Utilizing a Global Influenza Vaccination Strategy for Pandemic Influenza Preparedness in a Multi-Hospital System

Utilizing a Global Influenza Vaccination Strategy for Pandemic Influenza Preparedness in a Multi-Hospital System

June 2008 E27 and educational materials (sample preparedness plans, checklists, disaster kit items, etc.). This format facilitated discussions with ...

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June 2008


and educational materials (sample preparedness plans, checklists, disaster kit items, etc.). This format facilitated discussions with participants regarding their level of preparedness. Results: We had high interest and volume participation among HCW, volunteers, support staff, professional staff, physicians, and students. Several returned for additional copies of information for ‘‘family members and coworkers who were unable to leave clinical areas’’. Many indicated they had ‘‘thought about’’ emergency planning, but didn’t know where to start. Benefits included: improved hazard awareness, opportunity for individual preparedness, a better prepared workforce for the institution, and assisting public health in community education. Lesson Learned: The social marketing concept is a useful tool to engage participants in active learning of emergency preparedness. We identified a need to further assess level of personal preparedness of our HCW staff, and develop additional preparedness educational offerings.

Publication Number 3-16

Utilizing a Global Influenza Vaccination Strategy for Pandemic Influenza Preparedness in a Multi-Hospital System Lynne V. Karanfil, RN, MA, CIC, Corporate Infection Control Coordinator, MedStar Health, Columbia, MD; Karin Myerson, BSN, RN, COHN-S, Mary Jones, RN, BSN, CIC, Washington Hospital Center, Washington, DC. Issue: Major health agencies (United States Department of Health and Human Services, the World Health Organization, CDC) indicate that an influenza pandemic is due to occur and advise planning for the next influenza pandemic. Vaccinating staff with the influenza vaccine is a key component to pandemic planning. In a pandemic, more people will want and need to be vaccinated therefore building the vaccination infrastructure now will better position hospitals. Using a peer-peer approach allows unit based licensed staff to give the flu vaccine locally. During a pandemic, a broader group can thus provide the vaccine. Educating health care professionals (HCP) about the flu vaccine is also a key strategy. Project: MedStar Health, Inc. (a hospital system in the Baltimore/Washington region with more than 23,000 employees and 4,600 affiliated physicians) created a pandemic influenza workgroup. The Workgroup had representation from infection control and employee health leadership from all seven MedStar Health hospitals, its long-term care center and Visiting Nurse Association, as well as corporate pharmacy leadership. The group realized the need to aggressively promote influenza vaccination among staff and educate all employees on MedStar Health’s emergency preparedness plan and what to do in the event of an influenza pandemic. Intervention: MedStar Health solicited the assistance of a design agency to create a persuasive and thoughtprovoking marketing campaign. The campaign goal was to further enhance MedStar Health’s vaccination infrastructure for the preparation of an influenza pandemic. Key campaign objectives and goals emerged once the research was completed. A toolkit was developed and distributed to each hospital. Execution: MedStar Health’s flu awareness initiative entitled, KnowFlu, began with the early dissemination of a newsletter article and other publications across the system. A KnowFlu toolkit was created and distributed, which encompassed the necessary documents and materials for MedStar Health communicators and pandemic influenza workgroup members. The KnowFlu campaign was branded with a compelling logo, which addressed a key strategy. We capitalized on the ‘‘Be Smart, Get the Shot’’ tagline by using images of individuals who benefited from vaccination. Monthly e-mails, flyers and articles were all graphically coordinated for ease of recognition and recall. Several sites utilized a declination form and trended those statistics. Results: During its first season (2006-2007), the aggregate total of influenza vaccinations for all seven MedStar Health hospitals increased by 18 percent compared to the previous season. At one of our largest hospitals, there was a 33 percent increase in flu vaccinations among HCPs and physicians largely due to the peer-to-peer


Vol. 36 No. 5

campaign. MedStar Health communicators expressed positive feedback regarding the campaign. Data will be presented on the 2007-2008 campaign season. Lessons Learned: Use of the peer-to-peer campaign was not as successful system-wide during the first season due to inconsistent leadership support. Not obtaining the vaccine on a timely basis also posed problems and a strategy was developed for the next season on vaccine procurement. Using a declination form provides feedback on why staff are still reluctant to be vaccinated. Details of this season’s campaign and tactics will be presented.

Publication Number 3-17

Avian Flu-knocking on our door! Lessons in Avian Influenza Surveillance Linda K. Miller, RN, BS, CIC, Infection Control Manager, Angela Vassallo, MPH, Infection Control Practitioner, Methodist Charlton Medical Center, Dallas, TX, Zakir Hussain A. Shaikh, MD, MPH, CPE, FIDSA, Hopsital Epidemiologist & Medical Director, Infection Control, Methodist Health System, Dallas, TX. Issue: A 97 year old Asian male presented to his physician’s office with complaints of productive cough, fever, and chills within days of returning from a trip to Asia. He was admitted directly to the medical floor of our 255-bed community hospital with a diagnosis of right lower lobe pneumonia. Based on a pre-established protocol, nursing documentation of cough and travel history to Asia generated an electronic travel alert in the infection control (IC) office. Patient interview utilizing a Mandarin interpreter yielded limited information likely related to confusion from illness, advanced age and cultural barriers. His son-in-law, the family’s designated contact person, was then interviewed by IC. He confirmed that the patient along with his daughter and granddaughter had returned from a 3 week trip to China and Viet Nam 5 days prior, and all 3 had developed influenza-like illness. A detailed interview was conducted using the Dallas County Dept. of Health & Human Services (DCHHS) Influenza Surveillance Patient Questionnaire and specific travel destinations were compared with the avian influenza ‘‘hot spots’’ documented on the CDC/WHO websites. No correlations were found. Droplet precautions that had been initiated for pneumonia were continued; nursing administration and the attending physician were updated and instructed on the limitation of visitors and staff into and out of the room. Project: Upon notification of the DCHHS Pandemic Planning Coordinator, it was determined that the patient met the case definition for a possible case of H5N1 influenza and testing was recommended. Despite avian influenza being ruled out by a negative H5N1 PCR, it was decided by the Hospital Epidemiologist and DCHHS to pursue a full investigation since other family members were ill as well. This was conducted as if positive results had been returned, so that the situation would serve as a learning opportunity. The granddaughter who had actually traveled with the patient and was well conversant in English was interviewed. IC developed an epidemiologic questionnaire for use during the interview, which was attended by DCHHS. Results: There were several discrepancies in the information obtained versus the information received from the son-in-law the previous day. The details shared in the second interview would have significantly increased our threshold of suspicion for avian influenza, such as: o o o o

Multiple visits in Hanoi and China to open markets where contact with dead poultry was likely Multiple contact with coughing people while in China and Viet Nam Visiting a home in China with a cat as a house pet Presence of the patient’s symptoms prior to departure from China

Lessons Learned: Although our hospital’s established alerting process resulted in a timely and comprehensive response to a potential threat of avian influenza, several opportunities for improvement were identified: o In the event of barriers to direct patient interview, interview with a family member as closely involved with the situation as possible is vital. In this case, the designated family contact who was initially interviewed was not the most appropriate person to discuss the issue with, since he had not traveled with the patient.