Download Influenza Immunization for Health Care Workers Dr. Lisa Simon

Influenza Immunization for Health Care Workers
Dr. Lisa Simon, Associate Medical Officer of Health
Colleen Nisbet, Director, Clinical Service
September 9, 2013 – NSM CSS Collaborative
Outline
1.
Burden of influenza
2.
Influenza immunization for health care workers (HCWs):
rationale and effective strategies
3.
SMDHU’s internal and regional approach
4.
Getting started with a formal initiative
Burden of Influenza

Estimated 10-20% of population becomes infected with
influenza each year

Rates of serious illness and death are highest in
persons > 65 yrs, <2 yrs, and those with underlying
medical conditions

Ontario: Influenza 8th most burdensome infectious
agent, estimated 270 - 3200 attributed deaths annually

2012-13 influenza season unusually severe: SM had
429 lab-confirmed cases, 34 facility outbreaks
Influenza Immunization for HCWs:
Rationale

↓ risk of influenza transmission to patients, especially:
can’t be vaccinated (infants, contraindications)
 sub-optimal immune response (e.g. age, immunocompromise)
 risks of transmission with asymptomatic/mild influenza


Protect HCW within institution / organization / family /
community

Maintain essential health / healthcare services +
continuity of operations

Modelling vaccination behaviour for broader community
Slide acknowledgement: Drs. Doug Sider and Gary Garber, PHO
Influenza Immunization for HCWs:
Effective Strategies
Components of influenza vaccination campaigns to improve
uptake of influenza vaccine by health care personnel:

Education or promotion

Improved access to vaccine (eg. Mobile vaccine carts, peerto-peer vaccination, additional or extended vaccine clinics)

Legislation or regulation (eg. Staff vaccination policy,
mandatory vaccination programs, declination forms)

Measurement and feedback (eg. Regular monitoring of
vaccination coverage rates, reporting of coverage rates to
administrators and health care personnel)

Role models (eg. Vaccination advocates and champions,
public support from leaders, visible vaccination of senior staff)
Pearson ML, Bridges CB, Harper SA; Healthcare Infection Control Practices Advisory Committee (HICPAC);
Advisory Committee on Immunization Practices (ACIP). Influenza vaccination of health-care personnel:
recommendations of the healthcare infection control practices advisory committee (HICPAC) and the Ad visory
Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2006;55(RR-2):1-16.
Influenza Immunization for HCWs:
Condition of employment

Multiple organizations now recommend influenza
vaccination as condition of employment for HCWs, as/if
other approaches don’t achieve adequate rates, e.g.:




National Advisory Committee on Immunization (recurrent)
Provincial Infectious Disease Advisory Committee (2012)
Canadian Nurses’ Association (2012)
Association of Medical Microbiology and Infectious
Disease Canada (2012)
SMDHU: Our Experience

Have implemented aspects of all 5 effective strategies

Since 2007 – Staff Influenza Immunization Policy:
“All staff are required to get their annual influenza vaccination”

Prior to Nov 30 of every year, documentation of vaccination
status is required:



1) Proof of immunization, or
2) Medical exemption, or
3) Refusal of influenza immunization

Exclusion of non-immunized staff during community-wide
influenza activity, unless on prophylaxis

Staff immunization rates 90-95% each year
Simcoe Muskoka Influenza
Immunization Challenge (IIC):
2010 to Present
Goals:
 To enhance staff and resident / patient influenza
immunization rates in acute and long-term care (in order
to protect all of the above).
 To provide public recognition for facilities that achieve
high (or greatly improved) immunization rates.
Approach:
 Public recognition for achieving target immunization
rates
 Peer supports re: best practices – ‘positive deviance’
Supported by LHIN Leadership Council at Oct. 13, 2010
presentation by Dr Gardner and Dr Tanuseputro
2012-13 IIC Awards
Award*
Long Term Care Acute Care
Gold (>90%)
10
0
Silver (>80%)
11
0
Bronze (>70%)
4
1
Honourable
Mention (10%
absolute ↑)
0
2
*Awards based on Total Facility Immunization Rates: for staff in Acute
Care, and for staff and residents in Long Term Care
Rates in Long-Term Care Facilities
Rates in Acute Care Facilities
Local Leadership and Successful
Policy Innovations

Policy change in Simcoe Muskoka Acute Care facilities:


Policy change in Simcoe Muskoka LTC facilities:


Majority now have policies with protective requirements for
unimmunized staff during community-wide influenza
activity (non-outbreak policy)
At least 3 facilities now require staff influenza immunization
as condition of employment, and others are considering
Other key factors:



Support of leadership for staff influenza immunization
Determination of IPC/OH&S managers and staff
Multiple strategies employed (education, access, etc.)
Starting a formal initiative for CSS
organizations or sector

Greatest success achieved with a planned initiative

"Successful Healthcare Personnel Influenza Immunization
Programs: A Guide for Program Planners“:
 5 Steps to Planning an Effective Immunization Program,
from establishing program team through to evaluation
 Includes 5 effective strategies previously discussed
 Includes guidance for calculating immunization rates
 Associated tools, and Ottawa Influenza Decision Aid for
discussing influenza immunization with staff
 http://www.chiin.ca/

SMDHU resources:


Influenza immunization challenge (specific to HCWs)
Influenza immunization (public clinics, general info, etc.)
Thank You and Good Luck!
Comments / Questions ?