Seasonal Influenza and Tdap Vaccination Policies in Michigan Hospitals: MDCH Hospital Survey, Fall 2011 Cristi Carlton, MPH Vaccine Preventable Disease Epidemiologist Division of Immunization Michigan Department of Community Health Michigan Epidemiology Conference March 30, 2012
Health Care Personnel (HCP) Vaccination HCP are at increased risk of being exposed to serious diseases HCP expose vulnerable, at risk patients to these diseases Nosocomial transmission of vaccine preventable diseases cause patient morbidity and mortality Vaccines provide safe and effective protection http://www.cdc.gov/mmwr/pdf/rr/rr6007.pdf
Influenza ( Flu ) Highly infectious viral illness Abrupt onset of fever, fatigue, sore throat, cough and headache Influenza contributes to more than 200,000 hospitalizations and 3,000 to 49,000 deaths annually in the US The annual influenza vaccine is the most effective prevention tool Recommended for all persons 6 months of age and older Annual influenza vaccination recommendation of HCP since 1984
Pertussis ( Whopping Cough ) Highly contagious respiratory infection caused by Bordetella pertussis Michigan: rates increased from 1.3 per 100,000 in 2000 to 7.0 per 100,000 people in 2011 Infants are at greatest risk for severe pertussis, including hospitalization and death Non specific cough in adolescents and adults a likely source for pediatric cases HCP recommended to receive a Tdap vaccination since 2005
HCP Vaccination Coverage Influenza Prior to 2009 10 flu season: below 45% 2010 11 flu season: 63.5% Healthy People 2020 Goal: 90% Tdap Only 20% of HCP aged less than 65 years old received a Tdap vaccine in the past 5 years http://www.cdc.gov/mmwr/pdf/wk/mm6032.pdf http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5940a3.htm
Mandatory Vaccination Policies Mandatory policies are effective in increasing HCP coverage to above 90% Voluntary policies typically result in ~60% coverage Numerous national organizations support mandatory policies February 2012 National Vaccine Advisory Committee (NVAC) published recommendations: Health care facilities that have not achieved and maintained 90% HCP coverage, regardless of their existing influenza vaccination program, should strongly consider an employer requirement for flu vaccination Specific to flu vaccination policies, however: Application could be useful in improving Tdap HCP vaccination levels
MDCH Vaccination Policy Survey of Michigan Hospitals Goals of the study: determine the prevalence of mandatory annual influenza and Tdap vaccination policies determine critical factors associated with implementing mandatory polices identify hospital barriers associated with not implementing mandatory policies provide implementation resources
Methods MDCH telephone survey August 16, 2011 through September 19, 2011 177 MI hospitals interviewed 79 part of a health care system 98 self governing (vaccination policy determined independently) Infection control coordinators or employee health managers asked to complete the 5 minute survey Multiple follow up phone calls with nonresponders to reach a 100% response rate
Prevalence of Influenza Policies 41% (73/177) had a mandatory flu vaccination policy for all employees 41% (30/73) allowed unvaccinated HCP to wear a mask during the influenza season in lieu of vaccination 51% of Michigan hospital staff affected by mandatory flu vaccination policies 2009 American Hospital Association Annual Survey data
Influenza Policies Factors & Barriers Mandatory policies more likely among hospitals in a health care system (72%, 57/79) than among hospitals with self governing policies (16%, 16/98) Critical factor that led to the policy Leadership support (56%) Pressure from professional groups (14%) Policy implementation barrier Staff resistance (24%) Labor union policies (21%)
Prevalence of Tdap Policies 11%(19/177) mandatory policy for all staff Additional 14% (25/177) mandatory policy for some staff New hires, high risk areas and direct patient care 12% of hospital staff in Michigan impacted by a policy for all staff Additional 25 hospitals, employing 53,188 workers had a policy for some staff'
Tdap Policies Factors & Barriers Mandatory policies for all staff more likely among hospitals that were part of a health care system (18%, 14/79) than among hospitals under selfgoverning policies (5%, 5/98) Critical factor that led to the policy Patient safety (42%) Leadership support (32%) Policy implementation barrier Policy hadn t been considered or discussed (29%)
Hospital Leaders Leadership is responsible for: Establishing expectation that vaccination of HCP is a patient safety issue Making sure vaccination program has adequate resources. Reducing or eliminating barriers Being a role model Active leadership participation found to be significantly associated with higher influenza vaccination rates CDC and The Joint Commission Improving Your Vaccination Program 2009 Talbot T.R., et al; Infect Control Hosp Epidemiol 31:456 462, May 2010
Overcoming Barriers Labor union barriers Ensure clear, consistent language Discuss with key partners prior to implementation hospital leaders, managers of labor relations, and union leaders Engage in and respect the collective bargaining process May need to consider including a clause for unvaccinated HCP to wear a mask during the influenza season
Overcoming Barriers Staff resistance Provide free vaccinations at convenient times Effective educational campaigns and resources Benefits of influenza vaccination Ethical and moral duty to protect vulnerable patients Unique to Tdap vaccination policies First step: discuss importance of implementation of policy
Resources MHA: sample policy, talking points, etc. http://www.mha.org/mha_app/public_site/flu_vacc.jsp. The Immunization Action Coalition Honor Roll for Patient Safety: example policy language, summary of policy statements, archive of peer reviewed journal articles http://www.immunize.org/honor roll/ Immunization Action Coalition of Washington s online toolkit: background documents, sample policies http://www.immunizewa.org/healthcare_toolkit
Conclusions Employers and HCP have a shared responsibility to prevent transmission of diseases HCP vaccination has been recommended for nearly 30 years for annual influenza vaccination and over 7 years for Tdap vaccination Vaccination rates have risen slowly without hospital mandates Increasing trend in mandatory vaccination policies Hospital leaders are critical to policy implementation Barriers for not implementing policies can be overcome
Acknowledgments Patricia A. Vranesich Dean Sienko Nancy Tate Aimee Ragsdale Bob Swanson Rachel Potter MDCH staff Partners at MHA