Stop The Flu

At Your Office DoorGaurov Dayal, MD

Janet G. McNichol, SPHR, CAEAmanda Morgan, RN, BSN, MBA

www.LifeWorkStrategies.com An Affiliate of Adventist Healthcare

• Talking Points • Lessons learned in 2009• Considerations for the upcoming 2010 Flu

season• Clinical issues related to the 2010 Flu and

Vaccine• Signs and symptoms for the flu• Issues for management and the organization

The Panelists• Gaurov Dayal, MD

Vice President and Chief Medical OfficerAdventist HealthCare and LifeWork Strategies

• Janet G. McNichol, SPHR, CAEHuman Resources DirectorAmerican Speech-Language-Hearing Association

• Amanda Morgan, RN, BSN, MBADirector, Occupational Health Human Resources DepartmentAdventist HealthCare, Inc

• 2009• First influenza pandemic in more than 40 years• Businesses greatly affected• Businesses discussed policies and continuity of

operation procedures

• Vaccine Match, Effectiveness and Safety • >99% of 2009 H1N1 viruses well matched to the

vaccine strain• Preliminary estimates of effectiveness coming to

light• Generally in range expected with good match

• No safety concerns• Similar patterns to seasonal influenza vaccine

Estimated number and proportion of deaths in persons <65 years of age in the United States for seasonal and pandemic influenza*

Pandemic/season Total Estimated Deaths*

% deaths <65 years*

1918 H1N1 Pandemic (b) 546,000 99%*

1957-58 H2N2 Pandemic (b) 66,000 36%

1968-69 H3N2 Pandemic (b) 36,400 48%

1976-2003 Seasonal (c) 22,461 11%

2009-10 H1N1 Pandemic (d) 12,470 87%

aThe methods of estimating influenza deaths between pandemics and for seasonal influenza varied considerably. Estimates are not directly comparable, but are included to illustrate the wide range in potential impact by age group.bEstimated excess pneumonia and influenza deaths attributed to influenza. [32]cEstimated excess respiratory and circulatory deaths attributed to influenza.[33]dEstimated 2009 pandemic H1N1 influenza attributable deaths.[25][26] Available at: http://www.cdc.gov/h1n1flu/estimates_2009_h1n1.htm

• Adventist Healthcare - Lessons Learned in 2009• System Integration Flu Program - 17 locations

• Communication Flow based on most current CDC Guide

• Vaccine procurement and promotion by each location

• Vaccine administration 24/7 (clinics, fairs, appointments)

• Vaccine data entry into employee data base for tracking, trending and reporting

• Flu vaccine rates weekly leader report to all entities.

ASHA

http://insideworkplacewellness.blogspot.com/2010/08/staffing-continuity-flu-shots-and.html

• Why is Getting Vaccinated Annually important? • 5% to 20% of the population get the flu;• More than 200,000 people are hospitalized from

seasonal flu complications, including 20,000 children; and

• About 23,600 people die from seasonal flu.• This number increases if H3N2 circulates that

year.• The vaccine is effective!

• 2010 Flu Vaccine• Only one vaccine this year, not two• First year: all 6 months and older recommended for

annual vaccination• This summer, all 3 strains identified in US &

Internationally

• Vaccine strains:• A/California/7/2009-like H1N1

• Same strain as 2009 monovalent vaccine

• A/Perth/16/2009-like H3N2• New H3N2 strain for Northern

Hemisphere• B/Brisbane/60/2008

• Was in 2009-10 seasonal vaccine

• Rationale: Recommendation to vaccinate all people ages 6 months or older (simply stated)• Annual influenza vaccination is a safe and effective

prevention measure that provides a potential benefit for people in all age groups

• Morbidity and mortality occurs in all age groups, including among adults aged 19-49

• Some persons who have influenza complications • have no previously identified risk factors,• have risk factors but are unaware that they should be

vaccinated, or• might be at risk due to newly identified risk factors, such

as morbid obesity or race/ethnicity

• What sort of flu season is expected this year?• 160-165 million vaccines • Vaccine to be distributed now through October• A good match of vaccine to influenza strains• Continued spread of H1N1 and seasonal flu

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Prevalence, Novel H1N1 Deaths

Prevalence, General US Pop

Prevalence, Hospitalized H1N1 Patients

Underlying conditions among hospitalized patients and those who died from H1N1 compared to the general

population

• Obesity a New Risk Factor for Severe Illness due to 2009 H1N1? • Disproportionate number of obese, particularly morbidly

obese, among severely ill during 2009 H1N1 pandemic• Morbid obesity (BMI≥40) was associated with

hospitalization, and possibly death, due to 2009 H1N1 infection among adults without chronic medical conditions

• Additional studies with larger samples of patients and appropriate comparison groups are needed

Morgan OW, et al. PLOS ONE, 2010

• 2010 flu season impact on businesses – The focus during 2010 & beyond for

healthcare organizations is to increase HCW vaccination rate to 90% or greater• The Joint Commission, CDC and OSHA are in

favor of mandatory vaccinations• Internal Impact on resources to achieve rate• External Impact (Public perception & public record

of patient safety)

– Businesses can have a better effect duringthe 2010 flu season by implementing the CDC three pronged strategy for flu prevention • Making Flu vaccines available for all employees• Educating about frequent hand washing and CDC

etiquette of covering a cough with a tissue or elbow.• Schedule Flexibility –can stay home when ill with

the flu

• fever * • cough • sore throat • runny or stuffy

nose • body aches

• headache • chills • fatigue • sometimes

diarrhea and vomiting

You may have the flu if you have some or all of these symptoms:

*It’s important to note that not everyone with flu will have a fever.

• What to do if symptoms develop• Discuss Antiviral drugs with your physician

(preferred first 24-48 hours)• Get hydrated• Rest (stay home and prevent the spread)• If you have a fever, use fever reducing Agents

• When will flu activity begin and when will it peak?• The timing of flu is very unpredictable and can

vary from season to season. Flu activity most commonly peaks in the U.S. in January or February. However, seasonal flu activity can occur as late as May.

• Flu Prevention Plan • A written document/policy outlining a consistent

process• Addresses System position on employee & HCWs

vaccination (vaccine or declination)• Addresses flu prevention responsibility based on role• 24/7 vaccination availability & contact information for

after hours• Flu vaccine & declination data entry for trending &

reporting

• Employers play a role in allaying employees fears/misconceptions about the flu vaccine by:• Providing frequent education based on frequently

asked questions - visit CDC website for most recent info http://www.cdc.gov/flu/about/qa/1011season.htm)

• Using e-mail blast, posters, flyers, print media to communicate/educate & promote the vaccine

• Using employee newsletter as flu media• Unit specific education/clarify flu misconceptions

• Keep communication simple, consistent and to the point • Employees will notice inconsistencies and will

question them.• Have a point person to answer employee

questions if the manager cannot answer.• Listen to employees, answer their questions and

engage them in the process, because their opinions are valuable.

• Provide your managers with flu talking points

• Organizational Considerations • Sick employees should stay home.• Keep employee information confidential• Encourage your employees to wash their hands

often, cover their coughs and sneezes.• Clean surfaces and items that are more likely to

have frequent hand contact.• Encourage employees to get vaccinated.

• Organizational Considerations• Have a plan for the event that an increased

number of employees become absent due to employee flu illness or their family members. Plan to maintain essential business functions

• Advise employees before traveling to take certain steps or to follow-up with their physician prior to traveling abroad.

• Organizational Considerations• Prepare for the possibility of school dismissals or

temporary closure of child care programs.• If an epidemic, consider active screening of

employees who report to work. • Consider alternative work environments for

employees at higher risk for complications of flu during periods of increased flu activity in the community.

• Case Studies • An employee calls in sick to his manager…• An employee shows up to work and appears

symptomatic of influenza…• Influenza has become wide-spread, several

employees are symptomatic, and a major work deadline is approaching…

• Increasing participation in flu prevention programs:• Communication strategies• Long-term, trusting relationship with provider• Invite family members to participate

Implication for Comprehensive Wellness Efforts

People in all communities should be able to make healthy choices, but in order to make those choices there must be healthy choices to make. We need to change our communities into places where healthy eating and active living are the easiest path. ~ Dr. William Dietz

• Health challenges– Diabetes– Obesity– Cardiac issues

• And More…

• Wellness efforts– Fitness– Nutrition– Awareness

• Screenings• Education

• What other resources might be helpful to workplaces as they prepare to protect their employees this flu season?

www.flu.gov

www.cdc.gov

www.HelpStopTheFlu.com• http://www.cdc.gov/flu/freeresources/vis.htm

• In Summary:– Take time to get vaccinated (be a role model)– Take everyday preventive actions (wash

hands/sanitize frequently) cover your cough)– Prepare your workplace….

• Flu Communication to all employees• Have a point person to answer employee questions

or concerns• Educate…educate…use CDC resources and FAQ’s

• Access the CDC Flu VIS of 08/10/10 at- http://www.cdc.gov/vaccines/pubs/vis/default.htm#flu

For more information on the flu vaccine or to

schedule a clinic please call

Cyndi Fales

301-315-3655