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

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ould

be

vac

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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.

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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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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