine • Strong worksite, peer, or personal physician recommendations • Access to the vaccination/convenience • Vaccination provided free of charge • Benefit of vaccination outweighs the risk of side effects • Vaccine is a professional responsibility

2. Leadership Support • Leadership involvement essential for successful program • Leadership responsible for: • Establishing expectation that influenza vaccination of HCWs is patient safety issue • Make sure vaccination program is resourced • Reducing or eliminating barriers • Being a role model

3. Getting the Message Out • HCWs need to know when and where education and vaccinations will be offered and the importance of the vaccination • Promoting the vaccinations can take many forms in many venues, including: • E-mail notice and reminders • Newsletters, with regular updates • Posters • Screen savers • Stickers worn by health care workers • Messages delivered in person at meetings or health fairs

4. Educating HCWs is not enough • Providing free vaccines at work • Use leaders as supportive role models • Use vaccination clinics, mobile carts • Linking vaccinations to required activity • Mandatory tuberculin skin testing • Annual safety competency or skills days • Disaster drills

5. Incentives for HCWs • Have included: • Financial incentives (discounts on benefits, impact on merit increases, consideration in granting decisions regarding time off) • HCW recognition • Need to understand HCWs motivation

6. Measuring HCW Vaccination Rates • If you can’t measure – you can’t manage • Measurement essential to program • Capture alternative administration (for example, clinics, physician offices, pharmacies, etc.)

Conclusions • Organizations must promote HCW influenza vaccination program and make vaccination as accessible as possible • Multifaceted programs are more successful than a single approach • Monitor HCW influenza vaccination rates • Data drives improvements

Remember … • You could be contagious for a day before your symptoms appear • About one-half of infected individuals never develop symptoms Protect the patients – get vaccinated!

Resources • http://www.cdc.gov/flu • http://www.cdc.gov/h1n1flu/ • http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5808a1.htm

Resources • The Joint Commission • http://www.jointcommission.org/PatientSafety/InfectionControl/flu_monograph.htm • Joint Commission Resources • http://www.jcrinc.com/FLUChallenge/

Additional Resources • http://www.aha.org/aha/letter/2006/060210-cl-immunization.pdf • http://search.ama-assn.org/Search/ (type in the search term “influenza”) • http://preventinfluenzanow.org/ANAonHCW.pdf • http://www.apic.org/Content/NavigationMenu/PracticeGuidance/Topics/Influenza/APIC_Position_Paper_Influenza_11_7_08final_revised.pdf • http://www.shea-online.org/Assets/files/position_papers/HCW_Flu_SHEA_Position_Paper.pdf • http://www.idsociety.org/influenza.htm

Questions? • Ask a question after listening to the podcast and reviewing the PowerPoint slides • e-mail your H1N1 or seasonal influenza question to H1N1podcastquestion@jointcommission.org (October 15-30) • answers to the most frequently asked questions will be posted on The Joint Commission’s Web site at www.jointcommission.org/

Improving Your Influenza Vaccination Program