Presentation on theme: "Influenza Vaccination in Employees, California General Acute Care Hospitals 2008-2009 Tricia McLendon, MPH Healthcare Associated Infections Program California."— Presentation transcript:
Influenza Vaccination in Employees, California General Acute Care Hospitals 2008-2009 Tricia McLendon, MPH Healthcare Associated Infections Program California Department of Public Health May 27, 2010
Influenza Significant cause of morbidity and mortality each year –Elderly, young children and persons with underlying medical conditions Healthcare personnel (HCP) are an important source of transmission –High rate of asymptomatic infection in HCP –HCP work when ill Worker shortages, compensation and dedication Source: Pavia AT. Mandate to protect patients from health care-associated influenza. Clin Infect Dis: 2010; 50:465-7.
Influenza Vaccination Most effective strategy for influenza prevention is annual vaccination Effectiveness varies –Patient characteristics –Match between circulating and vaccine strains Modestly effective –Elderly, infants, immunocompromised Highly effective –Healthy younger adults (many HCP) Source: Pavia AT. Mandate to protect patients from health care-associated influenza. Clin Infect Dis: 2010; 50:465-7.
Influenza Vaccination among HCP Simple, safe and cost effective Recommended and endorsed by –CDC ACIP –SHEA –NFID Healthy People 2010 target: 60% Proposed Healthy People 2020 target: 90% National rates remain low (~40%) Source: Pavia AT. Mandate to protect patients from health care-associated influenza. Clin Infect Dis: 2010; 50:465-7.
Influenza Vaccination among HCP Three strategies to increase compliance in HCP –Education and free, easily accessible vaccine –Mandatory signed declination –Mandatory vaccination with refusal enforced by respiratory masks, reassignment or termination Source: Pavia AT. Mandate to protect patients from health care-associated influenza. Clin Infect Dis: 2010; 50:465-7.
California Influenza Vaccination and Reporting Mandate in Acute Care Hospitals September 2006 –Free vaccine to all employees –Mandatory signed declination –January 2008 – mandatory report vaccination and declination rates to CDPH –No CDPH program for implementation December 2009 –HAI program at CDPH established
Objectives Report influenza vaccination rates in California general acute care hospitals for the 2008-2009 season Provide preliminary findings and interpretation Share limitations of data Discuss next steps and recommendations
Methods Licensed California general acute care hospitals Passive surveillance submitted via fax or email September 1, 2008 - March 31, 2009 Three different data collection forms –Total number of employees and HCP –Vaccinations and declinations in each group –Employment status in each group –Calculated employee specific vaccination and declination rates
Methods Overall mean vaccination and declination rates –Proportion of all employees in California that were vaccinated Facility-specific calculations for employees –Mean vaccination and declination rates –Frequency of employees with unknown vaccination status
Definitions On report forms –Employee Collected primary paycheck from the reporting facility Examples: administrative, dietary, facilities management staff –HCP Mutually exclusive from employees Examples: physicians, nurses, therapists, EMS personnel, pharmacists, lab personnel, contractual staff –Outreach
Definitions Hospital demographics collected from other data sources –Bed size –Rurality –Patient population: Pediatric and Mixed –Teaching status
Methods Exclusions –HCP –Outreach –Facilities that rescinded their data Licenses –Single vs. consolidated Non-reporters –25% contacted to verify no report sent
California Demographics Population38.1 million Number acute care hospitals Single license Consolidated license 432 338 (78%) 97 (22%), 46 licenses Licensed beds ICU NICU 71,964 6313 (9%) 3606 (5%) Number of discharges (2008)3.7 million Average length of stay (LOS)4.3 days Estimated patient-days (discharges x LOS) 15.9 million
Results Preliminary data 98 (29%) did not report Contacted 26 (25%) to verify that no report was sent –11 had submitted a report
Response Rate: Single License 338 (78%) general acute care hospitals with a single license –240 (71%) submitted vaccination report 98 (41%) at or above Healthy People 2010 target of 60%
Consolidated Licenses 46 consolidated licenses had 97 facilities –29 influenza vaccination report forms 27 reports (licenses) representing 57 facilities Two from 2 different facilities under same license –CDPH received report forms from 59/97 facilities under a consolidated license –Remaining 38 facilities under 18 licenses sent no report Contacting all facilities with consolidated licenses
Lessons Learned Data still provide important information –71% single-license hospitals reported influenza vaccination data for 2008-2009 1 out of 4 hospitals are not meeting reporting mandate –55.6% employee vaccination rate Not at Healthy People 2010 target of 60% Low vaccination rate, but slightly higher than other published results
Limitations Self-report bias –Facilities did no quality control or assurance of data –Hospitals with low rates less likely to report –Hospitals with high rates more likely to report Data quality –Multiple forms with conflicting data –Consolidated licenses Data completeness –Low response rate (71%) –HCP inclusion
Limitations Misclassification bias –Employees, HCP, declinations –17% of employees with unknown status Vaccinated elsewhere Medical exemption Not vaccinated –More information is needed
Recommendations Standardize definitions and report forms Identify barriers to reporting Provide data to IP grant personnel in field Identify best practices and barriers to vaccination Sample a subset of facilities Recommendations on mandatory vaccination to improve compliance
Recommendations Electronic reporting –Improve accuracy, decrease data entry –Facilitate communication NHSN Role –Does not permit reporting of aggregate data –Data transfer to NHSN not available from third party employee health software –CDC interested in pilot testing aggregate reporting over next two years
Acknowledgements CDPH HAI Program Staff Field IPs Hospitals: IPs and Employee Health
Single v Consolidated Facilities Total # facilities 432 Consolidated 97 facilities 46 licenses Single 338 facilities No report: 38 facilities 18 licenses 98 no report240 reported 29 reports 2 reports: 2 facilities 1 license 27 reports: 57 facilities 27 licenses
Response Rate: Consolidated License 94 (22%) general acute care hospitals associated with a consolidated license –41 licenses –XX (XX%) submitted vaccination report –XX (XX%) did not report