# Presentation: 763283

## Influenza Vaccination of Health-care Personnel:An Initiative to Improve a Serious Public Health ProblemAnand Parekh, MD, MPHOffice of Public Health and ScienceDepartment of Health and Human ServicesSeptember 10, 2008

## Major 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 Vaccination of Health-care Personnel

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

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

## Common Themes*

- 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

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

**Notes:**
From a literature review by Hofman and colleagues, we know common themes for accepting the vaccine are... (read)

Common themes for rejecting the vaccine include ... (read)

## Cover of MMWR Recommendations

**Cover of MMWR Recommendations**

**Notes:**
This slide reminds us that CDC’s Advisory Committee on Immunization Practices and Healthcare Infection Control Practices Advisory Committee issued specific recommendations on influenza vaccination of health care personnel in 2006.

## 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

**Notes:**
ACIP- Advisory Committee on Immunization Practices
HICPAC – Healthcare Infection Control Practices Advisory Committee

## 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

- 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

**1**_[http://www.jcrinc.com/26813/newsletters/12882/](http://www.jcrinc.com/26813/newsletters/12882/)__, accessed 11/11/07;                   _**2****Pandemic and Seasonal Influenza Principles for U.S. Action, January 2007;       ****3**_[http://www.acponline.org/college/pressroom/hcw.htm](http://www.acponline.org/college/pressroom/hcw.htm)__, accessed 11/13/07;_
**4****http://www.nfid.org, accessed 05/15/08.**

**Support from Professional Groups**

**Notes:**
A number of professional groups have also support strategies to improve HCP vaccination rates.
For example, the ACP made a recommendation in Oct 2007 that . . . 

IDSA’s Pandemic and Seasonal Influenza Principles for the US, published in January 2007, include a recommendation that . . .

JCAHO’s infection control standard, which became effective 1/1/07 is a requirement for accreditation.  This standard includes elements of performance:   
- Annual influenza vaccination program that includes at least staff and licensed independent practitioners. 
- Access to influenza vaccination on-site.
- Educate staff and licensed independent practitioners about the following: 
Flu vaccination 
Non-vaccine control measures (such as the use of appropriate precautions) 
The diagnosis, transmission, and potential impact of influenza

- Evaluate annually vaccination rates and reasons for non-participation in the organization’s immunization program, and  
- Implement enhancements to the program to increase participation. 

Finally, the National Foundation for Infectious Diseases has had a Call to Action program for several years, urging influenza vaccination of health care personnel, which they recently updated, and have added a list of best practices for such vaccination programs.

## Strategies for Improving HCP Vaccination Rates

- Successful HCP vaccination programs are multifaceted and combine:
- Education campaigns
- Role models
- Improved access
- Measurement and feedback

**Notes:**
Successful strategies include ... (read bullets) 

Combinations of strategies work best.  

CDC’s Task Force on Community Preventive Services is currently reviewing factors influencing successful influenza workplace vaccination.

## HHS Initiative for Influenza Vaccination of Health Care Personnel:  Components

**Two components**
**Improving HHS health care employee influenza vaccination, with focus on**
**Federal Occupational Health**
**Indian Health Service**
**U.S. Public Health Service Commissioned Officers **
**NIH Clinical Center**
**CDC**
**Promoting influenza vaccination to non-federal health care organizations and HCP**

**Notes:**
The Department has begun an initiative to improve health care personnel vaccination through 2010:
Internally with HHS HCP, particularly at Federal Occupational Health, the Indian Health Service, U.S. Public Health Service Commissioned Officers, the NIH Clinical Center, and CDC.  

In addition, we are planning outreach to the non-federal community of health care personnel.

## HHS 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 containing**
**Standard presentation**
**Relevant articles**
**Posters**
**Fact sheets, questions and answers**
**Vaccine information statements**
**Links to other resources**
**Toolkit will be available on HHS OPHS website**

**Notes:**
The internal HHS influenza vaccination effort has three focus areas:  1) developing at least two specific office and agency strategies to improve vaccination levels, 2) measuring employee vaccination rates, and 3) disseminating a toolkit, that will include a standard slide presentation, relevant articles, CDC posters, fact sheets and  questions and answers about influenza vaccine effectiveness and safety, and links to other web-based resources.  The toolkit should be available on an HHS website in the near future. 

## 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**

**HHS will also promote Influenza Vaccination of Health Care Personnel (HCP) nationwide**
**Healthy People 2010 target:  60% of all HHS HCP will be vaccinated annually**
**By 2010**
**HHS plans to partner with many other organizations to promote HCP influenza vaccination **

**Notes:**
The second component of this HHS initiative is outreach to organizations such as the National Influenza Vaccine Summit, and the member organizations you all represent.  We really want to achieve the Healthy People 60% vaccination objective by the year 2010. 

## External 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**** **

## 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**

## HHS Toolkit

- _[http://www.hhs.gov/ophs/programs/initiatives/vacctoolkit/index.html](http://www.hhs.gov/ophs/programs/initiatives/vacctoolkit/index.html)_

**Notes:**
Screen capture of the Toolkit home page, which has received over 5,500 views since it went live in mid-July.