September, 2012

1. September, 2012 Prepared by: Mary-Clayton EnderleinDepartment: Occupational Health Services 2012 Influenza Campaign Facts and Information

2. Introduction Flu Vaccination Program • Seattle Children’s is committed to keeping patients, families, staff and volunteers safe. • Children’s recognizes that the single best way to protect against influenza (flu) is for individuals to receive a flu vaccination each year. • Children’s wants you to make an informed decision about getting a flu vaccination.

3. Learning Objectives Upon completion of this module, participants will be better able to: • Explain the importance of receiving a flu vaccination to protect patients, families, staff and yourself. • Explain the impact influenza may have on patients, staff and the greater community. • Address the professional ethics of receiving a vaccination. • Identify the steps necessary to decline a flu vaccination. • Describe the consequences for non-compliance. • Explain other measures you can take to prevent the flu including standard precautions.

4. Just the Facts • Seasonal flu accounts for about 225,000 hospitalizations and up to 50,000 deaths in the United States each year! • It is impossible to predict when the next influenza pandemic may arise or how severe it will be. • Vaccination rates of healthcare workers are only 50% to 60% nationally. • Like last year, the seasonal influenza vaccine will require only one vaccination which includes protection against the 2009 pandemic H1N1 strain as well as updated H3N2 and influenza B strains based on the current circulating virus.

5. CDC Recommendation The CDC recommends that ALL staff working for a healthcare organization receive the vaccine!

6. What Can I Do? Get your free flu vaccination beginning September 17. Why? • It protects you, patients, co-workers, family members and friends against the flu. • It only takes a few minutes and can save lives. • It’s the right thing to do. • It helps you use your PTO for vacations, rather than for illness.

7. Vaccination and Patient Safety • High vaccination rates among workers in healthcare organizations have been linked to improved patient outcomes, and reduced absenteeism and cases of flu among staff. • Up to 23% of unvaccinated healthcare workers may acquire influenza infection. • Some studies have shown that healthcare workers may have flu virus in their bodies and never develop flu symptoms, but can infect others. • Vaccination of healthcare workers (clinical and non-clinical staff) protects our patients and staff who may be at high risk for severe influenza infection due to other medical conditions.

8. Professional Ethics of Healthcare Workers to Protect Patients • We all serve as role models for the medical importance of vaccination, which is a professional responsibility when working in healthcare. • Patient safety is a greater priority than personal choice. • We are all obligated to “first do no harm.” • It is everyone’s duty to ‘cocoon’ and protect our most vulnerable patients by vaccinating those around them since they may be too young to be vaccinated or may have a weakened immune response.

9. Seattle Children’s Requirements All flu vaccinations and declinations must be completed by December 31, 2012. If you choose to receive a vaccination outside of Children’s: • You must provide written documentation to Occupational Health Services (OHS) proving you received the vaccine before December 31, 2012. • Submit documentation in the flu room or fax to (206) 985-3136. Documentation includes all of the following: • Name of individual receiving the vaccine • Date vaccine was given • Name of vaccine • Signature of healthcare provider who gave the vaccination

10. Medical Contraindications • People with previous severe reactions to flu vaccinations should be evaluated by their provider or OHS to determine whether they should receive the vaccine. • Recent studies demonstrate that the injectable flu vaccine is safe in most people with minor egg allergies, including hives. • Vaccine should not be given to people with rare anaphylaxis to eggs who experience lip or throat swelling and breathing difficulties.

11. Medical Contraindications: SCH Requirements If you wish to decline the vaccine for medical reasons, you mustdo the following by December 31, 2012: • Provide written documentation to Occupational Health Services (OHS) before December 31, 2012 stating you have a medical contraindication to receiving the vaccine. • Submit documentation in the flu room or fax to (206) 985-3136. Documentation must include all of the following: • Name of individual • Statement that you are unable to receive the influenza immunization for medical reasons – either permanently or for just this year • Signature of healthcare provider and date Once this information is received by OHS, you will be considered compliant and no further action is necessary this year.

12. Seattle Children’s Declination If you wish to decline the vaccine for personal reasons you must do the following by December 31, 2012: • Complete this educational module on Learning Center; • Print out a copy of your transcript and bring to the flu room; and • Participate in a confidential consultation with an OHS nurse in the flu room to be compliant… bring your transcript with you! If you are located off campus and can’t make it to the flu room, you must: • Call OHS at (206) 987-3392, Monday through Friday from 7:30 a.m. to 4 p.m. to speak with an OHS nurse about your reasons for declining; and • Fax your Learning Center transcript to (206) 985-3136.

13. If You Miss the Deadline If you are not in compliance with these requirements by December 31, 2012: • Employees: • You cannot return to work until you are compliant. • Providers: • You will risk temporary suspension of privileges.

14. Frequently Asked Questions I was vaccinated last year; do I need to be vaccinated again? • Due to your immune protection from the vaccine weakening over time and potential small changes in the virus, you must be vaccinated each year. • The vaccine is based on the most common circulating strains of influenza. • This year’s vaccine has the same influenza A H1N1 component, but uses different strains for influenza A H3N2 and influenza B from last year.

15. Frequently Asked Questions (cont’d) Will I get sick from the vaccine? • The injectable flu vaccine is inactivated and cannot cause the flu. • Flu vaccine may be associated with mild fever or local injection-site reactions. • During clinical studies, these reactions occurred in patients as often as those who received the placebo.

16. Frequently Asked Questions (cont’d) What about the preservatives in the vaccine? • Children’s uses only single-dose vials that do not contain thimerosal for our vaccinations. • Thimerosal is a preservative used in multi-dose vials of vaccine to prevent bacterial growth. • There is NO scientific evidence linking thimerosal to neurodevelopmental disorders, such as autism.

17. Frequently Asked Questions (cont’d) What about the risk of Guillain-Barré Syndrome? • The estimated risk for Guillain-Barré syndrome is approximately one additional case per one million people vaccinated. • The estimated risk of Guillain-Barré syndrome is four to seven times higher following influenza infection than after vaccination. • Please discuss your concerns with your healthcare provider or OHS.

18. Frequently Asked Questions (cont’d) Instead of vaccination, can I just take anti-viral medication (Tamiflu) if I get sick? • Anti-viral medications do not take the place of vaccination. • Unvaccinated staff may be infected without symptoms and risk transmitting the flu to vulnerable patients. • Resistance to current anti-influenza medications continues to emerge, making them less effective for treatment and post-exposure prophylaxis. • Do not rely on anti-viral medications, such as oseltamivir (Tamiflu) to protect you or your family.

19. People Who Should Not Receive the Vaccine • People who have documented severe anaphylactic reaction to chicken eggs. • People who developed Guillain-Barré syndrome within six weeks of getting the flu vaccine in the past. • Children less than 6 months of age. • People who have moderate to severe illness with a fever (they should wait until they recover to get vaccinated).

20. What Else Can I Do? In addition to getting your flu vaccination, remember these basic practices to protect yourself and those around you: • Wash your hands! • Practice proper respiratory etiquette and “cover your cough and sneeze.” • Place a mask on patients presenting with cough. • Stay home if you have flu-like illness, such as a fever, cough, sore throat, body aches, chills and fatigue.

21. Standard Precautions It is important to practice these standard precautions when caring for all patients: • Wash or gel hands before and after every patient contact. • Wear gloves for all procedures and contact with mucous membranes or bodily secretions. • Wear a gown when exposure to bodily fluids is likely. • Use a mask with eye protection when performing cough-inducing or aerosol-generating procedures.

22. Summary Now that this module has been completed, participants should be better able to: • Explain the importance of receiving a flu vaccination to protect patients, families, staff and yourself. • Explain the impact influenza may have on patients, staff and the greater community. • Address the professional ethics of receiving a vaccination. • Identify the steps necessary to decline a flu vaccination. • Describe the consequences for non-compliance. • Explain other measures you can take to prevent the flu including standard precautions.

23. Post-test for 2012 Flu Declination WBT Click here to download the Post test for Declination http://www.wsha.org/files/143/Seattle Childrens Post test for flu module_1.docx (If the link does not work, copy and paste the url into your browser)

24. Contact Information Occupational Health Services • Phone: (206) 987-3392 • E-mail: OHS@seattlechildrens.org

25. Related Information Additional reference sources: • Prevention and Control of Influenza with Vaccines, Recommendations of the Advisory Committee on Immunization Practices (ACIP), MMWR 59 (Aug. 6, 2010). • Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP), MMWR 60 (Aug. 18, 2011). • Prevention and Control of Influenza Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP) – United States 2012-2013 Influenza Season, MMWR 61 (August 17, 2012).