# Presentation: 288072

## Prioritization of Healthcare Worker Vaccination  

- NVAC/ACIP Influenza Pandemic Planning Working Group
- June 15-16, 2005

## HCW Prioritization Subgroup Members

- James Bentley
- Carolyn Bridges
- Matt Cartter
- Victoria Davey
- Steve Gordon
- Debra Levy

- Kristin Nichol
- Peggy Rennels
- Patrician Simone
- LJ Tan
- Rick Zimmerman

## Data Sources for Population Estimates 

- Bureau of Labor Statistics
- American Hospital Association
- Professional societies
- Kindness of colleagugesges strangers

## Estimated Size of Healthcare Workforce

- Overall                         14.8 million
- Hospitals                       5.1 million
- Outpatient clinics          2.9 million
- Nursing homes             1.6 million*
- Home health                  734,000
- EMS providers               820,000

***Excludes residential care**

## Overarching Assumption

- To reduce all-cause morbidity and mortality by preserving the healthcare workforce and delivery of essential healthcare services

## Definition of HCW

- Any person who provides direct patient care _and_ those in healthcare settings who duties are needed to maintain essential healthcare services
- Acute-care hospitals, nursing homes*, skilled nursing facilities, urgent care centers, physician’s offices, clinics, home care and blood collection centers

***excludes not include assisted living facilities**

## Estimated Impact of  Pandemic on Healthcare Delivery System

- Illnesses: 20-47 million
- Hospitalizations:  314,000-734,000
- Outpatient visits:  18-42 million
- Deaths:  89,000-207,000

**Meltzer, MI EID 1999;5:659-71**

## Relationship Between Nurse Staffing and Health Outcomes 

- Lower nurse staffing ratios associated with:
- Longer hospital stays
- Higher rates of healthcare-associated infections
- Increased inpatient mortality

## Potential Impact of Pandemic in General Hospitals

|  | BASELINE | PANDEMIC
 | CHANGE |
| --- | --- | --- | --- |
| No. admissions | 34.9 M | 314-734K
 | +0.9%-2.1%
 |
| Outpt. visits | 618 M | 18-42M | +2.9%-6.8% |
| Occupancy (ADC/#beds) | 66% (556K/848K)  | 67%-100% | +1-34% |

**AHA Hospital Statistics, 2004 Edition**

## Potential Impact of Pandemic in General Hospitals

|  | BASELINE | PANDEMIC
 | CHANGE |
| --- | --- | --- | --- |
| Staffing | 1.3M | 975K | -25% (assume) |
| #Beds | 845K | 845K |  |
| Staff:bed ratio | 1.5:1
 | 1.2:1  | -33% |
| Staff:occ bed | 2.3:1 | 1.7:1 (67%)
1.2:1 (100%) | -26%
-50% |

**Staff include FTE physicians, RNs, LPNs, **
**dentists, medical and dental trainees**

## Potential Impact of Pandemic in General Hospitals

|  | BASELINE | PANDEMIC
 |
| --- | --- | --- |
| RNs | 1.0 M | 750K |
| LPNs | 139K | 104K |
| RN:occ bed | 1.8:1 | 1.3:1  (67%)
1.1:1 (100%) |
| LPN:occ bed
(% occupancy) | 1:4
 | 1:5    (67%)
1:8  (100%) |

**Assume 25% decrease in staff**

## Vaccination Strategies:  Option 1

- 	Vaccinate direct patient care staff (physicians and nurses)
- 	_Limitation_: Will not be able to maintain other essential services, such as housekeeping, dietary.

## Option 1:  Estimated Vaccine Doses

- Hospitals				1.9 million
- Nursing homes			769,240
- Home Health			487,620
- Outpatient			141,646
- EMS				820,000
**TOTAL****	****	****	****	****3,299,326**

## Vaccination Strategies:  Option 2

- 	Vaccinate “frontline” healthcare workers and those who provide care to (ED, ICUs, geriatric units, transplant units) and essential healthcare service workers
- 	_Limitation_: High-risk patient not geographically separated within the facility

## Vaccination Strategies:  Option 3

- 	Vaccinate “comprehensive” healthcare team* that would be comprised of workers across specialties to provide a range of services to ill patients (e.g, surgery, obstetrics, pediatrics, gen medical, etc) who could be cohorted or physically separated on “flu wards”
- 	_Limitation_: Would only be a potential strategy during early phase on pandemic when case load is low

***Include essential healthcare services staff**

## Vaccination Strategies:  Option 4

- 	Vaccinate direct patient care workers and a proportion of those needed to maintain essential healthcare services.  Leave some autonomy to local decision makers regarding allocation of vaccine within these groups.
- 	_Limitation_: May create chaos/confusion due to variability in prioritization

## Option 4:  Estimated Vaccine Doses

- Hospitals				3.7 million
- Nursing homes			1.1 million
- Home Health			531,000
- Outpatient			585,470
- EMS				820,000
**TOTAL****	****	****	****	****6,771,470**

**Includes Healthcare practitioners, Healthcare support, **
**management/ admin support/ maintenance**

## SUMMARY

- Depending strategy for prioritization HCW definition number of required doses 3-7 million
- Need to consider both qualitative and quantitative staffing resources
- Limitations to numbers (categories not mutually exclusive; sources vary)

## Supplemental Measures for Healthcare Facilities 

- Deferral of visitors
- Cancellation of elective procedures and admissions
- Furlough of nonessential workers??

## Outstanding Issues 

- How do we integrate vaccine strategy with antiviral medication strategy?
- Should nursing homes be considered/handled differently than other healthcare facilities?
- What is rate of absenteeism among healthcare workforce?
- How do we deliver vaccine non-hospital based HCWs?