Los Angeles County: Preliminary Findings Dawn Terashita, MD, MPH - - PowerPoint PPT Presentation

1

Local Jurisdiction’s Health Officer Order Mandating Influenza Vaccination of Healthcare Personnel in Los Angeles County: Preliminary Findings

Dawn Terashita, MD, MPH Acute Communicable Disease Control Los Angeles County Department of Public Health Allison Bearden, MD, MPH University of Southern California LAC+USC Medical Center

2

Morbidity and Mortality

• Influenza: 6th leading cause of death

among US adults

– Accounts for 23,000 deaths

• 200,000+ annual hospitalizations for

respiratory and heart conditions illnesses associated with seasonal influenza virus infections

Recent data supporting HCP vaccination

• Presented at 41st annual conference of

APIC this summer

• An analysis of 2009-2012 CDPH data
• Purpose: To determine relationship

between vaccinating HCP against influenza and rate of influenza-like illness in surrounding community

Study Conclusion

• Conclusion:

– For every 15 healthcare providers who receive the influenza vaccination, 1 fewer persons in the community will contract an influenza-like illness – For the 2011-2012 influenza season, the influenza vaccination rate of California hospital HCP was 68%

• If 90% of California’s healthcare personnel were

vaccinated---Healthy People 2020 initiative goal-- there would be approximately 30,000 fewer cases

• f influenza-like illness in California

4

Hospital-Onset Influenza

• Data used from hospitals were part of Influenza

Hospitalization Surveillance Network (FluSurv- NET)

– Network conducting population-based surveillance in 16 states

• 6,171 influenza-positive hospitalizations

– 172 (2.8%) were defined as hospital-onset (>3 days after admit)

Source M.A. Jhung et al. AJIC 42(2014)7-11

Study Conclusion

• Hospital-onset cases had greater length of

stay and were more likely to be admitted to the intensive care unit or die compared with community-onset cases

Source M.A. Jhung et al. AJIC 42(2014)7-11

6

7

Supporting Rationale

• Unvaccinated HCP can transmit flu to
• ther HCP and patients

– Up to 25% of HCP infected with flu each season

• HCP more likely to work when ill than
• ther professions
• Asymptomatic HCP can spread influenza

unknowingly

8

Benefits of Immunized Workforce

• Reduced absenteeism
• Increased productivity
• Effective in reducing influenza among

HCP and patients

• Decreased morbidity and mortality among

patients

Study Objectives

To evaluate the impact of the 2013 DPH Order

• n:
• 1. HCP vaccination rates
• 2. Patient safety

– Incidence of nosocomial influenza

• 3. Worker absenteeism

Study Basics

• Included in the study are the 94 acute care

facilities in LAC (excluding Pasadena and Long Beach)

– 2 seasons pre-order, 1 season post-order

• The study involves:

– Review of mandatory reported HCP vaccination data – Direct laboratory influenza testing results – Survey data from IPs – Data from HR directors / staff on employee sick leave

HCP Vaccination Rates

• Using California DPH mandatory HCP

vaccination reporting data

• Look for impact of order

– Expect increase in rates overall – Expect greatest increase in those facilities who did NOT previously practice mandatory masking (or other consequences) for those who declined vaccine

HCP Absenteeism

• Data from Human Resources / Admin

– Number of sick days per total employees

• Challenge

– Who to contact for this information? – We have enlisted your help – You all received an email asking that you please:

• 1. Identify correct person in HR or other admin
• ffice (payroll, etc.) who can report # of sick days

for hospital employees

• 2. Forward the email to that correct person

Survey Snapshot

• Web-based (Qualtrics)
• Includes:

– nosocomial flu surveillance, definitions, and lab diagnostic method(s) – data on nosocomial influenza cases from

• 2013-2014
• 2012-2013
• 2011-2012

– Details on each case

• Sex, age, symptoms, patient location, etc.

– HCP vaccination policies at your facility – Implementation of the DPH 2013 order

IP Line Lists

• Asked to provide line list of cases

identified as nosocomial / hospital-onset influenza

• Provides details and characterization of

cases

16

Preliminary Results

• 29 IP surveys completed
• 14 IP line lists completed of cases identified as

nosocomial / hospital-onset influenza

• 13 Lab Director line lists completed of positive

flu test obtained > 72 hours from admit

• 16 Absenteeism forms completed
• 8 Facilities have completed all study

components

17

Descriptive Statistics

• Among facilities with a completed IP

survey

– 8 (of 29) are teaching facilities

18

2 4 6 8 10 12 14 16 Small facilities (1-100 beds) Medium facilities (101-350 beds) Large facilities (351 and > beds) Number of facilities

IP Surveys completed by Facility Size

• No. of facilities

19

Variable N %

• No. of Reported Nosocomial Flu

Cases 55 Age (mean) 65.04 Gender (female) 25 45.4 Hospitalization location General Ward 38 69.1 Intensive Care Unit 5 9.1 Respiratory Unit 3 5.4 Definitive Observation Unit 3 5.4 Pediatric Unit 2 3.6 Rehabilitation Unit 1 1.8 Critical Care Unit 2 3.6 Post partum 1 1.8 Nosocomial Cases in 2011-12 1 1.8 Nosocomial Cases in 2012-13 33 60.0 Nosocomial Cases in 2013-14 21 38.2

IP Line List Descriptive Statistics

Employee Absenteeism

Includes facility employees and staff, without distinguishing HCP

20

Influenza Season Average missed days per employee* 2011-2012 3.9 2012-2013 5.2 2013-2014 1.0

*Includes facilities with complete numerator and denominator data †(n=14)

Healthcare Personnel Vaccination/ Masking Rates

Influenza Season % of employees vaccinated % of employees who declined vaccination % of employees with an unknown vaccination status 2011-2012 69.4 25.6 5.6 2012-2013 75.9 24.8 3.6 2013-2014 87.2 9.5 2.7

†(n=29)

21

Implementation of the Health Officer Order

• On a scale of 0-5:

– 22 participants reported an average value of 2.77 (moderate difficulty relative to overall ease of implementation) – 23 participants reported an average value of 3.09 (fairly well accepted relative to overall HCP acceptance of the Health Officer Order) – 2.94 (among nurse practitioners) and 2.90 (among other employees with patient contact) moderate resistance relative to the amount of resistance encountered from HCP

22

Highlights

• Variability in surveillance definitions across

facilities

– >48 hours – 72 + hours – No timing reported

• Approximately half of respondents (45%)

indicated obtaining additional vaccine for HCP following the order; Vaccine successfully obtained by all respondents

23

Limitations

• Absenteeism reported differently across

facilities

– May include vacation time – May include employees without direct patient contact

• Limited responses and incomplete data

hinder robust analysis

• Inherent variability between flu seasons

creates challenges in analysis

24

Timeline

• This month

– Receive follow up emails and phone calls to

• btain project components

– IPs are asked to please identify and forward to correct HR person to assist with sick leave data

• Send contact information to Jessica Silvaggio

(jsilvaggio@ph.lacounty.gov)

• Fall 2014

– Present findings at local APIC chapters, conference calls, highlights, and conferences

Thank you!

Questions

Study Contacts:

Allison Bearden, MD/ MPH Study Coordinator 626-457-5820 Email: abearden@dhs.lacounty.gov Jessica Silvaggio, MPH Study Co-coordinator 213-240-7941 Email: jsilvaggio@ph.lacounty.gov Dawn Terashita, MD/ MPH Medical Epidemiologist 213-240-7941 Email: dterashita@ph.lacounty.gov Patricia Marquez, MPH Epidemiologist 213-240-7941 Email: pmarquez@ph.lacounty.gov

27