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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! 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