1. Vaccination for Healthcare Workers: Measures to Reduce Transmission Vaccination for Healthcare Workers: Measures to Reduce Transmission Patricia Kurtz Director of Federal Relations The Joint Commission on the Accreditation of Healthcare Organizations National Vaccine Advisory Committee Meeting September 27, 2006

2. Background/Overview Epidemiologic evidence has linked healthcare- associated transmission of influenza to unvaccinated healthcare workers Typically, about one-third of healthcare workers are vaccinated annually CDC has recommended annual influenza vaccination for healthcare workers since 1981 HICPAC, ACIP, NFID, SHEA and APIC recommend and support annual influenza vaccination for healthcare workers Vaccination Standards

3. New Standard New standard IC.4.15 “Immunization against influenza is offered to staff and licensed independent practitioners” Applies to Critical Access Hospitals, Hospitals and Long Term Care facilities Effective January 1, 2007 Vaccination Standards

4. New Standard EPs 1 – 3 can be scored in 2007 EP1: organization has a plan to vaccinate staff and licensed independent practitioners (does not apply to students) EP2: organization provides access to vaccination on-site EP3: education of staff & licensed independent practitioners about: vaccination; non-vaccine control measures; and diagnosis, transmission and impact of influenza Vaccination Standards

5. New Standard EPs 4 – 5 won’t be applicable until 2008 EP4: organization annually evaluates vaccination rates and reasons for non-participation EP5: organization implements enhancements to program to increase participation Vaccination Standards

6. Surveyors will address compliance during: - Surveyor planning session – initial tracer selection - Individual tracer, when applicable - System tracer for Infection Control - Issue resolution – if no evidence of program, RFI Vaccination Standards

7. Declination issue: individual healthcare workers will not be tracked IC.4.15 EP4 links to performance improvement (standard PI.3.10)

8. New Elements of Performance Standard MM.3.20 “Medication orders are written clearly and transcribed accurately.” – New elements of performance (EP 14, EP 15) Appropriate staff, other than physicians, as permitted by law, regulation and policy are allowed and encouraged to administer influenza and pneumococcal polysaccharide vaccines without a physician order The addition of EP 14 & EP 15 synchronizes Joint Commission requirements with those of CMS. (CAH: Corresponds to COP 485.635(a)(3)(v)) Vaccination Standards

9. New Elements of Performance Best practices, external and internal data, and medication risks are considered when the organization develops medication policies and procedures To reinforce the skills and judgments needed for safe medication ordering, the organization offers education to care providers Vaccination Standards

10. New Elements of Performance  EP 14 applies to AHC, CAH, HAP and LTC (Note: applicable only to organizations where medications are ordered, dispensed, or administered)  EP 15 applies to OME (Note: applicable only to organizations where medications are ordered, dispensed, or administered) Vaccination Standards

11. New Elements of Performance Effective July 1, 2007 EP 14: influenza and pneumococcal polysaccharide vaccines are administered with physician order or according to physician-approved, organization-specific protocol EP 15: influenza and pneumococcal polysaccharide vaccines are administered according to physician order or according to approved protocol developed in consultation with a physician Vaccination Standards

12. Surveyors will address compliance during: - Surveyor planning session – initial tracer selection - Individual tracer, when applicable (October through March for influenza, year-round for pneumococcal) - System tracer for Medication Management - Issue resolution – if no evidence of orders or protocol, RFI Vaccination Standards

13.  Issue of screening links to performance improvement (standard PI.3.10) Vaccination Standards