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 HCW Prioritization Subgroup Members
Data Sources for Population Estimates • Bureau of Labor Statistics • American Hospital Association • Professional societies • Kindness of colleagugesges strangers
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
Overarching Assumption • To reduce all-cause morbidity and mortality by preserving the healthcare workforce and delivery of essential healthcare services
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
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
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
Potential Impact of Pandemic in General Hospitals AHA Hospital Statistics, 2004 Edition
Potential Impact of Pandemic in General Hospitals Staff include FTE physicians, RNs, LPNs, dentists, medical and dental trainees
Potential Impact of Pandemic in General Hospitals Assume 25% decrease in staff
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.
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
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
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
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
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
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)
Supplemental Measures for Healthcare Facilities • Deferral of visitors • Cancellation of elective procedures and admissions • Furlough of nonessential workers??
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?