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1 Improving Healthcare Personnel Immunization Rates Thursday, April 5, :00 PM ET In Case of Technical Difficulties If you hear an echo: Make sure you are only logged in once on your computer Select one form of audio only (either computer speakers or telephone connection) If the audio is choppy: Press pause in the top left corner of your screen Wait 10 seconds and then click play Dial at any time for live assistance 1

2 Agenda Agenda Welcome and Introductions William Schaffner, MD, NFID Medical Director Professor of Preventive Medicine and Infectious Diseases Vanderbilt University School of Medicine Improving Healthcare Personnel Immunization Rates Ruth M. Carrico, PhD, RN, CIC NFID Director Associate Professor University of Louisville Patricia A. Stinchfield, RN, MS, CPNP, CIC NFID Secretary Senior Director, Infection Prevention and Control Children's Minnesota Questions and Answers General Information Please note that this webinar is being recorded All phone lines will be placed on mute throughout the program To hear audio: Computer: Follow directions Phone: ; Access Code After the presentations, there will be a Question and Answer period Use the Chat box on the lower left side of your screen to type your question At the end of the webinar, participants will be directed to an online evaluation Following the webinar, registered participants will receive an with a link to the presentation slides 2

3 CME Credit & Webinar Evaluation The National Foundation for Infectious Diseases (NFID) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education (CME) for physicians. NFID designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit TM To receive credit, you must complete the online evaluation and pass the post-test with a score of 80% or higher Online evaluation and post-test will be available following the webinar at: Certificate will be available for print or download following successful completion of online evaluation and post-test until April 5, 2019 Disclosures Marla Dalton (NFID staff, content reviewer) owns stock, stock options, patent, or other intellectual property from Merck & Co., Inc. William Schaffner (NFID medical director, presenter) served as an advisor or consultant for Dynavax, Merck & Co., Inc., Pfizer Inc., Seqirus, and SutroVax Ruth Carrico (Presenter) owns stock, stock options, patent, or other intellectual property from Merck & Co., Inc. and Pfizer Inc.; served as an advisor or consultant for Pfizer Inc. and Sanofi Pasteur; received grants for research from Pfizer Inc. and Sanofi Pasteur; and served as a speaker for Pfizer Inc. and Sanofi Pasteur All other activity planners/reviewers and staff for this activity have no relevant financial relationships to disclose 3

4 Learning Objectives At the conclusion of this activity, participants will be able to: Review the current US recommendations for healthcare personnel (HCP) and immunization rates Understand issues, challenges, and opportunities that may impact HCP immunization acceptance Discuss best practices and practical strategies to increase HCP immunization rates in various healthcare settings Non-profit 501(c)(3) organization dedicated to educating the public and healthcare professionals about causes, prevention, and treatment of infectious diseases across the lifespan Reaches consumers, healthcare professionals, and media through: Coalition-building activities Public outreach initiatives Professional educational programs (ACCME accreditation with commendation) About NFID Scientific meetings, research, and training Longstanding partnerships to facilitate rapid program initiation and increase programming impact Flexible and nimble organization 4

5 Improving Healthcare Personnel Immunization Rates Ruth M. Carrico, PhD, RN, CIC Associate Professor University of Louisville School of Medicine Patricia A. Stinchfield, RN, MS, CPNP, CIC Senior Director, Infection Prevention & Control Children s Minnesota Objectives Review current recommendations outlining immunizations important for US healthcare personnel (HCP) Describe what we know and don t know about current rates of immunization among HCP Identify current gaps in implementation of HCP immunization recommendations and subsequent improvement of immunization rates Review 2017 NFID Healthcare Personnel Immunization Summit discussions and challenges to improving rates Outline recommendations that are vital elements of a roadmap for improving HCP immunization rates 5

6 MMWR 2011;60 (RR-07):1-29 ACIP Recommendations for HCP Routine Requirements Hepatitis B Influenza MMR Varicella Tdap Lab workers Meningococcal Typhoid Polio MMWR 2011;60 (RR-07):

7 Who Are We Talking About? CDC: Healthcare workers include physicians, nurses, emergency medical personnel, dental professionals, students, medical and nursing students, lab technicians, pharmacists, hospital volunteers, and administrative staff NFID Call to Action: HCP in hospitals, long-term care, clinics, rehab centers, urgent care, home health, and EMS Hepatitis B 3 dose series upon hire if no evidence of completed series or serologic evidence of immunity Dose #1 upon hire, dose #2 in 1 month, dose #3 approximately 5 months after #2 Get anti-hb serologic test 1-2 months after dose #3 Repeat for non-responders; may do serology after 1 additional dose or end of second series Retesting not necessary for HCP with documented post-vaccination immunity Photo IAC image library. Liver cross section. Note enlarged cells and blistering of capsular surface 7

8 Influenza Get one dose annually When? Current recommendations say as soon as it becomes available Best before the end of October Mandatory vs. recommended varies Efficacy varies per strain and per season Best defense against severe influenza and related complications Safe MMR Documentation of vaccination with 2 doses of MMR If not: 1 dose upon hire, #2 at least 28 days later OR lab evidence of immunity OR lab confirmation of disease OR if born before 1957 and unvaccinated, and no lab evidence of immunity or lab confirmation of disease, give 2 doses MMR 8

9 Varicella If you have not had chickenpox, or have not had vaccine, or no current blood tests that show proof of immunity, get vaccinated 2 doses of varicella vaccine 4 weeks apart Pertussis Get one time Tdap as soon as possible if have not had one previously No minimum interval from last Td Get Td booster every 10 years thereafter Pregnant HCPs need a dose of Tdap with EACH pregnancy Copyright Dr. CW Leung, Dept of Peds/Adolescent Medicine, Princess Margaret Hospital, Hong Kong IAC Photo Library 9

10 Meningococcal: For Lab Staff Only One dose of each meningitis vaccine to lab staff who handle isolates of N. Meningitidis Give both MenACWY and MenB to microbiologists May give both at same time (administer in different site) Every 5 years boost with MenACWY if risk continues Current Rates of Immunization Among Healthcare Personnel This is part of the issue Not reportable by hospitals to anyone Not good statewide or national data Some CDC data for influenza 10

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12 Gaps in Implementation of Current Recommendations Reasons why HCPs don t embrace? No clear strong champion No regulations The Joint Commission has influenza standard Need stronger approaches to reach all Vaccine hesitancy similar to general public Public misinformation May not be an organizational priority 12

13 Improvement Approaches ACIP evidence-based recommendations exist, so where is the traction? Stakeholders Champions Leaders Innovators November 2017 NFID Healthcare Personnel Immunization Summit NFID invited subject matter experts, including representatives from professional healthcare organizations active in infection prevention and control, occupational health, and immunization Purpose was to discuss how to best optimize practices that will lead to improved immunization rates among HCP 13

14 Issues: Issue: Lack of Accountability Accountability is personal as well as organizational Ownership of the HCP immunization program Clear expectations and monitoring of program components, including outcomes Professional association support 14

15 Issue: No Consensus on Use of Mandates and Conditions of Employment Mandates and civil liberties Union concerns Human resources policies versus infection prevention and control policies Safety of the patient versus will of the HCP Employees, licensed independent providers, volunteers, students Impact on employee retention and recruitment Issue: Inconsistent Implementation and Performance Metrics Should immunization requirements be the same across all healthcare settings? Organizational structure Financial impact of full immunization 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap (approximately $450) add annual influenza immunization and titer(s) Possible additional vaccines Tracking of immunizations and reminders Availability of information for HCP Ultimate difficulties in determining and using performance metrics to drive increased adherence and program improvements 15

16 Issue: Lack of Targeted Messaging Economically-driven Science-driven Safety-driven Geared toward needs of individual HCP population groups Patient expectations (patient satisfaction) Clear, accurate, and action-oriented Address anti-vaccination messages Issue: Disproportionate Emphasis Between Influenza and Other Vaccines Recommended for HCP Primary emphasis on influenza vaccine, inadvertently minimizing the importance of all other vaccines important to HCP Minimization emphasized by regulators (e.g., CMS) and accrediting bodies (e.g., TJC) Misunderstanding about importance of other vaccines If a mismatch year and publicity regarding reduced efficacy of the annual influenza vaccine, may be misguided translation to other vaccines Impact and outcome of this discordance is not well understood and therefore not well communicated 16

17 Developing a Roadmap for Improvement and Engagement Summit Overview: Identification of the issues challenging forward progress in improving adherence to existing national guidelines Recommendations offering approaches that seek to engage a full spectrum of stakeholders and partners NFID Call to Action available at: Recommendation: Enhance Professional Education Understanding Training Where to find it, is it targeted, does it make sense, evidence-based, accessible Are all healthcare personnel included in the education Acceptance Influencing others Implementation in action at individual and organizational levels Clear identification of impact (personal, organizational, financial) of non-adherence 17

18 Algorithm to tell the story Value of prevention Cost of case identification, follow-up, worker furlough, patient treatment, employee treatment, publicity, community trust Recommendation: Establish Clear Accountability and Buy-in What is the expectation? Does the expectation have teeth? How deep is the accountability? What is the level of buy-in across the organization? Role of professional associations and organizations? What about HCP who may not have those associations or organizations to push the importance? 18

19 Recommendation: Publish Best Practices and Lessons Learned How much of what we need is actually in the literature? How much of what we know is in the literature? What questions are we asking at the practice level? What are the current knowledge and practice gaps? Adding granularity to existing recommendations so they are useful at the practice level (all sites where care is delivered) National research agenda Industry and practice partnerships (e.g., vaccine research, technology needs) Recommendation: Encourage Standardization Through Development of Recognized Set of Policies and Procedures Concerns that CDC/ACIP recommendations maintain a sense of optional Variability in approaches present in recommendations (e.g., how to handle a new employee and determining need for hepatitis B vaccine series versus titers versus challenge dose.) Guidance of the program at the organizational level (prescriptive authority); standing orders/protocols Algorithms to assist in understanding, acceptance, implementation, and metrics Local, state, national database for HCP immunization information 19

20 Recommendation: Consider Recognition and Incentives Balancing the carrot and the stick Ecological approach Organization incentives (e.g., inclusion as part of magnet status) Unit level incentives (e.g., posters, competition for completion) Individual incentives (e.g., opportunities for participation in immunization education) Recommendation: Drive Increased Public Acceptance and Demand for Vaccination Public education campaigns Policy development and policy change Cultural competence and culturally tailored approaches Competency in staff leading and implementing immunization program Opportunities to share ideas, outcomes, challenges, and best practices in transparent manner Engage and include; avoid alienation and exclusion 20

21 The Big Opportunity Individual responsibility and action Organizational responsibility and action Professional association responsibility and action Licensure, regulation, standards Research agenda that is multidisciplinary and multiagency Solid foundation where there is access to credible, accurate, complete, and enduring education Personal commitment References CDC. (2011). Immunization of health care personnel: recommendations of the Advisory Committee on Immunization Practices. MMWR. 60(RR-07):1-45. CDC. Vaccine Information for Adults. Retrieved from: CDC. (2016). The National Institute for Occupational Safety and Health (NIOSH). Retrieved from: Carrico RM, Weimken T, et al. (2013). Health care personnel immunization programs: an assessment of knowledge and practice among infection preventionists in US health care facilities. Am J Infect Control. 41(7): Infectious Disease Society of America. (2013). Mandatory Immunization of Health Care Personnel According to the ACIP-Recommended Vaccine Schedule. Policy Statement National Vaccine Advisory Committee. (2013). Strategies to Achieve the Healthy People 2020 Annual Influenza Vaccine Coverage Goal for Health-Care Personnel: Recommendations from the National Vaccine Advisory Committee. Public Health Reports. 128(1):7-25. Ofstead, C, Amelang, M, et.al. (2017). Moving the needle on nursing staff influenza vaccination in long-term care: Results of an evidence-based intervention. Vaccine. 35 (18):

22 Questions & Answers CME Credit & Webinar Evaluation The National Foundation for Infectious Diseases (NFID) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education (CME) for physicians. NFID designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit TM To receive credit, you must complete the online evaluation and pass the post-test with a score of 80% or higher Online evaluation and post-test will be available following the webinar at: Certificate will be available for print or download following successful completion of online evaluation and post-test until April 5,

23 Join Us For Upcoming NFID Webinars Increasing Influenza Immunization Rates among College Students April 30, 2018 at 12:00 PM ET Registration: Subscribe to NFID updates: 23