INFLUENZA VACCINATION STRATEGIES FOR RESIDENTS AND HEALTHCARE PERSONNEL IN NURSING HOMES

Transcription

1 INFLUENZA VACCINATION STRATEGIES FOR RESIDENTS AND HEALTHCARE PERSONNEL IN NURSING HOMES Nursing Home Knowledge Share Webinar Sherri Atherton MS, RN, CNS-BC, CIC 9/12/12

2 Objectives Describe the incidence of influenza in nursing home populations Explain the importance of healthcare personnel and nursing home resident vaccinations Implement effective, evidence-based strategies to improve vaccination rates for personnel and residents Learn about educational and promotional resources available for the season 2

3 Facts About Influenza Influenza (flu) is a contagious respiratory tract infection caused by influenza viruses. Influenza can cause mild to severe illness, and at times can lead to death Symptoms generally include: fever, cough, sore throat, muscle aches, headache, and/or fatigue During most influenza seasons, between 10 and 20% of the population is infected with influenza viruses More than 200,000 people are hospitalized with influenza each year in the U.S. Certain groups of people, including older adults, young children, pregnant women, and people with certain health conditions, are at higher risk for serious complications from influenza illness. 3

4 Influenza in Oregon in ,316 Oregonians were hospitalized 67 died of influenza-related illnesses No two seasons are alike Surveillance data updates: Flu.oregon.gov 4

5 5

6 Importance of Vaccination For the healthcare worker: -Infectious hours prior to symptoms For the Nursing home residents: - High risk population due to age and co-morbidities -Homelike setting increases transmission risk 6

7 Evidence Supporting Vaccination Vaccinating healthcare workers and residents has been shown to reduce mortality of residents by 30-40% even when patient vaccination rate is high > 60% vaccination rate led to a decreased risk of influenza outbreak J Infect Dis 1997: , Lancet 2000: 355: 93-7, B MJ; 333:

8 Outbreak Impact Each year 13-34% of skilled nursing homes report an influenza outbreak On average: 33% of residents and 23% of staff develop Influenza-like Illness 14% of residents are hospitalized 6% of residents die Financial and social implications result Clinic Infect Dis 2004; 39: , Age and Ageing 2010: 39:

9 Influenza in Oregon in

10 People at High Risk of Developing Flu Related Complications Children younger than 5, but especially children younger than 2 years old Adults 65 years of age and older Pregnant women American Indians and Alaskan Natives *Most people recover from flu in about two weeks *Some develop Flu-related complications: Pneumonia, bronchitis, sinus infections and ear infections, and occasionally, death. 10

11 People at High Risk of Developing Flu Related Complications People who have medical conditions including: Asthma Neurological and neurodevelopmental conditions Chronic lung disease (such as chronic obstructive pulmonary disease [COPD] and cystic fibrosis) Heart disease (such as congestive heart failure and coronary artery disease) Blood disorders (such as sickle cell disease) Endocrine disorders (such as diabetes mellitus) Kidney disorders Liver disorders Metabolic disorders Weakened immune system due to disease or medication (HIV or AIDS, or cancer, or those on chronic steroids) People who are morbidly obese (Body Mass Index, or BMI, of 40 or greater) 11

12 Vaccine and Indications seasonal influenza vaccine contains three vaccine viruses: A/California/7/2009 (H1N1) pdm09-like virus; A/Victoria/361/2011 (H3N2)-like virus; B/Wisconsin/1/2010-like virus (from B/Yamagata lineage of viruses). The H1N1 virus is same virus from vaccine, but the H3N2 and B vaccine viruses are new. Everyone over the age of 6 months should be vaccinated! It s critical for those at high risk for complications should be vaccinated! 12

13 Requirements for Resident Influenza Vaccination Program (F334) Residents should be informed about the benefits and risks of immunizations Residents should have the opportunity to receive the influenza vaccine, unless medically contraindicated, refused or already immunized 13

14 Resident Care Policies Physician approved vaccination policies (standing order programs recommended) System to screen for contraindications and identify those eligible for vaccination Have a documentation process for immunization status that includes both the individual resident medical record but also a facility level report. 14

15 Resident Education Educate the residents and family members on the benefits of influenza vaccination Use Vaccine Information Statements (VIS) for educational programs Document education that has been provided to the resident/family and at the facility 15

16 Resident Influenza Consent May be verbal Written consent is not a federal or licensure requirement Recommend having declination of immunization in writing 16

17 Successful Resident Influenza Vaccination Programs Eliminate individual physician orders Eliminate written consent requirements Education is simple, directed at understanding the risks of not getting vaccinated and focuses on areas where immunization rates are low Campaigns start as soon as vaccines become available 17

18 National Vaccination Survey Health care personnel influenza vaccination coverage by work setting, mid- November 2011, United States Health Care Personnel Flu Vaccination Internet Panel Survey, United States, November

19 How is Oregon Doing? According to the Healthcare Acquired Infection Reporting Program: Healthcare Worker Influenza Vaccination Rates Season (Published December 2011) Office for Oregon Health Policy and Research survey of healthcare worker Influenza vaccination rates for 60 Oregon hospitals and 141 long-term care facilities 91% of 141 long term care facilities provided HCW data 19

20 Vaccination Targets 20

21 Understanding Attitudes 21

22 Other Reasons for Declining I have already had the flu I don t want it I have concerns regarding mercury additives in vaccine I don t want to inject in my body I don t think it works I believe building natural immunity is better than vaccination I use homeopathic methods/supplements I stay home when I get the flu, so I will not spread it to others I don t believe the vaccine is important I believe I am immune to flu HCW also noted the personal right to refuse in the other category 22

23 Oregon Efforts 23

24 Improving Vaccination Rates Target patients and healthcare workers with similar efforts Bundle interventions to build on success and target other reasons for declining Year-round emphasis with leadership support 24

25 Strategies to Consider Begin vaccination campaign earlier Involve representatives from each unit/wing Use multiple campaign and education strategies Distribute vaccine using various avenues Throw a kick off campaign Locate vaccination site near time clocks or where paystubs/checks are distributed Have influential peers and leaders promote vaccination New York City DOH Slide set: Employee Influenza vaccination campaign in Long-Term Care Facilities 25

26 More Strategies to Consider Use a dedicated employee health nurse Have MDs give flu vaccine talks All departments need to participate hold competitions In service to all shifts Provide mini-flu module on-line training courses Year-round focus Combine vaccine with other services New York City DOH Slide set: Employee Influenza vaccination campaign in Long-Term Care Facilities cination_campaign_in long-term_care_facilities_mjh_[read-only]_[compatibility_mode].pdf 26

27 27

28 28

29 Local Lessons Learned Create a sense of urgency 29

30 Local Lessons Learned Have staff set improvement goal/designate leads who are responsible for their achievement Utilize emergency drill format - Practice for outbreak or pandemic - Peer pressure: mandatory check-in Target What s in it for them - Pregnant or family with risk factors - Money saved with less use of sick leave - Dialog about past experience with vaccine 30

31 31

32 National Resources National Influenza Vaccination Campaign Special Events: Flu Season Kickoff (National Foundation for Infectious Diseases) September 27, 2012 Press Briefing National Influenza Vaccination Week (NIVW) December 2-8, General & customizable poster Tailored messages New & traditional media resources NIVW-specific calendar of events All other NIVW plans will be forthcoming 32

33 In Conclusion Influenza vaccination is important Greatest improvement needed for HCW Build on success: bundle interventions based on facility culture Resources are available It s time! 33

34 Questions? 34