Experts: Time to prepare for next flu season

CDC, JCAHO issue vaccination guidelines

At this writing, the 2005/2006 flu season is not quite over — and yet, say the experts, it’s not too early to start planning for next year’s season. In fact, the National Influenza Vaccine Summit has advised health care providers they may want to order flu vaccine for the next flu season from several distributors, noting that most of sanofi pasteur’s projected supply of 50 million doses already has been pre-booked by health care providers.

At the same time, leading organizations have come out with new statements on the vaccination of health care staff: The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) has proposed a standard for staff immunization, and the Centers for Disease Control and Prevention (CDC) has released a new guidance aimed at increasing flu vaccination among health care workers.

The timing is not entirely coincidental, says Michelle Pearson, MD, chief of the prevention and evaluation branch of the CDC’s Division of Healthcare Quality Promotion, and lead author of the new guidance. "It’s absolutely not too early to start thinking about next season," she says. "Actually, what we recommend is for organizations to start planning their flu programs in February or March, so people can have time to implement what we are recommending."

Seeing the need

"This not a planned concurrence, but health care organizations have to order their flu vaccine now," adds Nancy Kupka, DNSc, MPH, RN, Project Director, Division of Standards and Survey Methods at JCAHO.

Both organizations felt a strong need for new statements on staff immunization. "Influenza is responsible for a lot of deaths every year, and this has been an ongoing problem," says Kupka. "People spend a lot of time worrying about pandemic flu, but we already have a significant amount of morbidity and mortality, and one of the best ways we can help to control transmission of influenza is to vaccinate health care workers."

"The recommendation to vaccinate health care workers is not new, but what has happened in previous recommendations is that the real estate it was given has been quite small — maybe a paragraph," Pearson concedes. "We felt we needed to focus more on the issue, and this format [a formal guidance] provided a more expanded way to do that."

Specific recommendations

What’s more she says, despite the long-standing recommendation, only 40% of health care workers actually receive a flu vaccine (this despite the fact that 98% of surveyed hospitals say they provide staff vaccinations). "That’s better than it has been in the past, but it’s been really flat for five or six years," she notes.

The CDC guidance includes a number of recommendations: That facilities offer flu vaccine annually in the workplace to all eligible personnel at no cost; that they use reminders, education, and other proven strategies to improve vaccination coverage; and that they obtain a signed form from staff who decline vaccination for non-medical reasons to help in monitoring and addressing barriers to vaccination. The guidance also recommends using flu vaccination coverage rates as one measure of a patient safety quality program.

An important component of the guidance, Pearson notes, is a series of evidence-based practices that are recommended.

"Health care workers have told us why they don’t get vaccinated," she observes. "The barriers include cost, availability [i.e., scheduling which conflicts with night and weekend shifts], and some proportion of providers actually have needle phobia."

Education is critical

In light of those objections, she says, "Things like the availability of nasal flu vaccine would be an option. We want organizations to make it available at no cost, and at times that are off-peak hours. Also, we recommend the use of strategies like mobile carts, so you can bring the vaccine to the provider, and having a person on the unit or ward serve as a vaccinator; all of these decrease barriers."

Education is critical, she continues, as it can overcome misperceptions about the effectiveness of the vaccine and, in some cases, a lack of knowledge about its role as a safety benefit for providers and patients.

"Another really key notion is tracking and monitoring what’s happening with coverage in the institution," says Pearson. "We need to know who didn’t get vaccinated and the characteristics of those who didn’t. This will help us target hard-to-reach people."

The proposed JCAHO standard has many similarities: It includes a mandatory staff vaccination program; providing vaccinations at convenient locations and times; educating staff about the flu vaccine, transmission, diagnosis, and so forth; and maintaining records of those who have been vaccinated — that is, monitoring influenza vaccination rates, learning why people are not participating, and implementing program enhancements aimed at increasing vaccination rates.

Declination

There is one controversial component of the JCAHO proposal, says Kupka. "This involves tracking declination of vaccines," she says. "In other words, I have to ask you if you want to be vaccinated, and you must accept or decline. If you decline, you must sign something saying you chose not to have the vaccination."

JCAHO is not recommending that vaccination be made mandatory by the institution but that those declining sign something saying they chose to decline. "People who are against it are saying it’s because it’s an administrative burden; it’s not a HIPAA issue," she says. "People who are in favor say, if you are really going to make a concerted effort to find these people, then getting a declination is not that different. In getting one, you gain the ability to get data about what people are declining."

The standard is scheduled to be finalized this month, Kupka notes.

[To see the new CDC guidance, go to www.cdc.gov, then "Publications and Products and click on MMWR. Go to "recommendations and reports."]

For more information, contact:

Michelle Pearson, MD, Chief, Prevention and Evaluation Branch, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA. Phone: (404) 639-4251.

Nancy Kupka, DNSc, MPH, RN, Project Director, Division of Standards and Survey Methods, Joint Commission on the Accreditation of Healthcare Organizations. Phone: (630) 792-5935.