Local Jurisdiction’s Health Officer Order Mandating Influenza Vaccination of Healthcare Personnel in Los Angeles County: Preliminary Findings Dawn Terashita, MD, MPH Acute Communicable Disease Control Los Angeles County Department of Public Health Allison Bearden, MD, MPH University of Southern California LAC+USC Medical Center 1
Morbidity and Mortality • Influenza: 6 th leading cause of death among US adults – Accounts for 23,000 deaths • 200,000+ annual hospitalizations for respiratory and heart conditions illnesses associated with seasonal influenza virus infections 2
Recent data supporting HCP vaccination • Presented at 41 st annual conference of APIC this summer • An analysis of 2009-2012 CDPH data • Purpose: To determine relationship between vaccinating HCP against influenza and rate of influenza-like illness in surrounding community
Study Conclusion • Conclusion: – For every 15 healthcare providers who receive the influenza vaccination, 1 fewer persons in the community will contract an influenza-like illness – For the 2011-2012 influenza season, the influenza vaccination rate of California hospital HCP was 68% • If 90% of California’s healthcare personnel were vaccinated---Healthy People 2020 initiative goal-- there would be approximately 30,000 fewer cases of influenza-like illness in California 4
Hospital-Onset Influenza • Data used from hospitals were part of Influenza Hospitalization Surveillance Network (FluSurv- NET) – Network conducting population-based surveillance in 16 states • 6,171 influenza-positive hospitalizations – 172 (2.8%) were defined as hospital-onset (>3 days after admit) Source M.A. Jhung et al. AJIC 42(2014)7-11
Study Conclusion • Hospital-onset cases had greater length of stay and were more likely to be admitted to the intensive care unit or die compared with community-onset cases Source M.A. Jhung et al. AJIC 42(2014)7-11 6
Supporting Rationale • Unvaccinated HCP can transmit flu to other HCP and patients – Up to 25% of HCP infected with flu each season • HCP more likely to work when ill than other professions • Asymptomatic HCP can spread influenza unknowingly 7
Benefits of Immunized Workforce • Reduced absenteeism • Increased productivity • Effective in reducing influenza among HCP and patients • Decreased morbidity and mortality among patients 8
Study Objectives To evaluate the impact of the 2013 DPH Order on: 1. HCP vaccination rates 2. Patient safety – Incidence of nosocomial influenza 3. Worker absenteeism
Study Basics • Included in the study are the 94 acute care facilities in LAC (excluding Pasadena and Long Beach) – 2 seasons pre-order, 1 season post-order • The study involves: – Review of mandatory reported HCP vaccination data – Direct laboratory influenza testing results – Survey data from IPs – Data from HR directors / staff on employee sick leave
HCP Vaccination Rates • Using California DPH mandatory HCP vaccination reporting data • Look for impact of order – Expect increase in rates overall – Expect greatest increase in those facilities who did NOT previously practice mandatory masking (or other consequences) for those who declined vaccine
HCP Absenteeism • Data from Human Resources / Admin – Number of sick days per total employees • Challenge – Who to contact for this information? – We have enlisted your help – You all received an email asking that you please : 1. Identify correct person in HR or other admin office (payroll, etc.) who can report # of sick days for hospital employees 2. Forward the email to that correct person
Survey Snapshot • Web-based (Qualtrics) • Includes: – nosocomial flu surveillance, definitions, and lab diagnostic method(s) – data on nosocomial influenza cases from • 2013-2014 • 2012-2013 • 2011-2012 – Details on each case • Sex, age, symptoms, patient location, etc. – HCP vaccination policies at your facility – Implementation of the DPH 2013 order
IP Line Lists • Asked to provide line list of cases identified as nosocomial / hospital-onset influenza • Provides details and characterization of cases 16
Preliminary Results • 29 IP surveys completed • 14 IP line lists completed of cases identified as nosocomial / hospital-onset influenza • 13 Lab Director line lists completed of positive flu test obtained > 72 hours from admit • 16 Absenteeism forms completed • 8 Facilities have completed all study components 17
Descriptive Statistics • Among facilities with a completed IP survey – 8 (of 29) are teaching facilities IP Surveys completed by Facility Size 16 14 Number of facilities 12 10 8 No. of facilities 6 4 2 0 Small facilities (1-100 beds) Medium facilities (101-350 Large facilities (351 and > beds) beds) 18
IP Line List Descriptive Statistics Variable N % No. of Reported Nosocomial Flu 55 Cases Age (mean) 65.04 Gender (female) 25 45.4 Hospitalization location General Ward 38 69.1 Intensive Care Unit 5 9.1 Respiratory Unit 3 5.4 Definitive Observation Unit 3 5.4 Pediatric Unit 2 3.6 Rehabilitation Unit 1 1.8 Critical Care Unit 2 3.6 Post partum 1 1.8 Nosocomial Cases in 2011-12 1 1.8 Nosocomial Cases in 2012-13 33 60.0 Nosocomial Cases in 2013-14 21 38.2 19
Employee Absenteeism Includes facility employees and staff, without distinguishing HCP Influenza Season Average missed days per employee* 2011-2012 3.9 2012-2013 5.2 2013-2014 1.0 *Includes facilities with complete numerator and denominator data †(n=14) 20
Healthcare Personnel Vaccination/ Masking Rates Influenza Season % of employees % of employees % of employees vaccinated who declined with an unknown vaccination vaccination status 2011-2012 69.4 25.6 5.6 2012-2013 75.9 24.8 3.6 2013-2014 87.2 9.5 2.7 †(n=29) 21
Implementation of the Health Officer Order • On a scale of 0-5: – 22 participants reported an average value of 2.77 (moderate difficulty relative to overall ease of implementation) – 23 participants reported an average value of 3.09 (fairly well accepted relative to overall HCP acceptance of the Health Officer Order) – 2.94 (among nurse practitioners) and 2.90 (among other employees with patient contact) moderate resistance relative to the amount of resistance encountered from HCP 22
Highlights • Variability in surveillance definitions across facilities – >48 hours – 72 + hours – No timing reported • Approximately half of respondents (45%) indicated obtaining additional vaccine for HCP following the order; Vaccine successfully obtained by all respondents 23
Limitations • Absenteeism reported differently across facilities – May include vacation time – May include employees without direct patient contact • Limited responses and incomplete data hinder robust analysis • Inherent variability between flu seasons creates challenges in analysis 24
Timeline • This month – Receive follow up emails and phone calls to obtain project components – IPs are asked to please identify and forward to correct HR person to assist with sick leave data • Send contact information to Jessica Silvaggio (jsilvaggio@ph.lacounty.gov) • Fall 2014 – Present findings at local APIC chapters, conference calls, highlights, and conferences
Thank you!
Questions Study Contacts: Allison Bearden, MD/ MPH Study Coordinator 626-457-5820 Email: abearden@dhs.lacounty.gov Jessica Silvaggio, MPH Study Co-coordinator 213-240-7941 Email: jsilvaggio@ph.lacounty.gov Dawn Terashita, MD/ MPH Medical Epidemiologist 213-240-7941 Email: dterashita@ph.lacounty.gov Patricia Marquez, MPH Epidemiologist 213-240-7941 Email: pmarquez@ph.lacounty.gov 27
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