Download - Immunizations: Who, What , When and Why
Immunizations: Who, What ,
When and Why
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.
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
Network 6 Goals for Immunizations
• 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
WH
O sh
ould
be
vac
cina
ted
Conditions for Coverage –
Interpretative Guidelines • 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.
WH
Y V
acci
nate
? T
he ri
ght t
hing
to
do
and…
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Conditions for Coverage –
Interpretative Guidelines • 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.
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acci
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to
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and…
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Current Data - Influenza
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 20120.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Network 6 Influenza Immunization Rate by Year2000-2012
Perc
ent o
f Pati
ents
Vac
cina
ted
16.9% Increase over 12 years
From 2011-2012, 5,102 more Network 6 ESRD patients received the Influenza Immunization
Stil
l not
at
Net
wor
k 6
goal
of
90%
- W
HY
Current Data - Pneumococcal
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
Stil
l not
at
Net
wor
k 6
goal
of
90%
- W
HY
2009 2010 2011 20120.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Pneumococcal Immunization Rate by Year 2009 - 2012
Perc
ent o
f Pati
ents
Vac
cina
ted
Current Data – Hepatitis B
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
Stil
l not
at
Net
wor
k 6
goal
of
90%
- W
HY
2009 2010 2011 20120.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Hepatitis B Immunization Rate by Year 2009-2012
Perc
ent o
f Pati
ents
Vac
cina
ted
Healthcare Workers A
noth
er W
ho
that
sho
uld
be
vacc
inat
ed!
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.
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.
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
0.0%10.0%20.0%30.0%40.0%50.0%60.0%70.0%80.0%90.0%
100.0%
Percent of Staff Receiving Influenza Immunization474 Facilities0% - 89.5%
169 facilities be-low 40%
Increasing Our Rates
Angela Adams – Utilizing the Health Belief Model to Assess Attitudes and Beliefs of Hemodialysis Patients Regarding the Seasonal Influenza, Pneumococcal and Hepatitis B VaccinesH
OW
Network Success Stories
HO
W Dedicated person at the facility to
track immunizationsFollow up with patients that refuseFollow up with new patients
Educational Focus on Immunizations
and dispelling the “MYTHS” Incorporated standing orders for immunizations
48.8% 93.0%
Network Success Stories
HO
W Dedicated immunization manager Second round follow up by Physician
or PA to all refusals Fun focus on immunizations with
immunization day and games
52.6% 88.0%
Network Success Stories
HO
W 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
18.0% 86.9%
Network Success Stories
HO
W Ordered the vaccine in a timely
manner Reminder systems in place (computer
generated) Physician discussed with patients and
in-service to staff
0.0% 92%
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!
HO
W
Questions