A Multi-Level Approach to Preventing Colds and Flu on Campus

1. A Multi-Level Approach to Preventing Colds and Flu on Campus Sherry Bell, M.Ed. Charlotte Katzin, B.S.N., R.N.

2. Objectives • Describe the planning, implementation, and evaluation of a low-cost, campus-wide poster campaign to reduce the transmission of colds and flu. • List the barriers to getting a flu shot and initiating other cold and flu prevention measures as well as ways to overcome them. • Discuss the considerations to be made in implementing efficient, campus flu shot clinics.

3. Annual Economic Impact of Colds and Flu • Colds cost the nation $39.5 billion in direct and indirect costs • Flu costs the nation $87 billion in direct and indirect costs

4. Prevalence of Colds and Flu 5 – 20% of people in the US get the flu each year (CDC) 72% of survey respondents reported having at least one cold in the previous year (Univ. of Michigan Health Systems)

5. Top 20 Diagnoses at UHS in 2008

6. Top 20 Diagnoses at UHS in 2008

7. Colds/Flu/Sore Throats: Academic Impact Within the last school year, have any of the following affected your academic performance? • 28% colds / flu / sore throats • 9.3% sinus infections / ear infection / bronchitis / strep throat Spring 2008 NCHA National Reference Group Data

8. Colds/Flu/Sore Throats: Academic Impact • 11.7% reported experiencing asthma in the last 12 months • 16.8% reported ever having been diagnosed with asthma Spring 2008 NCHA National Reference Group Data

9. Photo courtesy of CDC

10. Prevention for Colds and Flu • Hand washing • Cough covering • Flu shots

11. Poster Campaign Budget • 2,500 copies • cost = $566.40 • $.23 per poster

12. Poster Campaign Evaluation From 1/18/08 – 2/18/08 • 427 hits to black & white flyer • 363 hits to color flyer Number of posters distributed • 230 due to email to administrators • 260 in residence halls • 120 sent to Greek houses

13. Cover Your Cough / Clean Your Hands Campaign

14. NCHA Spring 2008 Survey Evaluation Data Of the 680 (60%) who had seen the posters: • 132 (19.4%) were encouraged to clean hands • 68 (10%) were encouraged to cover coughs • 282 (41.5%) were encouraged to both cover coughs and clean hands • 70.9% were encouraged to do one or both

15. Non-Personnel Costs of Campaign 610 posters x $.23 each = $140.30 Postal/supply costs = 35.00 $175.30

18. A LOVE LETTER I will seek and find you.I will take you to bed and have my way with you.I will make you ache, shake, & sweat until you moan & groan.I will make you beg for me to stop.I will exhaust you to the point that you will be relieved when I'm finished with you.And, when I’ve had my way with you, you will be weak for days.All my love,

19. The Flu

20. Barriers to Getting a Flu Shot • Misinformation • Cost • Inconvenience

21. Barrier: Misinformation • I got a flu shot last year. • I’m healthy, I never get the flu. • I know people who got the shot and got the flu anyway. • My friend got the shot and it gave him the flu.

22. 2008 Cost • GSK Fluarix $12.00/dose (9,755 doses) • Sanofi Pasteur Fluzone $15.63/dose (2,400 doses) Average total vaccine cost per dose = $12.71 True cost to administer each vaccine = $14.72 for students $16.98 for faculty/staff

23. Determining True Cost Costs directly associated with each shot • Vaccine • Safety needles • Alcohol preps • Band-aids • Cotton balls • Consent forms • Vaccine Information Statements

24. Determining True Cost Costs averaged over total number of shots • Salaries/fringe (planning & implementation) • Advertising • HIPAA statements, receipts, pens, stickers • Sharps containers, gloves, hand sanitizer, Wypalls, thermometer probe covers, etc. • Site set up/rental fees • Staff lunches/parking

25. Barrier: Cost • $5 for students/$10 for faculty/staff • $34,000 subsidy from the Office of the President for faculty/staff • Accept departmental vouchers • Approximately $70,000 in non-recouped expenses

26. Barrier: Inconvenience • Twelve 4-hour clinics • Noon – 4:00 pm • 4 clinics in Student Services Building • 8 clinics at various campus sites

31. Clinic Size and Pace • 5 – 14 immunization stations per clinic • Averaged 957 shots/clinic 2008 • 1,118 shots at largest clinic (12 stations) • 93 shots/clinical staff/4 hours • One shot every 2.5 minutes

32. Clinic Staffing • Clinic Coordinator • Assistant Clinic Coordinator • Courier/Driver • Line/Crowd Manager • 4 Cashiers • Number Caller • Nurse Manager • 5 Nurses to start • Nursing/Pharmacy students to staff up to 11 stations (if we have 14 stations)

33. Keeping Up the Pace Well in advance of the clinics • Buy pre-filled, single-dose syringes • Peel band-aids • Separate alcohol preps and needles • Pre-print lot numbers on consent forms Day of the clinic • Take vaccine out of packaging and re-package trays in gallon zip-lock bags

34. Sample Site Layout

37. Sample Site Layout

38. Nurses’ Vaccine Reconciliation # of doses at the station at start of shift + #of doses received during the shift = # of spoiled doses + # of consent forms + # of doses left at end of shift

39. Clinic Vaccine Reconciliation Total # of consent forms from the clinic + Total #of spoiled vaccine at the clinic + # of doses returned to the fridge = # of doses signed out from the fridge

40. Safety Considerations • Needle safety • Sharps container • Hand sanitizer • Needlestick Policy & Procedure

41. Adverse Reactions • Fainting • Allergic Reaction

42. Things to consider when working with students • Begin planning well in advance • Identify goals for UHS and for students • Identify coordinators from School of Nursing and College of Pharmacy • Sufficient supervision • Training of students

43. Training Materials • VIS • Needle safety device • IM injection instructions • Consent form • Competency check-off sheet Images courtesy of the Immunization Action Coalition

44. Immunization Resources Immunization Action Coalition immunize.org Centers for Disease Control and Prevention www.cdc.gov/flu

47. Hand Sanitizer • Start-Rite, Inc. P.O. Box 148 Bohemia, NY 11716 www.startriteinc.com PHONE 631-205-1900 FAX 631-205-1593 40z bottles/$.72 ea cases of 96 bottles

48. To request permission to use CDC’s Cover Your Cough poster: www.cdc.gov/flu/protect/covercough.htm For supplemental information for this presentation, including procedures and forms: www.healthyhorns.utexas.edu/ACHA09.html

49. Sherry Bell, MEd Senior Program Coordinator The University of Texas at Austin 512/475-8458 s.bell@uhs.utexas.edu Charlotte Katzin, BSN Nurse Manager, Allergy/Immunization Clinic The University of Texas at Austin 512/475-8330 c.katzin@uhs.utexas.edu