Did You Take Your Medicine Did You Take Your Medicine? Influenza vaccination in hospitals: the San Diego Hospital Influenza Immunization Project Supported by CDC Grant #U01 IP000063-01. Contents are solely the responsibility of the authors and do not necessarily represent the official view of the Centers for Disease Control and Prevention

Goals and Objectives Goal: To increase influenza vaccination of hospital- based Health Care Workers and Physicians Objectives: Understand current systems Document coverage rates and knowledge, attitudes, and behavior (KAB) Implement interventions Perform cost-analysis Share best practices KAB = Knowledge, attitude

SDHIIP Study Background Two year grant funded by the CDC (9/05-9/07) Partnership involves 15 major San Diego county hospitals, County HHSA, I-3, CHIP, and the Hospital Association First year of study and data analysis complete Second year of study and data collection began in January 2007

2005-2006 SDHIIP Data Weekly report forms from hospitals Healthcare worker (HCW) surveys, Key Informant Interviews Random Digit Dialing Survey

Vaccine Delivery

Who is getting vaccinated? 2005-2006 HCW Survey Data Flu Vaccine Up-to-Date Job Category No Yes % MD 14.7 85.3 Nursing 30.5 69.5 Healthcare Support Services 32.3 67.7 Non-Healthcare Support Services 32.1 67.9 Administrative 25.3 74.7 Average 29.0 71.0

Source – 2005/2006 SDHIIP Survey Data

Influenza Vaccine Coverage Rates

HCW Influenza Vaccine Coverage None of our participating hospitals had verifiable coverage rate information Numerators inaccurate Immunizations given outside facility Vaccine given in multiple venues and in some cases ordered by different units Denominators inaccurate What is a healthcare worker? Traveling nurses, part-time employees, HCW’s that work in more than one facility, physicians difficult to quantify

Influenza Vaccine Coverage Rates SDHIIP Hospitals 2005-2006 Weekly Reports Survey Hospital A 44.0% 69.8% Hospital B 55.1% 74.0% Hospital C 40.0% 59.3% Hospital D 48.9% 73.4% Hospital E 11.7% 70.4% Overall 49.2% 70.9%

Coverage Rates: Hospital-based HCWs Random Digit Dialing Survey 2006 HCW contacted at home Total of 510 respondents 353 received flu vaccine within the past 12 months Coverage rate = 69.2%

The Rest of the Story

Hospital-based HCW RDD Survey results 2006 Ever received flu vaccine 85.9% For those who have never received vaccine, why not? Not in priority group/healthy 44.4% Vaccine side effects 19.4% Vaccine doesn’t work 13.9% Had to pay for vaccine 7.1% Received nasal vaccine 2.0% Offered nasal vaccine 8.2% Received vaccine at workplace 87.3%

Hospital-based HCW RDD Survey results 2006 Preferred nasal vaccine (21.1%) Dislike injections 63.7% Convenience 12.0% Fewer side effects 3.7% Vaccine more effective 0.9% Preferred injectable vaccine (47.7%) Used to it 63.4% Don’t know enough about nasal 12.9% Don’t like stuff in my nose 5.2%

Ideas for Improving Coverage Rolling carts LAIV days Bucket brigade Immunize at meetings Publicly vaccinate hospital leaders Make this a patient safety issue Improve promotion Implement a declination statement

SDHIIP – Year Two SDHIIP Partners met via monthly conference calls Data from 2005-2006 HCW surveys, Weekly reports, and Key Informant Interviews were analyzed Sub-group created to develop new strategies for 2006-2007 flu season Influenza Vaccination Planning Kit created and evaluated HCW surveys, Weekly Activity Reports, and Key Informant Interviews were revised Unit-based surveys were created and distributed January 29 – February 9, 2007 in 5 partner hospitals

SDHIIP Influenza Vaccination Planning Kit for Healthcare Workers

New JCAHO Standard Effective January 2007, in addition to offering influenza vaccinations organizations will also have to: Evaluate vaccination rates and reasons for non-participation in the organization's immunization program - Implement enhancements to the program to increase participation

SB 739* - July 2007 Offer annual onsite influenza vaccinations State Department of Health Services in California shall require that each general acute care hospital, in accordance with the Centers for Disease Control guidelines, take the following actions: Offer annual onsite influenza vaccinations Make vaccine available to all hospital employees at no cost to the employee Require its employees to be vaccinated Declare in writing that he or she has declined the vaccination if employee elects not to be vaccinated *Approved by Governor Schwarzenegger September 28,2006 Chapter 526:1288.7

LAIV

LAIV use in 2005-2006 Offered to only 8.2 % of HCW’s Hospitals reluctant to provide free LAIV Storage and handling concerns Infection control concerns Lack of familiarity, in both those administering and those receiving 32% of HCWs stated they do not know enough about LAIV to choose it over TIV

HCW who received LAIV in 2007 Age UTD in 2005-6 Not UTD 2005-6 N % 18-29 years 43 51.8 40 48.2 30-39 years 60 65.2 32 34.8 40-49 years 81 71.1* 33 28.9 *2.28 times more likely (p<.01, 95% CI 1.27, 4.12)

Conclusions San Diego hospitals need to continue to step up their efforts to immunize their staff through: Increased promotion Better tracking Offering options (LAIV/TIV) Implementing Declination Statements JCAHO is watching!

Acknowledgement Michelle Dzulynsky , Chrissy Hawley, Karina Gardea, Kathy Holcomb, Michelle DeGuire, Wendy Wang, Mike Peddecord, John Fontanesi, Kathe Gustafson, Adrienne Collins-Yancey, Mark Sawyer, Barbara Bardenheier (CDC Project Officer) San Diego Immunization Branch staff San Diego Acting Public Health Officer - Dr. Wilma Wooten San Diego Assistant Deputy Director – Carmel Angelo County of San Diego ● Health and Human Services Agency ● Public Health Services ● Immunization Branch

Project Contact Information SDHIIP Principal Investigator: Dr. Mark Sawyer mark.sawyer@sdcounty.ca.gov SDHIIP Project Coordinator: Michelle Dzulynsky michelle.dzulynsky@sdcounty.ca.gov SDHIIP Study Staff: Mark H. Sawyer, Michelle Dzulynsky, Michelle De Guire, Wendy Wang, Kathy Holcomb, Robert Vryheid, K. Michael Peddecord, Hajime Kamiya, John M. Fontanesi, Kathleen W. Gustafson, Christina Hawley, Karina Gardea, and Barbara H. Bardenheier