1. 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 IP Contents are solely the responsibility of the authors and do not necessarily represent the official view of the Centers for Disease Control and Prevention

2. 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

3. 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

4. 2005-2006 SDHIIP Data Weekly report forms from hospitals
Healthcare worker (HCW) surveys,
Key Informant Interviews
Random Digit Dialing Survey

5. Vaccine Delivery

8. 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

9. Source – 2005/2006 SDHIIP Survey Data

10. Influenza Vaccine Coverage Rates

11. 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

12. 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%

13. 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%

14. The Rest of the Story

15. 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%

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

17. 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

18. SDHIIP – Year Two SDHIIP Partners met via monthly conference calls
Data from HCW surveys, Weekly reports, and Key Informant Interviews were analyzed
Sub-group created to develop new strategies for 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

19. SDHIIP Influenza Vaccination Planning Kit for Healthcare Workers

21. 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

22. 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

23. LAIV

24. 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

25. HCW who received LAIV in 2007
Age
UTD in
Not UTD 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)

26. 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!

27. 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

28. Project Contact Information
SDHIIP Principal Investigator: Dr. Mark Sawyer
SDHIIP Project Coordinator: Michelle Dzulynsky
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