1. Using Federal and Local Health Mandates to Develop Sustainable Workplace Immunization Programs in Southern Nevada Presented by: Adele M. Solomon Southern Nevada Health District A. Solomon RN, S. Sanders RN, V. Morata-Nichols RN

2. 1904-1905 1 residence Land Auction 800 residents

3. 1960’s 400,000 residents SNHD Established NRS for Food Handlers Health Cards with TB Testing 800 Food Establishments

4. 1990’s OSHA Blood Borne Pathogen Standard National Hepatitis A Outbreaks NV Hepatitis A on the rise Health Cards give hepatitis A vaccination 1 million residents

5. 2007: What (HAV/HBV) Comes to Vegas Does NOT Stay in Vegas 1.9 million residents (50,000 undocumented) 39 million visitors Hepatitis A decrease 500,000 at risk people Hepatitis B Hepatitis B vaccination Program Created

6. Impact of Health Card Program on Hepatitis A Rates

7. Health Cards Logistics Available through 6 Public Health clinics No appointments Cost $50 per card, includes Hepatitis A vaccine – Vouchers through non-profits – Mandatory food handling movie – Additional doses with renewal – Immunization history entered into local and state registries Photo id Health cards renewed every 2 years

8. Health Card

9. Health Cards Enforcement SNHD Environmental Health – 69 inspectors w/ 15,848 facilities – Check compliance annually and randomly – Part of annual health inspection grade – Cannot pursue legal recourse unless “downgraded” Police Department Lends Additional Enforcement – Can fine owners and employees (up to $500) – Investigate fraud and counterfeit

10. Enforcement Issues – Counterfeit – Non-compliance (Uncooperative, Expired) – In-house job transfers Resolutions – Centralized database – Auto-lock, by employer – Super compliance, by employer

11. Building on Health Card Program Successes HC program now includes: – Barbers – Body art – Massage Identified unmet workplace vaccination need for HBV OSHA regulation 1910.1030 for BBP

12. OSHA 1910.1030 (b) Target Areas – National – Local OSHA Specific Requirements for BBP – Written BBP program with classes – Medically trained personnel – Vaccines or signed rescindable declinations – Timeliness of vaccination – Record Keeping

13. Workplace Vaccination Program Social Marketing Theoretical Framework Target Populations: – Employers – Employees Primary strategy: Direct consumer education Key messages to: – Employers: OSHA Compliance, economic benefits – Employees: Health, economic benefits

14. Reaching Employers Product: – Offering hepatitis B vaccine is the law – Save money due to decreased loss time injuries Price: – Barrier: Unaware of need Cost (vaccines can be greater than OSHA Penalties) Record keeping – Benefit: Pass OSHA, no fines Save money in decreased loss time injuries

15. Reaching Employers Promotion: – Mailings – Telephone and 1:1communication – Presentations – Partnerships Place: – At worksite – At SNHD – At various association locations

16. Reaching Employees Product (Health & Vaccine): – “You” are at risk for Hepatitis B – Vaccine protects “you” from Hepatitis B Price: – Barrier: Unaware of risk and need Low knowledge of HAV and HBV differences No access to vaccine (cost, time) – Benefit: Reduce “your” risk vaccinate Vaccine is free

17. Reaching Employees Promotion: – Capitalize on OSHA requirements – Q and As at classes – Supply employers with educational materials – Vaccinated clients “spread the word” Place: – Worksite: clinics and BBP classes – SNHD

18. Cost Recovery Contract sent Possible site fee Appointments made Letter of authorization Monthly billing Spread sheet of employees’ vaccination history

19. Percent Compliant with OSHA Regulations by Industry (n=25)(n=76)(n=97) (n=133) (n=18)

20. Lessons and Future Plans Mandates Help Tremendously Health Cards/ counterfeit – Change imbedded codes – Sting operations – Education classes – “No vax”

21. Mandates excellent basis Hepatitis B vaccines – Liaisons – Competition – Centralized documentation – “offered vs. required” – Increase awareness – Non Targeted Industries – Unions – Other Vaccines Lessons and Future Plans

22. What Comes to Vegas Does NOT Stay in Vegas Adele M. Solomon Southern Nevada Health District wpv@snhdmail.org 702-759-0784