Implementing BC s Influenza Prevention Policy

Transcription

1 Implementing BC s Influenza Prevention Policy A survey of healthcare facilities Alexandra Nunn 1, Audrey C. Campbell 1, Monika Naus 1,2, Jeffrey C. Kwong 2, David Puddicombe 1, Meena Dawar 3, Susan Quach 2, Bonnie Henry 1,4 1 BC Centre for Disease Control 2 University of British Columbia 3 University of Toronto 4 Vancouver Coastal Health 5 Office of the Provincial Health Officer CPHA Conference 2015 No conflicts of interest May 27, 2015

2 BC s Influenza Prevention Policy The Policy requires all healthcare workers in British Columbia to either be vaccinated annually against influenza or wear a surgical/procedure mask in patient care areas throughout the influenza season. Health Authority employees Physicians Residents Students Volunteers Contractors Vendors Visitors

3 Timeline BC Influenza Prevention Policy / / /15 X no disciplinary measures Facility Survey Conducted (You are here)

4 Background Impact of mandatory policies Impact of facility-level activities Rakita ICHE 2010;31:881

5 Study Objectives What was the process of implementing the policy at the facility level? LOGISTICS SUPPORTS CHALLENGES

6 Cross-sectional online survey Study Methods Population 453 long term care (LTC) & acute care facilities in BC Sample 263 facilities from 3 of 5 regional Health Authorities in BC Respondents Person most responsible for coordinating the influenza prevention policy at their facility

7 Analysis Descriptive Statistics Qualitative analysis Multivariable regression Proportions T-tests Coded free-text responses Deductive approach Linear regression Factors associated with higher immunization rates

8 Results 132 facilities responded (29% of facilities in the province) o 33 Acute care o 99 LTC Mean HCW immunization coverage o ACUTE: 73% for responding facilities vs. 73% for non-responding facilities o LTC: 73% for responding facilities vs. 82% for non-responding facilities o o Significantly lower coverage than non-responders (p<0.001) Our sample was less representative of LTC facilities

9 Perspectives on policy implementation 89% 89% of respondents reported that their facility successfully implemented the policy......but only 52% of respondents found the policy EASY to implement at their facility. 52% Indicators of success Staff compliance & cooperation High immunization rates o Direct care staff Challenges to success Resistance and refusal to be vaccinated or masked Masking enforcement

10 Perspectives on policy implementation Not quite sure the definition of "easy" - it was a lot of work by people at all levels throughout the organization Corporate respondent Considerable added work load for every manager LTC respondent

11 LOGISTICS Top 3 most successful methods for delivering the vaccine to staff Onsite clinics weekday, daytime Peer immunization Mobile clinics directly to unit 100% 80% 60% 40% 20% 0% Acute care facilities LTC facilities

12 LOGISTICS Top 3 most successful methods for delivering the vaccine to staff Peer immunization Associated with a 7.5% higher facilitylevel immunization rate (p=0.005)

13 LOGISTICS Top 5 activities to facilitate mask-wearing at LTC and acute care facilities 89% Ensured mask availability in patient care areas 81% Monitored staff mask-wearing in patient care areas 78% Posted masking reminders in patient care areas 71% Provided education to unvaccinated healthcare workers about masks 69% Encouraged peer support and monitoring

14 SUPPORTS Over 95% of acute facilities and 80% of LTC facilities were supported by clear guidance from their Health Authority All management staff were very supportive of policy. The issue came from front-line staff not being supportive as they felt this was not a consultative process Acute care respondent Not all physicians supported the campaign so caused much discussion as to why they as a group were not facing consequences if they choose not to immunize or wear a mask. A double standard being set was the sentiment shared by non-physician care providers Acute care respondent Physicians have a powerful voice in this setting and their ambivalence serves to generate more confusion LTC respondent

15 CHALLENGES Top 3 challenges enforcing mask-wearing for unvaccinated staff Managers limited capacity to monitor mask adherence Unvaccinated staff were not wearing masks Difficulties identifying who was unvaccinated 100% 80% Acute care facilities LTC facilities 60% 40% 20% 0%

16 CHALLENGES Top 3 challenges enforcing mask-wearing for unvaccinated staff Managers limited capacity to monitor mask adherence Unvaccinated staff were not wearing masks Difficulties identifying who was unvaccinated Perceived inaccuracy of reporting 43% of acute facilities had accurate reports vs. 76% of LTC facilities

17 CHALLENGES Top 3 challenges enforcing mask-wearing for unvaccinated staff Managers limited capacity to monitor mask adherence Unvaccinated staff were not wearing masks Difficulties identifying who was unvaccinated Inconsistency of enforcement 57% of acute facilities always enforced mask wearing vs. 77% of LTC facilities

18 Impact of the policy on HCW influenza vaccine uptake 100% 80% Policy No disciplinary measures LTC Acute 60% 40% 20% 0% 2005/ / / / / / / / /14

19 Recommendations 1. Support managers Recognize increased workload Gain support from physician & nurse leaders Provide training on enforcement 2. Improve consistency Set clear expectations of policy compliance 3. Establish a more accurate process for identifying HCW immunization status Ensure ability to rapidly update reporting system Simplify process for HCW to update their immunization status 4. Consider further increasing vaccine accessibility Peer immunization Mobile clinics Evening and weekend clinics

20 ACKNOWLEDGEMENTS Thanks to: Dr Bonnie Henry 1,2 Dr Audrey Campbell 1 Dr Monika Naus 1,3 Rob Balshaw 1 Michael Otterstatter 1 David Puddicombe 1 Funding PHAC/CIHR Influenza Research Network (PCIRN) now known as CIRN funded by Canadian Institutes of Health Research Public Health Agency of Canada 1 BC Centre for Disease Control 2 Office of the Provincial Health Officer 3 University of British Columbia

21 Thank you. Questions?