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Prioritization of Healthcare Worker Vaccination NVAC/ACIP Influenza Pandemic Planning Working Group June 15-16, 2005 James Bentley Carolyn Bridges Matt Cartter Victoria Davey Steve Gordon Debra Levy Kristin Nichol Peggy Rennels Patrician Simone LJ Tan Rick Zimmerman

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Prioritization of Healthcare Worker Vaccination

NVAC/ACIP Influenza Pandemic Planning Working Group

June 15-16, 2005


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James Bentley

Carolyn Bridges

Matt Cartter

Victoria Davey

Steve Gordon

Debra Levy

Kristin Nichol

Peggy Rennels

Patrician Simone

LJ Tan

Rick Zimmerman

HCW Prioritization Subgroup Members


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Data Sources for Population Estimates

  • Bureau of Labor Statistics

  • American Hospital Association

  • Professional societies

  • Kindness of colleagugesges strangers


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Estimated Size of Healthcare Workforce

  • Overall 14.8 million

  • Hospitals 5.1 million

  • Outpatient clinics 2.9 million

  • Nursing homes 1.6 million*

  • Home health 734,000

  • EMS providers 820,000

*Excludes residential care


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Overarching Assumption

  • To reduce all-cause morbidity and mortality by preserving the healthcare workforce and delivery of essential healthcare services


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Definition of HCW

  • Any person who provides direct patient care and those in healthcare settings who duties are needed to maintain essential healthcare services

  • Acute-care hospitals, nursing homes*, skilled nursing facilities, urgent care centers, physician’s offices, clinics, home care and blood collection centers

*excludes not include assisted living facilities


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Estimated Impact of Pandemic on Healthcare Delivery System

  • Illnesses: 20-47 million

  • Hospitalizations: 314,000-734,000

  • Outpatient visits: 18-42 million

  • Deaths: 89,000-207,000

Meltzer, MI EID 1999;5:659-71


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Relationship Between Nurse Staffing and Health Outcomes

  • Lower nurse staffing ratios associated with:

    • Longer hospital stays

    • Higher rates of healthcare-associated infections

    • Increased inpatient mortality


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Potential Impact of Pandemic in General Hospitals

AHA Hospital Statistics, 2004 Edition


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Potential Impact of Pandemic in General Hospitals

Staff include FTE physicians, RNs, LPNs,

dentists, medical and dental trainees



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Vaccination Strategies: Option 1

Vaccinate direct patient care staff (physicians and nurses)

Limitation: Will not be able to maintain other essential services, such as housekeeping, dietary.


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Option 1: Estimated Vaccine Doses

  • Hospitals 1.9 million

  • Nursing homes 769,240

  • Home Health 487,620

  • Outpatient 141,646

  • EMS 820,000

  • TOTAL 3,299,326


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Vaccination Strategies: Option 2

Vaccinate “frontline” healthcare workers and those who provide care to (ED, ICUs, geriatric units, transplant units) and essential healthcare service workers

Limitation: High-risk patient not geographically separated within the facility


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Vaccination Strategies: Option 3

Vaccinate “comprehensive” healthcare team* that would be comprised of workers across specialties to provide a range of services to ill patients (e.g, surgery, obstetrics, pediatrics, gen medical, etc) who could be cohorted or physically separated on “flu wards”

Limitation: Would only be a potential strategy during early phase on pandemic when case load is low

*Include essential healthcare services staff


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Vaccination Strategies: Option 4

Vaccinate direct patient care workers and a proportion of those needed to maintain essential healthcare services. Leave some autonomy to local decision makers regarding allocation of vaccine within these groups.

Limitation: May create chaos/confusion due to variability in prioritization


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Option 4: Estimated Vaccine Doses

  • Hospitals 3.7 million

  • Nursing homes 1.1 million

  • Home Health 531,000

  • Outpatient 585,470

  • EMS 820,000

  • TOTAL 6,771,470

Includes Healthcare practitioners, Healthcare support,

management/ admin support/ maintenance


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SUMMARY

  • Depending strategy for prioritization HCW definition number of required doses 3-7 million

  • Need to consider both qualitative and quantitative staffing resources

  • Limitations to numbers (categories not mutually exclusive; sources vary)


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Supplemental Measures for Healthcare Facilities

  • Deferral of visitors

  • Cancellation of elective procedures and admissions

  • Furlough of nonessential workers??


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Outstanding Issues

  • How do we integrate vaccine strategy with antiviral medication strategy?

  • Should nursing homes be considered/handled differently than other healthcare facilities?

  • What is rate of absenteeism among healthcare workforce?

  • How do we deliver vaccine non-hospital based HCWs?


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