>> So good afternoon everyone and welcome
to the training session
on healthcare personnel influenza vaccination reporting
for long-term care facilities.
My name is Elizabeth Kalayil and I work
in the immunization services division at CDC.
So this presentation will cover two main items.
The first objective is to review the value
in reporting health care personnel flu vaccination data
in long-term care facilities.
The second objective is
to review the healthcare personnel vaccination module
in NHSN and how facilities can use this to track your flu data.
So before we get into the presentation,
I was wondering how many of you received your flu shot
for last year's flu season, and you can raise your hand.
Oh wow, that's great.
It's a very good number.
So the 2018-2019 flu season was quite challenging and millions
of people contracted influenza.
So hopefully everyone will start to get their flu shot
for the upcoming 2019-2020 flu season by this fall.
So now we'll review a few points
about health care personnel working
in long-term care facilities
and why flu vaccination is so important.
So as of 2009, over 4 million health care personnel worked
in long-term care facilities.
So approximately 3 million
of these health care personnel provided direct care
to patients.
And this is nearly one-third of the total healthcare workforce.
And by the year 2050, the number of health care personnel working
in long-term care settings is projected to increase
between 5.7 and 6.6 million.
So influenza is problematic in residential facilities,
as the virus can spread very quickly.
Residents of long-term care facilities are at increased risk
of complications from infection because of their age
and their chronic conditions.
Also, healthcare personnel can contract influenza
from and/or also transmit the virus
to the residents of the facility.
And there are some barriers surrounding the vaccination
of healthcare personnel in these settings.
So for example, facilities may not offer the influenza vaccine
or promote vaccination of healthcare personnel.
High levels of staff turnover can be problematic in terms
of vaccination and tracking.
There are several benefits
to having health care personnel working
in long-term care facilities vaccinated against influenza.
Influenza vaccination will help to prevent the spread
of influenza not only among the residents of the facilities
but to other health care personnel.
This could reduce illness related to influenza
in facility residents and may also reduce deaths.
Influenza vaccination also reduces illness
and absenteeism among health care personnel.
The Society for Post Acute
and Long-term Care Medicine advocates mandatory influenza
vaccination of health care personnel
in long-term care facilities.
And exceptions to influenza vaccination should only be made
in the case of medical contraindications.
All healthcare personnel, and that's regardless
of patient contact, should be vaccinated.
Unvaccinated healthcare personnel are advised
to wear masks when they have direct contact
with patients during the flu season.
It's also recommended
that facilities offer free influenza vaccine to paid
and volunteer healthcare personnel in the post-acute
and long-term care settings.
So there are several strategies
that long-term care facilities can implement
to increase the vaccination rates among
healthcare personnel.
These evidence-based strategies include providing free
vaccination on-site at the long-term care facility.
Offering influenza vaccinations to healthcare personnel
at a variety of times and locations.
Facilities are also encouraged to actively promote vaccination,
and they can also deliver reminders on an individual level
about the importance of vaccination.
Facilities can also review and assess vaccination rates
and give feedback on performance.
So now I'll turn the presentation
over to my colleague, Megan Lindley,
and she'll be reviewing how
to use the healthcare personnel vaccination module in NHSN.
>> Thank you, Elizabeth.
My name is Megan Lindley and I work
as the Deputy Associate Director for Science
in the Immunization Services division at CDC.
Now we will go over how NHSN data can be used
to improve health care personnel vaccination
in long-term care facilities.
So all the information that we've given you leads
to the question why should you use the healthcare personnel
vaccination module, and the answer is not
because CMS is making me.
The healthcare personnel vaccination module is designed
to ensure that healthcare personnel influenza vaccination
percentages are both consistent over time
within a single facility and comparable across facilities,
so you can track your own progress from year-to-year
as well as benchmark your healthcare personnel vaccination
rates against other facilities, should you choose.
Using NHSN to monitor influenza vaccination among health care
personnel may also result in increased vaccination coverage
because improvements in tracking
and reporting health care personnel vaccination status
will allow long-term care facilities to better identify
and target unvaccinated healthcare personnel,
and I'll show you a little more about that in a minute.
And hopefully increased influenza vaccination coverage
among health care personnel should result
in reduced morbidity and mortality related
to influenza among the health,
long-term care facility residents as well
as health care personnel working in long-term care.
So there are several ways
that long-term care facilities can put these data to good use.
The healthcare personnel vaccination module allows
facilities to monitor vaccination trends over time
as I noted, among the different health care personnel groups,
and I'll show you detail on that in a subsequent slide.
The data will also show if there are certain groups
with lower vaccination rates.
For example, a long-term care facility might notice
that employees have higher influenza vaccination rates
than volunteers.
And reviewing the data may also help facilities identify
barriers to improving health care personnel influenza
vaccination in their facility.
For example, the facility in the previous example may realize
that vaccination rates are lower among volunteers
because the volunteers are not covered by policies and programs
that apply to influenza vaccination
of long-term care employees at the facility.
Facilities can also use NHSN data to help them make decisions
about efforts to increase influenza vaccination among
health care personnel.
For example, a long-term care facility could update its annual
influenza vaccination program to cover employee
and non-employee staff or could choose to increase the number
of days vaccination is offered
to healthcare personnel at the facility.
Alternately, it may not be the vaccination program
that is an issue but the tracking.
So a facility may decide
to improve internal tracking systems, for example,
by turning to a computer-based or automated tracking
to better identify unvaccinated healthcare personnel
in real time during the influenza season.
So now we will very briefly go over the reporting requirements
for the healthcare personnel vaccination module.
There's information, information on where to find more details
about this included later in the presentation.
So for purposes of NHSN reporting,
there are three required denominator categories shown
on this slide.
One category consists of employees,
the other two are nonemployees.
And for the required employee category, for purposes
of NHSN reporting in this module, an employee is anybody
who receives a direct paycheck from the facility,
so who is on your payroll.
The second denominator category are nonemployee licensed
independent practitioners who are defined as physicians,
nurses in advanced practice or physician assistants
who are affiliated with the facility but not employed by it,
so do not receive a paycheck.
The third denominator category that's required is adult
students and trainees and volunteers aged 18 or over,
and these are exactly who it sounds like.
It's medical, nursing and other health professional students,
residents, interns and trainees and anyone who volunteers
in the facility who again is affiliated
but not employed by the facility.
There's also a final optional denominator category
which is other contract personnel.
These are persons providing care, treatment or services
at the facility through a contract who do not fit into any
of the three previous categories.
This category is optional for NHSN reporting.
It is something that can be used for example to meet requirements
for Joint Commission accreditation if you're required
to report on contract staff.
So the numerator for this measure is all employees who are
in the denominator and fall into one of these five categories.
The first category is healthcare personnel
who received influenza vaccination
at your healthcare facility during the time the vaccine
becomes available, which can be usually August or September
through March 31st of the influenza season.
So it does cut off.
The second category is healthcare personnel
who were vaccinated outside the facility
and provided a written report or other documentation
of influenza vaccination.
This can include their own written attestation
and this is the only numerator category
for which documentation is required
for NHSN reporting in this module.
The third category is healthcare personnel
who have a medical contraindication
to influenza vaccine and for NHSN,
the accepted medical contraindications are a severe
allergic reaction, so anaphylaxis or similar
to a previous dose of influenza vaccine
or to any influenza vaccine component including egg protein.
And the other contraindication is a history
of Guillen-Barre a syndrome
within six weeks following a previous influenza vaccination.
The fourth numerator category is healthcare personnel
who declined to receive influenza vaccine
for nonmedical reasons and that category would include
if your facility has religious
or personal belief exemptions in place.
That's where you could record those personnel.
And the final category is healthcare personnel whose
vaccination status is unknown or do not meet the criteria for any
of the other categories above.
A couple additional reporting notes.
The denominator for the measure consists
of health care personnel who are physically present
in the facility for at least one day between October 1st
and March 31st, so staff who are working always off-site,
doing telemedicine, otherwise not
at the facility are not counted in this measure.
And healthcare personnel are included regardless
of clinical responsibility or patient contact,
which is consistently that policy from the Society
of Post-acute and Long-term Care Medicine
that Elizabeth mentioned as well as ACIP recommendations.
So if you have an employee for example who is working
in accounting or something who doesn't encounter patients,
that person if they are still
in your facility would be included in this measure.
So, I know you're all very excited to report these data.
So how do I get started in NHSN?
The healthcare personnel vaccination module is located
within the healthcare personnel safety component.
That means it's separate from all of the component,
the modules that you're already used to using that are
in the long-term care component.
So the first step is for your NHSN facility administrator
to activate the healthcare personnel safety component
for your facility.
And within the healthcare personnel vaccination module,
there are two required forms that need to be completed
in order to report data.
The first is the healthcare personnel safety monthly
reporting plan and the second is the healthcare personnel
influenza vaccination summary data report.
The seasonal survey on influenza vaccination programs
for health care personnel collects data
on facility programs
for encouraging influenza vaccination
of healthcare personnel.
The survey is not required but we do encourage you to fill it
out because it provides valuable information on how the policies
and practices at your facility may correlate
with the vaccination that you report.
So you may have noticed we have an immunization booth right
outside this auditorium, and we would love it
if you would come see us
at the break this afternoon or tomorrow morning.
We can assist you with adding the healthcare personnel safety
component if your facility's already enrolled
and you have a computer, or we can provide you with information
on how you can set this up when you return to work.
The next few slides I'll outline a few resources
that may be useful to you.
CDC has created a resource toolkit
for long-term care employers that you can find
at the URL that's located on that slide.
It includes a wealth of information on the importance
of influenza vaccination of healthcare personnel
in long-term care as well as some of the information
on challenges and strategies to overcome these challenges
that Elizabeth presented.
The second resource is of course the NHSN website.
If you look under materials for enrolled facilities
and long-term care, there's a section
on health care personnel influenza vaccination
that includes the data collection forms I mentioned
as well as the reporting protocol,
frequently asked questions, and other valuable information.
And your final resource is us, of course, Elizabeth and myself.
You can email that user support address that you know so well,
NHSN at CDC.gov and please include healthcare personnel flu
summary and long-term care in the subject line
so that it gets triaged to us faster.
This concludes our presentation
and we really appreciate your time and are happy
to answer any questions you have now
or at the booth at the break.
[ Applause ]