Transcript H1N1 & Seasonal Influenza: Improving Your Vaccination Program

H1N1 & Seasonal Influenza:
Improving Your Vaccination Program
The Joint Commission and
Centers for Disease Control and Prevention
1
Purpose of Presentation:
Protect your patients
Improve your influenza vaccination program
Special challenges
– H1N1 and seasonal influenza
2
Carol Friedman, D.O.
Captain, US PHS
Associate Director for Adult Immunization
Centers for Disease Control and Prevention
Robert Wise, M.D.
Vice President
Division of Standards and Survey Methods
The Joint Commission
3
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 …
4
Transmissibility (continued)
Adults shed the infectious influenza
virus at least 1 day before any
symptoms appear
5
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 …
6
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
7
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.
8
9
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 …
10
Flu Activity Update (continued)
Total influenza hospitalization rates for laboratoryconfirmed 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 …
11
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
12
CDC Key Public Health Messages
CDC recommends a three-step approach to
fighting the flu
1. Vaccination
2. Everyday preventive actions, including
covering coughs, frequent hand washing,
and staying home when sick
3. Correct use of antiviral drugs if your
doctor recommends them
– HCW taking antivirals doesn’t protect
your patients
13
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!
14
“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 …
15
“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
16
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 …
17
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
18
“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
19
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 …
20
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
21
Health Care Personnel Influenza
Vaccination Coverage—NHIS 2004-2008
(National Health Interview Survey)
NHIS Year
Flu Season
2004
2003/04
2005
2004/05
2006
2005/06
2007
2006/07
2008
2007/08
Physicians
64.5%
57.0%
56.4%
65.2%
77.9%
Nurses
58.6%
38.9%
52.4%
58.0%
61.0%
Ambulatory
Health Care
41.8%
32.4%
42.1%
38.3%
40.4%
Hospital
51.4%
42.1%
51.1%
55.5%
63.4%
Nursing Home
36.0%
27.6%
29.5%
43.4%
36.2%
45%
36%
43%
46%
49%
All*
Source: CDC, unpublished www.cdc.gov/nchs
22
Improve Influenza Vaccination Program
How’s your HCW vaccination program?
Overcoming challenges
23
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
24
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
25
Improve Effectiveness of Your Program
Goal:
Every HCW receives both vaccinations
– H1N1
– Seasonal influenza
26
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 …
27
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
28
Typical Challenges
These may not be the same in all organizations
Focus your program on HCW concerns
29
“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
30
“The flu shot does not work”
Overall, up to 80% effective
Getting vaccine, best available protection
31
“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
32
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
33
What’s Different This Year?
2 types of influenza
– H1N1 & seasonal and
2 separate vaccinations
This may be your biggest challenge
34
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/PatientSaf
ety/InfectionControl/flu_monograph.htm
– Next 6 slides are highlights
35
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
36
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
37
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
38
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
39
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
40
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.)
41
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
42
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!
43
Resources
http://www.cdc.gov/flu
http://www.cdc.gov/h1n1flu/
http://www.cdc.gov/mmwr/preview/mmw
rhtml/rr5808a1.htm
44
Resources
The Joint Commission
– http://www.jointcommission.org/PatientSafe
ty/InfectionControl/flu_monograph.htm
Joint Commission Resources
– http://www.jcrinc.com/FLUChallenge/
45
Additional Resources
 http://www.aha.org/aha/letter/2006/060210-climmunization.pdf
 http://search.ama-assn.org/Search/
(type in the search term “influenza”)
 http://preventinfluenzanow.org/ANAonHCW.pdf
 http://www.apic.org/Content/NavigationMenu/PracticeGuida
nce/Topics/Influenza/APIC_Position_Paper_Influenza_11_
7_08final_revised.pdf
 http://www.sheaonline.org/Assets/files/position_papers/HCW_Flu_SHEA_P
osition_Paper.pdf
 http://www.idsociety.org/influenza.htm
46
Questions?
Ask a question after listening to the podcast and
reviewing the PowerPoint slides
– e-mail your H1N1 or seasonal influenza
question to
[email protected]
(October 15-30)
– answers to the most frequently asked
questions will be posted on The Joint
Commission’s Web site at
www.jointcommission.org/
47