9/25/2012. House Keeping. Mandatory Influenza Vaccination in Healthcare: Are We There Yet? Questions. Betsy Buehrer, DO, MPH

Transcription

1 3M Infection Prevention Solutions Learning Connection Mandatory Influenza Vaccination in Healthcare: Are We There Yet? Betsy Buehrer, DO, MPH 3M Corporate Occupational Medicine September 26, All Rights Reserved. House Keeping Questions From the WebMeeting webinar page: Look for Chat with Presenter in lower left corner of screen. Type your question in the chat box Press Send House Keeping Continuing Education Each 1 hour web meeting qualifies for 1 contact hour for nursing. 3M Health Care Provider is approved by the California Board of Registered Nurses CEP Post webinar Link to Course Evaluation CE Certificate Included Forward to Others in Attendance 1

2 Disclosure Betsy Buehrer, DO MPH Occupational Medicine Physician Corporate Occupational Medicine 3M Medical Department Learner Objectives 1.Explain the basis of an employee influenza vaccination program 2.Identify the attitudes, beliefs and motivating factors for influenza vaccination of healthcare personnel 3.Analyze the pros and cons for a mandatory influenza vaccination program 4.Describe some of the state legislative and regulatory requirements for influenza vaccination programs for healthcare personnel 5.Describe use of personal protective equipment and work practices for influenza prevention 6.Describe features of best practice influenza vaccination program All Rights Reserved. 2

3 Influenza Illness Influenza viruses are spread from person to person primarily through large particle respiratory droplet transmission (cough or sneeze) Transmission via large-particle droplets requires close contact between source and recipient--droplets do not remain suspended in the air and generally travel only a short distance (less than or equal to 1 meter) Contact with respiratory droplet contaminated surfaces is another possible source of transmission Influenza Illness The typical incubation period for influenza is 1-4 days (average: 2 days) Adults shed influenza virus from the day before symptoms begin through 5-10 days after illness onset Persons with asymptomatic influenza shed virus Severely immunocompromised persons can shed virus for weeks or months Influenza Impact Hospitalizations greater than 200,000 annually Deaths 36,000 annually Leading cause of vaccine preventable deaths 3

4 Influenza Impact US annual influenza economic impact 87 billion cost burden 610,660 life years lost 3.1 million days of hospitalization 31.4 million outpatient visits Influenza Impact Presenteeism or working with flu symptoms contributes to the cost burden HCP Presenteeism is a threat to patient safety Productivity decline US Center for Disease Control (CDC) since 1981 Advisory Committee on Immunization Practices (ACIP) since 1984 Healthcare personnel (HCP) and persons in training for healthcare professions, workers in healthcare settings, emergency medical response workers, employees in nursing home and long-term care facilities, and students in these professions 4

5 Prevents influenza in 70-90% of healthy adults < 65 Most effective when vaccine and circulating viruses are antigenically similar Reduces risk for influenza related deaths and hospitalizations for adults > 65 Prevents transmission to patients Reduces risk for infection of HCP Creates herd immunity Maintains critical HCP workforce during disease outbreaks Influenza vaccination in healthy adults prevents 25% fewer upper respiratory infections 44% fewer physician visits 43% fewer sick days off 47$ cost savings per person 5

6 Immunization rates of 80% or greater are essential for herd immunity and impacting transmission of influenza by HCP Prior to influenza season hospital- based HCP vaccination coverage was 45-55% Influenza season included seasonal influenza and H1N1 vaccines for HCP, CDC estimates for HCP 61.9% for seasonal influenza vaccine 37.1% for H1N1 vaccine 34.7% for both vaccines Influenza season hospital- based HCP vaccination coverage 68.5% nationally 98.0% when vaccine consequences applied 35.2% when no vaccine requirements or recommendations 6

7 Vaccination coverage of 100% in HCP 43% risk reduction for influenza in hospitalized patients 60% risk reduction in nursing home patients Permissible for states to enforce public health initiatives when interventions are: Public health necessity Proven effectiveness Not gratuitously onerous or unfair No health risk to recipient Vaccination Mandates Childhood immunizations Hepatitis B, MMR and varicella for HCP Although not a vaccine, annual tuberculin skin testing for HCP 7

8 Impact and benefits of a mandatory vaccination program Reduces staff illness and absenteeism Reduces influenza related morbidity and mortality in high risk persons for severe illness Decreases incidence of nosocomial infections Decreases staffing issues related to ill employees Improves patient safety Ethical duty of beneficence and nonmaleficence Challenges to a mandatory vaccination program Creates conflict between frontline HCP and leadership Reduces adherence to basic infection and prevention controls Potential P t ti l resistance by organized employee organizations Impact on HCP freedom of choice and autonomy Inconclusive data on impact of HCP immunizations on patients Insufficient time to address beliefs and attitude barriers Barriers to Vaccination Fear of vaccine side effects Perceived ineffectiveness Perceived low likelihood of getting influenza Inconvenient, not enough time to get vaccinated Medical contraindications Fear of needles Reliance Rli on homeopathic hi treatments 8

9 Factors for Vaccine Acceptance Desire for self-protection Desire to protect patients Prior influenza vaccination Perceived vaccination effectiveness Peer influence Medical Contraindications Medical Exemption Statement Severe allergic reaction after a previous dose or to a vaccine component (e.g. eggs) History of Guillian Barré Syndrome Current moderate or severe acute illness with or without fever (until symptoms have abated) Program Features Leadership advocacy and participation as role models Customize program for facility and location Access to vaccination is easy Free vaccine Publicize program for all levels of HCP Offer incentives Provide education about purpose and benefits Use universal form with defined acceptable medical and religious exemptions Clear policy for management of employees with exemptions Clear policy when vaccination is a condition of employment and/or professional privileges 9

10 Use of masks and respirators Used by HCP who refuse or unable to receive vaccination Used when performing patient care during influenza season Provide a source control for viral shedding in infected HCP with limited or no symptoms of influenza Protect unvaccinated HCP from unrecognized and unisolated influenza patients Can be logistically challenging to implement regarding identification of noncompliance Influenza Safe Work Practices Use of PPE Hand washing and use of alcohol based sanitizers Cough hygiene Influenza patient isolation HCP and visitor restrictions when ill Supporters American Academy of Family Physicians American Academy of Physician Assistants American Hospital Association American College of Occupational and Environmental Medicine American Nurses Association Society for Healthcare Epidemiology of America Centers for Medicare & Medicare Services Centers for Disease Control and Prevention American Academy of Pediatrics American College of Physicians American Medical Association National Medical Association Joint Commission 10

11 Support of Minnesota Medical Association of Health Care Personnel The MMA supports universal influenza vaccination of health care personnel in order to improve patient safety and quality of care. Health care personnel should receive the vaccine annually unless it is detrimental to an individual s personal health. A declination of the influenza vaccine should be documented. Further, the MMA encourages each health care facility to implement a tracking system to monitor annual influenza immunization rates of staff. Healthy People 2020 Healthy People provides science-based, 10-year national objectives for improving the health of all Americans. For 3 decades, Healthy People has established benchmarks and monitored progress over time in order to: Encourage collaborations across communities and sectors. Empower individuals toward making informed health decisions. Measure the impact of prevention activities. Goal for 2020: 90% influenza vaccination of health care personnel Joint Commission Enhanced standard released November 2011 Influenza vaccination program available to licensed independent practitioners The hospital sets incremental influenza vaccination goals, consistent with achieving the 90% rate established in the national influenza initiatives for 2020 The hospital evaluates the reasons given by staff and licensed independent practitioners for declining the influenza vaccination The hospital improves its vaccination rates according to its established goals at least annually 11

12 Centers for Medicare & Medicaid Services Beginning January 2013 reporting influenza vaccination Report 3 groups Employees Licensed independent practitioners Students/trainees and volunteers 5 categories for each group Vaccinated by facility Vaccinated elsewhere Medical contraindication Declined vaccination non-medical Unknown vaccination status State and Legislative Regulations Multiple states with legislation requiring influenza immunization in HCP Some states require pneumococcal immunization Exemptions for medical contraindications and religious beliefs Programs Virginia Mason Medical Center, Seattle, WA All healthcare workers, students, and volunteers, as well as clerical, dietary, janitorial, and laboratory staff, must receive influenza vaccine. Those who are exempted for medical, religious, or other reasons are required to wear a mask for the duration of influenza season. The center requires all persons who work in the facility during the influenza season to comply with VM's influenza fitness for duty policy, this includes vendors, students, physicians with privileges at our facility and contract workers in addition to all staff. In 2010, VM mandated H1N1 influenza vaccination for all, in addition to influenza vaccination. Implementation date: Policy implemented 2004 (due to vaccine non-availability that year, policy was fully implemented in 2005) 12

13 Programs Johns Hopkins Health System, Baltimore, MD All staff, students, volunteers, and personnel who have direct patient contact must receive the influenza vaccine or complete an online influenza questionnaire form. The vaccine is provided free to all staff, students, volunteers, and personnel who work in the hospital. Everyone with direct patient contact or working in clinical areas who has not received the influenza vaccine by December 20 must wear a mask within 3 feet of a patient. Vaccinated staff will receive a yellow ID badge clip. After December 20, those who do not have a yellow ID badge clip will be required to wear a mask. Implementation date: September 2009 Programs Boulder Community Hospital, Boulder, CO All healthcare workers, contractors, and volunteers, as well as clerical, dietary, janitorial, and laboratory staff, are required to receive influenza vaccine. Exemption to immunization is allowed for medical, religious, and other reasons, but employees covered by this policy will be required to wear a mask while at work during influenza season. Implementation date: September 1, 2010 Programs Cincinnati Children's Hospital Medical Center, OH All healthcare workers, students, and volunteers, as well as clerical, dietary, janitorial, and laboratory staff, must receive influenza vaccine or face dismissal. Exemption to immunization is only allowed for valid medical contraindications (stringently applied) and religious reasons. In addition, vaccination is required for all vendors and contractors; t those in non-compliance will not be allowed in the facility. Implementation date: July 15,

14 Mandatory Vaccination: Are we there yet? No US federal mandate Some states have regulatory requirements Many healthcare institutions are implementing programs Required written documentation for medical contraindications and religious beliefs Support from multiple healthcare and professional organizations Thank You 14