Immunizations: Who, What , When and Why

1. Immunizations: Who, What , When and Why

2. Objectives • Discuss the Network 6 goals for Immunizations and how they relate to the Conditions for Coverage and Healthy People 2020 • Demonstrate the use of the Health Belief Model to promote acceptance of immunization in the hemodialysis patient population • Describe Best Practices for Increasing Immunizations in the dialysis setting and practical application.

3. Healthy People 2020 • Healthy People is a set of goals and objectives with 10 year targets designed to guide national health promotion and disease prevention efforts to improve the health of ALL people in the United States • Network 6 MRB uses these set goals and objectives to drive the Immunization Initiative • www.healthypeople.gov/2020

4. Network 6 Goals for Immunizations WHO should be vaccinated • Goals based on Healthy People 2020 goals • Influenza – 90% eligible patients vaccinated • Pneumococcal – 90% eligible patients vaccinated • Hepatitis B – 90% eligible patients vaccinated • New focus – Healthcare workers vaccinated – goal 80% eligible workers vaccinated

5. Conditions for Coverage – Interpretative Guidelines WHY Vaccinate? The right thing to do and….. • V 506: Immunization History and Medication History • “Immunization history” should include whether the patient has received standard immunizations (pneumococcal, hepatitis, and influenza), and has been screened for tuberculosis. The immunization record is expected to include at least the patient’s immunization history as of the effective date of this regulation. • The Centers for Disease Control and Prevention (CDC) recommends that all dialysis patients: • Be offered influenza and pneumococcal vaccine and have immunization histories for these vaccines be tracked. Both are universally recommended for this population and relate directly to infection control issues.

6. Conditions for Coverage – Interpretative Guidelines WHY Vaccinate? The right thing to do and….. • V 637: (ix) Infection control; with respect to this component the facility must— • (A) Analyze and document the incidence of infection to identify trends and establish baseline information on infection incidence; • (B) Develop recommendations and action plans to minimize infection transmission, promote immunization; and • (C) Take actions to reduce future incidents. • Surveillance information available for review should include, but not be limited to, patients’ vaccination status (hepatitis B, pneumococcal pneumonia, and influenza vaccines); viral hepatitis serologies and seroconversions for HBV(and HCV and ALT, if known); bacteremia episodes; pyrogenic reactions; vascular access infections; and vascular access loss due to infection.

7. Current Data - Influenza Still not at Network 6 goal of 90% - WHY 16.9% Increase over 12 years From 2011-2012, 5,102 more Network 6 ESRD patients received the Influenza Immunization

8. Current Data - Pneumococcal Still not at Network 6 goal of 90% - WHY 37.9% increase over 3 years (note: first time collected in 2009) From 2011-2012, 3,221 more Network 6 ESRD patients received the Pneumococcal Immunization

9. Current Data – Hepatitis B Still not at Network 6 goal of 90% - WHY 25.6%% increase over 3 years (note: first time collected in 2009) From 2011-2012, 621 more Network 6 ESRD patients received the Hepatitis B Immunization

10. Healthcare Workers From National Influenza Vaccine Summit: Vaccination of health-care workers (HCWs) has been shown to reduce influenza infection and absenteeism among HCWs, prevent mortality in their patients, and result in financial savings to sponsoring health institutions. Influenza vaccination coverage among HCWs in the United States, however, remains low. Another Who that should be vaccinated! From the CDC: Because of their contact with patients or infective material from patients, many healthcare workers (HCWs) (e.g., physicians, nurses, emergency medical personnel, dental professionals and students, medical and nursing students, laboratory technicians, hospital volunteers, and administrative staff) are at risk for exposure to and possible transmission of vaccine-preventable diseases. Maintenance of immunity is therefore an essential part of prevention for HCWs.

11. Network 6 Staff Influenza Vaccination Rates • 2012 First Year collected data on Staff Rates • MRB goal – 90% of staff vaccinated against influenza • 35% of Network 6 facilities below 40% vaccinated • 99 facilities (17.3%) met the 90% goal

12. Increasing Our Rates HOW Angela Adams – Utilizing the Health Belief Model to Assess Attitudes and Beliefs of Hemodialysis Patients Regarding the Seasonal Influenza, Pneumococcal and Hepatitis B Vaccines

13. 48.8% 93.0% Network Success Stories • Dedicated person at the facility to track immunizations • Follow up with patients that refuse • Follow up with new patients • Educational Focus on Immunizations • and dispelling the “MYTHS” • Incorporated standing orders for • immunizations HOW

14. 52.6% 88.0% Network Success Stories • Dedicated immunization manager • Second round follow up by Physician or PA to all refusals • Fun focus on immunizations with immunization day and games HOW

15. 18.0% 86.9% Network Success Stories • Vaccine day • Used resources from Network and Immunization Action Coalition website • Reminder systems in place (mailed to house) • Reminder system for staff • Physician discussed during rounding HOW

16. 0.0% 92% Network Success Stories • Ordered the vaccine in a timely manner • Reminder systems in place (computer generated) • Physician discussed with patients and in-service to staff HOW

17. Staff Vaccination • CDC recommends annual influenza immunization for ALL Health Care Workers • Overall Network 6 rate – 57.7% (Season 2011-12) • Good news we are above the average • Bad news our patients are still at risk!

18. HOW

20. Questions