i TRUST WIDE DOCUMENT DOCUMENT TITLE: SEASONAL INFLUENZA PLAN DOCUMENT NUMBER: ELHT Version 1 DOCUMENT PURPOSE: Seasonal Influenza (Flu) Plan sets out a coordinated and evidence-based approach to planning for and responding to the demands of Seasonal Flu across the organisation. SUPPORTING REFERENCES Annual Flu Letter from the Department of Health, NHS England, and Public Health England issued March 2015. Public Health England, NHS England & Department of Health Flu Plan Winter 2013/14 issued March 2015. Influenza chapter in Immunisation against infectious disease (the Green Book, chapter 19)2 which is updated regularly, sometimes during a flu season. TARGET AUDIENCE: All Trust Personnel DISTRIBUTION: All Trust policy manuals and intranet AUTHOR(S): EXECUTIVE DIRECTOR RESPONSIBLE: Occupational Health & Well Being Department Director of Operations Page 1
CONSULTATION VIA Emergency Preparedness Group DOCUMENT REPLACES DOCUMENT Version 1 DATE ACCEPTED: AUTHORISED BY: Submitted to Emergency Preparedness Group 10 th Sept 2015 Emergency Preparedness Group NEXT REVIEW DATE: June 2016 AMENDMENTS: Page 2
Table of Contents Introduction Page 4 Aims of the Flu Programme Page 4 Roles & Responsibilities Pages 5,6,7 Influenza The condition Page 8 Infectivity Page 8 At risk / Eligible Groups Page 9 Patient & Staff Protection Page 9 Patients Page 9 Staff Page 9 Provision of the vaccine for Staff Page 10 Annual Cycle of the Flu Programme Page 11, 12 Flu uptake trajectory & weekly target Page 13 Appendix 1 Groups eligible for the Page 14 Flu Vaccination Page 3
Introduction East Lancashire Hospitals NHS Trust (ELHT) 2015/2016 Seasonal Influenza (Flu) Plan sets out a coordinated and evidence-based approach to planning for and responding to the demands of Seasonal Flu across the organisation taking account of lessons learnt during previous Flu seasons. The plan provides an overview of the coordination and the preparation for the Flu season and signposting to further guidance and information. It is important to remember that this plan is for the annual Seasonal Flu. Pandemic Flu planning and response is covered by ELHT/IC 23 Version 2 Policy of Infection Prevention Precautions For Pandemic Influenza, The ELHT Major Incident Plan, Emergency Preparedness documents and the Pandemic Flu Action Plan. Aims of the Flu Programme The aim of the Flu programme is to minimise the health impact of Flu through effective monitoring, prevention and treatment. This will be achieved by: Actively offering the Flu vaccination to 100% of all those in the eligible groups within the organisation.(for eligible groups see appendix 1) Vaccinating at least 75% of the at risk in-patient population of ELHT and offering antiviral medicines to patients in at-risk groups as well as those patients who the prescriber believes may suffer serious complications if not treated, in line with national guidance. Vaccinating at least 75% of staff within the organisation. Monitoring Flu activity, severity of the disease, vaccine uptake and impact on the organisation and provide data to The Department of Health (DH), Public Health England (PHE) and NHS England as required. Providing information to prevent and protect against Flu. Managing and implementing the response to incidents and outbreaks of Flu in conjunction with the wider strategy of business continuity policies, procedures and plans in place as per the Major Incident Plan, Pandemic Flu response and Pandemic Flu Action Plan. Ensuring ELHT is well prepared for the Flu season and has appropriate surge and resilience arrangements in place. Page 4
Roles and Responsibilities National The Department of Health is responsible for: Policy decisions on the response to the Flu season Holding NHS England and Public Health England to account through their respective framework agreements, the Mandate, and the Section 7A agreement. Oversight of the supply of antiviral medicines NHS England is responsible for: Commissioning the Flu vaccination programme under the terms of the Section 7A agreement. Assuring that the NHS is prepared for the forthcoming Flu season. Building close working relationships with Directors of Public Health to ensure that local population needs are understood and addressed by providers of flu vaccination services. Public Health England is responsible for: Planning and implementation of the national approach. Monitoring and reporting of key indicators related to flu, including flu activity and vaccine uptake. Oversight of vaccine supply and the strategic reserve. Advising NHS England on the commissioning of the flu vaccination programme. Supporting Directors of Public Health in local authorities in their role as local leaders of health and ensuring that they have all relevant expert input, surveillance and population data needed to carry out this role effectively. Local Local authorities via the Director of Public Health is responsible for: Providing appropriate challenge to local arrangements and advocacy with key stakeholders to ensure access to flu vaccination and to improve its uptake by eligible populations Providing independent scrutiny and challenge to the arrangements of NHS England, Public Health England and local authority employers of frontline social care staff and other providers of health and social care Providing leadership, together with local resilience partners to respond appropriately to local incidents and outbreaks of flu infection. Page 5
Clinical Commissioning Groups (CCGs) are responsible for: A duty of quality assurance and improvement which extends to primary medical care services delivered by GP practices including flu vaccination and antiviral medicines. GP practices and other providers are responsible for: Ordering the correct amount and type of vaccine for their eligible patients, taking into account year on year increases or new groups identified for vaccination and the ambition for uptake. Ensuring that all those eligible for the flu vaccine are invited personally to receive their vaccine. Encouraging and facilitating flu vaccination of their own staff. Ensuring that antiviral medicines are prescribed for appropriate patients, once the Chief Medical Officer letter has been distributed alerting them that antiviral medicines can be prescribed. Within ELHT Director of Operations is responsible for: Executive leadership and advice during the Seasonal Flu period. Emergency Preparedness Officer is responsible for: Acting as a point of contact for local and regional monitoring for seasonal Flu. Providing regular updates to the Emergency Preparedness group. Input into the review and development of the Seasonal Flu Programme. Communications Lead is responsible for: Ensuring all the National communications information is disseminated internally. Produce in conjunction with the Seasonal Flu Group a communications strategy for the Flu campaign and implement this throughout the Flu Season. Act as a contact point for media following requests regarding seasonal Flu information. Seasonal Flu Lead is responsible for: Co-ordinating, delivering, reporting on and reviewing the Flu plan. Page 6
Seasonal Flu Group are responsible for: Evaluating the previous Flu campaign and producing the action plan for the following year. Occupational Health & Well Being Team are responsible for: Delivering vaccinations to all ELHT employees. Provide advice to staff on Seasonal Flu. Divisional General Managers are responsible for: Divisional Leadership of the Flu Campaign by informing, encouraging and facilitating uptake of the vaccine. Ward Managers are responsible for: Ensuring all long stay patients who fall into the eligible groups for vaccination are educated regarding the risks and benefits of Flu and offered the vaccination during the patients stay. Infection Control Team are responsible for: Providing expert advice and guidance regarding infection control issues for both staff and patients. Page 7
Influenza (Flu) The Condition Influenza is an acute viral infection of the respiratory tract (nose, mouth, throat, Bronchial tubes and lungs. There are three types of Flu virus A, B and C. Types A and B are responsible for most clinical illness. Following infection Flu has an incubation period of one to three days. The disease is characterised by a sudden onset of fever, chills headache, muscle, joint pain and fatigue. Additional symptoms include: cough, sore throat, nasal congestion and diarrhoea. In the healthy population Flu is an unpleasant but usually self-limiting disease with recovery within 2 and 7 days. A small portion of infected people have very mild illness or no symptoms. However patients in vulnerable groups may become sick and the illness may be complicated by bronchitis or pneumonia either from the virus or secondary bacterial infection. The particular complication for children is Otisis Media. In some rare cases infection can cause cardiac problems, Meningitis or Encephalitis. The risk of serious illness from Flu is higher among children under 6 months of age, older people and people with underlying health condition such as respiratory disease, cardiac disease or immunosuppression as well as pregnant women. The genetic make-up of the Flu virus is unstable and new variations/strains often emerge. Minor viral changes occur from season to season with major changes occurring periodically resulting in the emergence of a new type of virus. This can result in epidemics or even pandemics as there is little or no resistance to the new virus. The World Health Organisation (WHO) monitors the changes in Flu viruses and recommends what strains need to be included in the seasonal flu vaccine. Infectivity Flu is passed from person to person through droplets via an infected person coughing or sneezing. Spread can also be via contact with surfaces where the virus has been deposited hence it can spread rapidly. Most cases of Flu in the United Kingdom tend to occur during an 8-10 week period during the winter. However the timing, extent and severity can vary and are unpredictable. Type A Flu is the predominant virus causing outbreaks most years and usually causes epidemics which occur intermittently. Page 8
At risk / Eligible Groups The Department of Health and Public Health England stipulate the eligible groups to be offered Flu vaccination nationally. The full list of eligible groups is detailed in Appendix 1. However this is not an exhaustive list and clinicians should apply their clinical judgement and refer to the revised Department of Health/ Public Health England- The Green Book, Immunisation against Infectious Diseases, Influenza chapter for further guidance. Patient and Staff Protection Patients Patients who fall into the at risk / eligible groups who are envisaged to remain as long stay patients (admitted for 4 weeks and have no imminent plans for discharge) should be offered the vaccine during their in-patient stay. It is the responsibility of the ward manager to ensure that the Flu vaccine is offered and administered to patients who fall into this category. Staff It is important that healthcare workers protect themselves by having the Flu vaccine, and in doing so, they reduce the risk of spreading Flu to their patients, clients, colleagues and family members. Vaccination of healthcare workers against Flu significantly lowers rates of flu-like illness, hospitalisation and mortality in older people in healthcare settings. Flu immunisation of healthcare workers is likely to reduce the transmission of infection to vulnerable patients who may have impaired immunity. Vaccination of healthcare workers also helps reduce the level of sickness absences and will contribute to keeping the organisation running. This is particularly important in the face of winter pressures. During the 2014/15 flu season the uptake of the Flu vaccine in healthcare workers nationally was 54.9%. Within ELHT the uptake was 80.1% during the 2014/15 season. Although this represents an increase in uptake over the last few seasons nationally and locally there is still room for further improvement. Page 9
Healthcare workers are a very influential group. Patients trust their nurses, doctors and other healthcare professionals and their opinions can affect the way patients act. A healthcare worker who opts to be vaccinated can talk from first-hand experience with patients and reassure them of the benefits of being vaccinated. Healthcare workers need to understand the benefits of the vaccine and dispel the myths that may have developed about the vaccine. A range of interventions will be employed to encourage an increase in uptake within the organisation throughout the Flu season. Senior clinical staff can be influential in increasing staff awareness and understanding of the importance of staff vaccination against Flu, and can lead by example to drive up rates of vaccination among frontline staff. Provision of the vaccine for staff ELHT understands its responsibilities to ensure, so far as is reasonably practicable, that health care workers are free of, and are protected from exposure to infections that can be caught at work, and that all staff are suitably educated in the prevention and control of infections. ELHT will ensure that occupational health policies and procedures in relation to the prevention and management of communicable diseases in healthcare workers, including immunisation, are in place. ELHT will make the Flu vaccine available free of charge to all employees. The flu vaccination given to healthcare staff has been documented to: Act as an adjunct to good infection prevention and control procedures. Reduces the risk to the patient/client of infection, Causes the reduction of Flu infection among staff, and reduced staff absenteeism. ELHT will use all forms of communication to ensure that health care staff are encouraged to be immunised and that processes are in place to facilitate this. Students, trainees and volunteers who are working with patients will also be included in the vaccination programme. Page 10
Annual Cycle of the Flu Programme The cycle for preparing for and responding to Flu is set out below: 1. November March: Vaccine orders placed with suppliers. 2. February: WHO announces the virus strains selected for the next season s Flu vaccine for the northern hemisphere. ELHT reflects upon lasts year s campaign & discusses lessons learnt. Draft action plan for current year s campaign written. 3. April May: Annual Flu Letter from the DH, NHS England, and PHE (previously referred to as the CMO Annual Flu Letter ) is sent to the NHS and local government setting out key information for the autumn s immunisation programme. 4. April June: Communications preparation- planning communications campaigns & checking updates in the Green book. 5. April June: Liaison with manufacturers to assure the availability of vaccine. 6. July: Letter from DH, NHS England, and PHE with any updates or final arrangements. Centrally produced communications materials made available and order placed by Occupational Health Team to NHS Employers. 7. July August: Publication of the revised influenza chapter of the Green Book. Medicines management and vaccination training updates for vaccination team. 8. August: Communications and guidance about vaccine uptake data collections issued. Seasonal Flu Plan updated. 9. September: communication activities to confirm the dates, times & venues of vaccination sessions & promotion of early uptake of the vaccine. 10. August March: DH in regular contact with manufacturers of antiviral medicines and wholesalers to ensure enough antiviral medicines in the supply chain. 11. September- February: Suppliers deliver vaccine and vaccination programme commences under the co-ordination of the Occupational Health and Well Being Team. Page 11
12. September: Weekly and monthly vaccination data collection begins and is widely communicated throughout the organisation. 13. October: From week 40 (early October) PHE publishes weekly reports on flu incidence, vaccine uptake, morbidity and mortality. 14. October February: The CPhO and CMO may issue advice on the use of antiviral medicines, based on advice from PHE in light of flu surveillance data. Antiviral medicines from the national pandemic flu stockpile may be made available. 15. October February: The NHS implements winter pressures coordination arrangements. 16. October February: A respiratory and hand hygiene campaign is communicated throughout the organisation. 17. March May: The CPhO and CMO may issue letter asking GPs and other prescribers to stop prescribing antiviral medicines, once PHE informs DH that surveillance data are indicating very little flu circulating in the community and other indicators such as the number of flu-related hospital admissions. Page 12
Flu Trajectory and Weekly Targets Week Date Week Number Projected Percentage % Target Oct 7-13 th 1 10% Oct 14-20 th 2 15% Oct 21-27 th 3 20% Oct 28-3 rd Nov 4 25% Nov 4-10 th 5 30% Nov 11-17 th 6 35% Nov 18-24 th 7 40% Nov 25-1 st Dec 8 45% Dec 2-8 th 9 50% Dec 9-15 th 10 55% Dec16-22 nd 11 60% Dec 23-29 th 12 65% Dec 30-5 th Jan 13 70% Jan 6-12 th 14 75% Jan 13-19 th 15 80% Jan 20-26 th 16 83% Jan 27-31 st 17 85% Actual % Target Achieved RAG Status Page 13
Appendix 1 Groups eligible for the Flu vaccination Flu vaccinations are currently offered free of charge to the following at-risk groups: People aged 65 years or over (including those becoming age 65 years by 31 March 2014). All pregnant women (including those women who become pregnant during the flu season). People with a serious medical condition such as: Chronic (long-term) respiratory disease, such as severe asthma, chronic obstructive pulmonary disease (COPD) or bronchitis, chronic heart disease, such as heart failure, chronic kidney disease at stage 3, 4 or 5, chronic liver disease, chronic neurological disease, such as Parkinson s disease or motor neurone disease, diabetes. A weakened immune system due to disease (such as HIV/AIDS) or treatment (such as cancer treatment). People living in long-stay residential care homes or other long-stay care facilities where rapid spread is likely to follow introduction of infection and cause high morbidity and mortality. This does not include, for instance, prisons, young offender institutions, or university halls of residence. People who are in receipt of a carer s allowance, or those who are the main carer of an older or disabled person whose welfare may be at risk if the carer falls ill. The list above is not exhaustive and decisions should be based on a practitioner s clinical judgement. Consideration should also be given to the vaccination of household contacts of immunocompromised individuals, specifically individuals who expect to share living accommodation on most days over the winter and therefore for whom continuing close contact is unavoidable. Also recommended to be vaccinated as part of occupational health: Health and social care workers with direct patient/client contact Healthcare practitioners should refer to the Green Book influenza chapter for further guidance. Page 14