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Influenza Vaccination of Health-care Personnel:

An Initiative to Improve a Serious Public Health Problem

Anand Parekh, MD, MPHOffice of Public Health and Science

Department of Health and Human Services

September 10, 2008

Influenza Vaccination of Health-care Personnel:

An Initiative to Improve a Serious Public Health Problem

Anand Parekh, MD, MPHOffice of Public Health and Science

Department of Health and Human Services

September 10, 2008

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Major PointsMajor Points

• Influenza causes frequent and serious illnesses in the United States

• Influenza vaccine is underutilized, including by health care personnel

• There are proven, recommended strategies available to improve vaccination rates

• HHS has begun an initiative to reach the Healthy People 2010 objective for health care personnel of 60% vaccination

• Influenza causes frequent and serious illnesses in the United States

• Influenza vaccine is underutilized, including by health care personnel

• There are proven, recommended strategies available to improve vaccination rates

• HHS has begun an initiative to reach the Healthy People 2010 objective for health care personnel of 60% vaccination

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Influenza Vaccination of Health-care Personnel

Influenza Vaccination of Health-care Personnel

• Only 42 percent of U.S. health-care personnel were vaccinated in 2006

• Only 42 percent of U.S. health-care personnel were vaccinated in 2006

MMWR 2006;55 (RR-2). February 24, 2006.MMWR 2006;55 (RR-2). February 24, 2006.

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Common Themes*Common Themes*

• Reasons for accepting influenza vaccination

– Protect self

– Protect patients

– Convenience

– Peer influence

– Prior experience

• Reasons for accepting influenza vaccination

– Protect self

– Protect patients

– Convenience

– Peer influence

– Prior experience

• Reasons for rejecting influenza vaccination

– Concerns about vaccine safety or efficacy

– Not at risk (healthy immune system)

– Lack of understanding of transmission of influenza

– Fear of needles

– Not convenient

• Reasons for rejecting influenza vaccination

– Concerns about vaccine safety or efficacy

– Not at risk (healthy immune system)

– Lack of understanding of transmission of influenza

– Fear of needles

– Not convenient

*Hofman F, Ferracin C, Marsh G, Dumas R. Infection 2005;34:142-147

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Cover of MMWR RecommendationsCover of MMWR Recommendations

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HICPAC/ACIP Recommendations HICPAC/ACIP Recommendations

• Offer influenza vaccine annually

• Educate HCP regarding the benefits of influenza vaccination and the potential health consequences of influenza illness

• Provide influenza vaccination to HCP at the work site and at no cost

• Monitor HCP influenza vaccination coverage and declination; provide feedback to staff and administration

• Obtain a signed declination from HCP who decline influenza vaccination

• Use the level of HCP influenza vaccination coverage as one measure of a patient safety quality program

• Offer influenza vaccine annually

• Educate HCP regarding the benefits of influenza vaccination and the potential health consequences of influenza illness

• Provide influenza vaccination to HCP at the work site and at no cost

• Monitor HCP influenza vaccination coverage and declination; provide feedback to staff and administration

• Obtain a signed declination from HCP who decline influenza vaccination

• Use the level of HCP influenza vaccination coverage as one measure of a patient safety quality program

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• American College of Physicians (ACP)3

– October 2007 - Recommendation that annual influenza vaccine should be required for every health care worker with direct patient care activities.

• Infectious Diseases Society of America  (IDSA)2

– January 2007- Recommendation that U.S. adopt policy to include mandatory annual influenza vaccination among healthcare workers

• Joint Commission on Accreditation of Healthcare Organizations (JCAHO)1 – New standard, effective 1/1/07: Influenza immunization offered to staff

and licensed independent practitioners.

• National Foundation for Infectious Diseases (NFID)4

– Call to Action recommendations and Best Practices for immunizing health care personnel against influenza

• American College of Physicians (ACP)3

– October 2007 - Recommendation that annual influenza vaccine should be required for every health care worker with direct patient care activities.

• Infectious Diseases Society of America  (IDSA)2

– January 2007- Recommendation that U.S. adopt policy to include mandatory annual influenza vaccination among healthcare workers

• Joint Commission on Accreditation of Healthcare Organizations (JCAHO)1 – New standard, effective 1/1/07: Influenza immunization offered to staff

and licensed independent practitioners.

• National Foundation for Infectious Diseases (NFID)4

– Call to Action recommendations and Best Practices for immunizing health care personnel against influenza

1http://www.jcrinc.com/26813/newsletters/12882/, accessed 11/11/07; 2Pandemic and Seasonal Influenza Principles for U.S. Action, January 2007; 3http://www.acponline.org/college/pressroom/hcw.htm, accessed 11/13/07;

4http://www.nfid.org, accessed 05/15/08.

Support from Professional GroupsSupport from Professional Groups

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Strategies for Improving HCP Vaccination Rates

Strategies for Improving HCP Vaccination Rates

• Successful HCP vaccination programs are multifaceted and combine:

–Education campaigns

–Role models

–Improved access

–Measurement and feedback

• Successful HCP vaccination programs are multifaceted and combine:

–Education campaigns

–Role models

–Improved access

–Measurement and feedback

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HHS Initiative for Influenza Vaccination of Health Care Personnel: Components

HHS Initiative for Influenza Vaccination of Health Care Personnel: Components

• Two components– Improving HHS health care employee

influenza vaccination, with focus onFederal Occupational HealthIndian Health ServiceU.S. Public Health Service Commissioned

Officers NIH Clinical CenterCDC

– Promoting influenza vaccination to non-federal health care organizations and HCP

• Two components– Improving HHS health care employee

influenza vaccination, with focus onFederal Occupational HealthIndian Health ServiceU.S. Public Health Service Commissioned

Officers NIH Clinical CenterCDC

– Promoting influenza vaccination to non-federal health care organizations and HCP

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HHS Initiative for Influenza Vaccination of Health Care Personnel: HHS EmployeesHHS Initiative for Influenza Vaccination of Health Care Personnel: HHS Employees

• Three focus areas– Developing office and agency specific

strategies to improve HCP vaccination levels

– Measuring employee vaccination rates

– Disseminating a toolkit containingStandard presentationRelevant articlesPostersFact sheets, questions and answersVaccine information statementsLinks to other resourcesToolkit will be available on HHS OPHS website

• Three focus areas– Developing office and agency specific

strategies to improve HCP vaccination levels

– Measuring employee vaccination rates

– Disseminating a toolkit containingStandard presentationRelevant articlesPostersFact sheets, questions and answersVaccine information statementsLinks to other resourcesToolkit will be available on HHS OPHS website

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HHS Initiative for Influenza Vaccination of Health Care Personnel: Outreach

HHS Initiative for Influenza Vaccination of Health Care Personnel: Outreach

Potential Partners include:

• American Academy of Family Physicians

• American Academy of Pediatrics

• American College of Obstetricians and Gynecologists

• American College of Occupational and Environmental Medicine

• American College of Physicians

• American Hospital Association

• American Medical Association

• American Nurses Association

• American Society of Health-System Pharmacists

• Association for Professionals in Infection Control and Epidemiology, Inc.

• National Black Nurses Association• National Hispanic Nurses Association• National Foundation for Infectious Diseases• National Influenza Vaccine Summit• National Medical Association• National Hispanic Medical Association

• National Medical Association

• AFL-CIO

• AFSCME

• SEIU

Potential Partners include:

• American Academy of Family Physicians

• American Academy of Pediatrics

• American College of Obstetricians and Gynecologists

• American College of Occupational and Environmental Medicine

• American College of Physicians

• American Hospital Association

• American Medical Association

• American Nurses Association

• American Society of Health-System Pharmacists

• Association for Professionals in Infection Control and Epidemiology, Inc.

• National Black Nurses Association• National Hispanic Nurses Association• National Foundation for Infectious Diseases• National Influenza Vaccine Summit• National Medical Association• National Hispanic Medical Association

• National Medical Association

• AFL-CIO

• AFSCME

• SEIU

HHS will also promote Influenza Vaccination of Health Care Personnel (HCP) nationwide

Healthy People 2010 target: 60% of all HHS HCP will be vaccinated annuallyBy 2010

HHS plans to partner with many other organizations to promote HCP influenza vaccination

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External PartnersExternal Partners

• Target specific HCP groups in initial phase

• Identify critical partners based on impact and access – narrower scope

• Meetings scheduled with the various groups– Long term care

– HCP unions

– Health professions’ schools’ representatives

– Multiple organizations Sept 10, 2008

• Target specific HCP groups in initial phase

• Identify critical partners based on impact and access – narrower scope

• Meetings scheduled with the various groups– Long term care

– HCP unions

– Health professions’ schools’ representatives

– Multiple organizations Sept 10, 2008

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HHS Strategies for Assistance to Partners

HHS Strategies for Assistance to Partners

• ASH will offer to co-sign letters to membership of interested HCP organizations

• HHS staff are available to either present at upcoming national or regional association meetings or to identify other potential briefers

• Write articles for organization newsletters and/or journals

• Promote use of HHS toolkit

• ASH will offer to co-sign letters to membership of interested HCP organizations

• HHS staff are available to either present at upcoming national or regional association meetings or to identify other potential briefers

• Write articles for organization newsletters and/or journals

• Promote use of HHS toolkit

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HHS ToolkitHHS Toolkit

http://www.hhs.gov/ophs/programs/initiatives/vacctoolkit/index.html