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

residence Land Auction 800 residents

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

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

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

Impact of Health Card Program on Hepatitis A Rates

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

Health Card

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

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

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

OSHA (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

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

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

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

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

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

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

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

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

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

What Comes to Vegas Does NOT Stay in Vegas Adele M. Solomon Southern Nevada Health District