1. 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

2. 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

3. 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 8 th 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

4. 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

5. 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, peer- to-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.

6. 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)

7. 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

8. 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

9. 2012-13 IIC Awards *Awards based on Total Facility Immunization Rates: for staff in Acute Care, and for staff and residents in Long Term Care Award*Long Term CareAcute Care Gold (>90%)100 Silver (>80%)110 Bronze (>70%)41 Honourable Mention (10% absolute ↑) 02

10. Rates in Long-Term Care Facilities

11. Rates in Acute Care Facilities

12. Local Leadership and Successful Policy Innovations  Policy change in Simcoe Muskoka Acute Care facilities:  Majority now have policies with protective requirements for unimmunized staff during community-wide influenza activity (non-outbreak policy)  Policy change in Simcoe Muskoka LTC facilities:  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.)

13. 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/ http://www.chiin.ca/  SMDHU resources:  Influenza immunization challenge (specific to HCWs) Influenza immunization challenge Influenza immunization challenge  Influenza immunization (public clinics, general info, etc.) Influenza immunization Influenza immunization

14. Thank You and Good Luck! Comments / Questions ?