This presentation and the material accompanying this presentation were prepared by its author/and or organization and have been published on the PHO

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1 This presentation and the material accompanying this presentation were prepared by its author/and or organization and have been published on the PHO website for your use as outlined in the PHO Website Terms of Use. PHO accepts no responsibility for the presentation and the material accompanying it.

2 HCA Overview / Influenza Patient Safety Program Scott B. Cormier Director, Emergency Preparedness & Management scott.cormier@hcahealthcare.com

3 Agenda HCA Overview & Clinical Perspective HCA Influenza Patient Safety Program

4 HCA Overview 18 million patient contacts / year Nearly 5% of all US hospital services Category HCA* % National* Anchorage Southwest Group Central Group National Group International Central London Deliveries CABG 226,735 10, % 5.63% CHF 38, % `1 W San San Jose Jose Southern California Western W Idaho W W Idaho Falls W Utah W Las Vegas Northeast Kansas City Terre Haute No. VA C Denver Terre Wichita Kansas City Haute C C C Richmond SW VA Wichita W Frankfort SW VA Nashville C Oklahoma W City Chattanooga Augusta Grand Strand Oklahoma Central City NW NW GA GA Atlanta El Paso Dallas/FtW Louisiana Atlanta Trident/Charleston Dallas/FW W Columbus E Columbus Middle GA Palmyra W Austin Austin Panhandle** E Jacksonville San Antonio San Antonio W Houston North Central Florida W W Panhandle Treasure Coast Lafayette Tallahassee W Corpus Christi Tampa Palm Beach Broward New Brownsville Orleans Dade C Oncology Total Inpatients 164 hospitals In 20 US states (158) and England (6) From complex tertiary referral & academic medical centers to urban and suburban community medical centers Approximately 125 free-standing surgery centers and > 550 physician practices 28,633 1,775, % 4.82% *4Q10-3Q11 ~ 35,000 affiliated physicians ~ 200,000 employees

5 Clinical and Physician Services Group Clinical Services Mission To provide evidence-based guidance, tools, measurement and support for improving performance and growth of safe, effective, efficient and compassionate healthcare 2012 Focus Areas Improving patient safety, including reduction of hospital-acquired infections and conditions Achieving industry-leading performance on measures of quality, value and patient experience Reducing clinical variation company-wide through Clinical Excellence; implementing Electronic Health Records across care continuum; engaging physicians for improved clinical integration and performance; avoiding preventable readmissions

6 HCA Quality Facts For the four quarters ending 1Q2011, HCA s Core Measures composite score reported on the CMS Hospital Compare website was 99% compared to the national average of 96.6% 96 HCA hospitals were identified as Top Performers by The Joint Commission in 2012 Established new care standard to eliminate elective deliveries prior to 39 weeks gestation, outside of medical issues, in collaboration with American College of Obstetrics and Gynecology (ACOG) and March of Dimes Eliminated newborn death and brain damage from kernicterus (high bilirubin); HCA protocol became worldwide standard Bar Code Medication Administration implemented at all HCA hospitals in 2003

7 Influenza Introduction Influenza is the leading vaccine-preventable cause of death in the US Mandatory flu prevention for patient safety is a new imperative Evidence for vaccination is strong Protects patients, health workers, institutions Saves lives and money Objections to vaccination are not evidence-based Rates of HCW vaccination remain inadequate Healthcare community has ethical and professional obligation to protect at-risk patients from vaccine-preventable diseases Balance of patient rights and worker rights grounded in evidence Work with unions to share moral high-ground patient safety The New Norm Presents a Choice: Lead or be led... 6

8 Flu Committee Representation Executive leadership Ambulatory care Communications Division office Emergency preparedness Human resources Employee health Infection prevention Information systems Legal Pharmacy Regulatory compliance Supply chain Medical leadership (as available) 7

9 3 Year Seasonal Influenza Vaccination and Reasons for Declination Year Influenza Vaccination Rate 96% 92% 95% Total Number of HCW 104, , ,332 Reasons for Declination (%): 4% 8% 7% Allergy 5% 5% 9% Contraindicated 2% 2% 5% Fear 1% 4% 5% Pregnancy 1% 1% 1% Religion 1% 2% 4% Other/No Reason 90% 86% 76%

10 Influenza Patient Safety Program Goal: Prevent influenza transmission at all sites of care through 100% compliance with prevention protocols Healthcare Workers Patients Seasonal flu vaccination (or surgical masks) Presenteeism policy (stay home when ill) Select appropriate PPE when caring for known or suspected flu cases Appropriate use of antiviral medications Early recognition, separation, and droplet precautions for suspected or confirmed cases Appropriate use of antiviral medications Everybody Compulsive hand hygiene Compulsive respiratory etiquette 9

11 Influenza Vaccines Provided at no cost to employees Household members Non-clinical site vaccinations provided by third-party vendor Vaccines for members of employee households offered at no cost at many facilities Centralized ordering process and tracking Standardized consent and declination form 10

12 Masks for Unvaccinated HCW: Rationale Masks can serve as method of source control of infected HCW who may have no symptoms Masks may protect unvaccinated HCW from as yet unrecognized infected patients or visitors with influenza Masks, in conjunction with hand hygiene, shown to have reduced rates of influenza-like illness in residents of college dormitories and households 1,2 Mask or respirator can filter influenza virus to undetectable levels when measured by real-time polymerase chain reaction (PCR) at a distance of 20 cm from an infected patient 3 1. JID 2010; 201: Ann Intern Med 2009; 151: CID 2009; 49:

13 Masking and Influenza Vaccine Status HCP Vaccine Status Unvaccinated Vaccinated Vaccinated Scenario In areas within 6 feet of where patients are located or where healthcare personnel may come in contact with patients Caring for patients in droplet precautions for suspected respiratory illness like influenza Performs aerosol generating procedures* Action/Rationale Place a face mask on in areas within 6 feet Place a face mask on in areas within 6 feet of patients. Add eye protection as appropriate Wear N95 respirator during procedures *Aerosol generating procedures include bronchoscopy, sputum induction; endotracheal intubation and extubation; open suctioning of airways; cardiopulmonary resuscitation; autopsies

14 FLU IQ messages from HCA Senior Leadership and Influenza FAQ s

15 Flu Season Messaging: Employee Health and Wellness Newsletter ATLAS Intranet Home Page YOU Magazine

16 HCA Corporate Intranet Site for Seasonal Influenza Resources and Newsletter

17 Communication Dedicated flu address Any employee can ask a question to a member of our flu team Nearly 665 s for the 2009/10 flu season were received and answered Nearly 140 s were received for the 2010/11 flu season 300 s to date for the 2011/12 flu season 16

18 Electronic Forms Click the radio button for individual choice: o I consent to receive the influenza vaccination o I decline to receive the influenza vaccination o I already received the influenza vaccination

19 Vaccine Tracking Weekly Reports provided to each facility Hospital Division Refuse % Undocumented Vaccination Rate Capital 4% % Tristar 5% % Far West 10% % Mountain 4% % Continental 4% % East Florida 16% % S Atlantic 4% % N Florida 7% % West Fl 10% % Cntr/west Tx 3% % North Texas 3% % Gulf Coast 3% % San Antonio 3% % Midamerica Divi 6% % 18

20 Surveillance Daily surveillance (Emergency Departments) White blood cell test counts less than 5,000 and greater than 10,000 Patients with influenza-like illness (fever > 100.4⁰ with cough and/or sore throat) Rapid influenza test results Compliance 19

21 Data Collection 20

22 Implementation Calendar December: Begin discussions for new season Vaccine supply and vendors Review Southern hemisphere data Review enterprise (HCA) data January: Initiate seasonal planning with facilities Ordering process and deadlines Non-clinical site vendors February: Vaccine ordered Consider additional stockpile 21

23 Implementation Calendar March: Wrap up current season Review data Discuss program improvements April July: Continue planning Send final vaccine data to all facilities Implement program improvements Update consent/declination forms August: Employee Health/Human Resources webcast Tutorial for entering employee vaccine data into database 22

24 Implementation Calendar September: Flu-Season Kickoff Company-wide webcast of flu season outlook and review of the patient safety program Begin collecting vaccine data Begin electronic publication of HCA Influenza Update newsletter October November: Continue program Review data, provide support as needed Monitor influenza season data Weekly influenza report to CDC 23

25 Focus on patient safety Visible leadership support Keys to Success Multi-disciplinary team involvement Infection prevention, human resources, communication, pharmacy, supply chain, legal, emergency preparedness Effective communication to leaders and staff, including medical staff Clear expectations for leaders and staff Consistent data collection and feedback to leaders and staff Coordination of logistics The question is not why to do it, but why we are not doing it! 24

26 References Allison E. Aiello, G. F. (2010). Mask Use, Hand Hygiene, and Seasonal Influenza-Like Illness Among Young Adults: A Randomized Intervention Trial. Journal of Infectious Diseases, Benjamin J. Cowling, K.-H. C. (2009). Facemasks and Hand Hygiene to Prevent Influenza Transmission in Households: A Cluster Randomized Trial. Annals of Internal Medicine, Brian J. Feery, M. G. (1979). Different Protection Rates in Various Groups of Volunteers Given Subunit Influenza Virus Vaccine in The Journal of Infectious Diseases, Carman WF, E. A. (2000). Effects of Influenza Vaccination of Health-Care Workers On Mortality of Elderly People in Long-term Care: A Randomised Controlled Trial. Lancet, Cassandra D. Salgado, E. T. (2004). Preventing Nosocomial Influenza by Improving the Vaccine Acceptance Rate of Clinicians. ICHE, D. F. Johnson, J. D. (2009). A Quantitative Assessment of the Efficacy of Surgical and N95 Masks to Filter Influenza Virus in Patients with Acute Influenza Infection. Clinical Infectious Diseases, D. J. Stott, G. K. (2002). Nosocomial Transmission of Influenza. Occupational Medicine, DR Feikin, A. S. (2000). Mortality from Invasive Pneumococcal Pneumonia in the Era of Antibiotic Resistance, American Journal of Public Health, Elder AG, O. B. (1996). Incidence and Recall of Influenza in a Cohort of Glasgow Healthcare Workers during the Epidemic: Results of Serum Testing and Questionnaire. BMJ, Interim Results: Influenza A (H1N1) 2009 Monovalent and Seasonal Influenza Vaccination Coverage Among Health-Care Personnel --- United States, August January (2010). MMWR Weekly Report,

27 References J. Potter, D. J. (1997). Influenza Vaccination of Health Care Workers in Long-Term-Care Hospitals Reduces the Mortality of Elderly Patients. The Journal of Infectious Diseases, 1-6. Lester RT, M. A. (2003). Use of, Effectiveness of, and Attitudes Regarding Influenza Vaccine Among House Staff. ICHE, Maltezou, H. C. (2010). Novel (pandemic) Influenza A H1N1 in Healthcare Facilities: Implications for Prevention and Control. Scandinavian Journal of Infectious Disease, Prevention and Control of Influenza with Vaccines. (2010). MMWR Recommendations and Reports RR-8, Saxén H, V. M. (1999). Randomized, Placebo-Controlled Double Blind Study on the Efficacy of Influenza Immunization on Absenteeism of Health Care Workers. Pediatric Infectious Disease Journal, Talbot TR, C. D. (2005). Duration of Virus Shedding after Trivalent Intranasal Live Attenuated Influenza Vaccination in Adults. ICHE, Talbot TR, S. W. (2010). On Being the First: Virginia Mason Medical Center and Mandatory Influenza Vaccination of Healthcare Workers. ICHE, Talbot, R. A. (2009). Do Declination Statements Increase Health Care Worker Influenza Vaccination Rates?. Clinical Infectious Diseases, Thomas R. Talbot, M. M. (2010). Revised SHEA Position Paper: Influenza Vaccination of Healthcare Personnel. ICHE, Vaccine Preventable Deaths and the Global Immunization Vision and Strategy, (2006). MMWR Weekly, van den Dool C, B. M. (2009). Modeling the Effects of Influenza Vaccination of Health Care Workers in Hospital Departments. Vaccine, Wilde JA, M. J. (1999). Effectiveness of Influenza Vaccine in Health Care Professionals: A Randomized Trial. JAMA, William W. Thompson, P., David K. Shay, M. M., Eric Weintraub, M., Lynnette Brammer, M., Nancy Cox, P., Larry J. Anderson, M., et al. (2003). Mortality Associated With Influenza and Respiratory Syncytial Virus in the United States. JAMA,