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VA Influenza Manual 2008-2009

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VA Influenza Manual 2008-2009 VA Influenza Manual 2008 / 2009 VA Influenza Manual 2008–2009 Infection: Don’t Pass It On team Office of Public Health & Environmental Hazards Public Health Strategic Health Care Group Occupational Health, Safety, and Prevention Strategic Health Care Group Employee Education System Office of Patient Care Services VA Infection Control Professionals National Center for Health Promotion and Disease Prevention Infectious Diseases Program Office National Center for Patient Safety www.publichealth.va.gov/flu www.publichealth.va.gov/infectiondontpassiton vaww.vhaco.va.gov/phshcg/flu/index.htm vaww.vhaco.va.gov/phshcg/infectiondontpassiton/index.htm Veterans Health Administration U.S. Department of Veterans Affairs Contents Foreword V Introduction VII Goals of the VA Influenza Vaccination Program, 2008–2009 IX 01 Vaccine Information 1 Inactivated (Injectable) Influenza Vaccine 2008–2009 4 Live, Attenuated Intranasal Influenza Vaccine (laiv) 2008–2009 7 02 How to Improve VHA Employee, Trainee, and Volunteer Vaccination Rates 21 03 Best Strategies for Increasing Veteran Influenza Vaccination Rates 37 04 Resource Materials on Influenza Prevention 43 05 Frequently Asked Questions (FAQs) on Influenza and Influenza Vaccination 49 01: General Questions 49 02: Employees, Volunteers, and Influenza Vaccine 55 03: Live, Attenuated, Intranasal Influenza Vaccine (laiv or FluMist®) 55 04: Influenza Antiviral Agents 56 05: Eligibility for Influenza Vaccination in va 58 06: hiv/aids and Influenza Vaccination 59 07: Special Considerations for Pregnant Women 60 08: Influenza Vaccine Storage and Prefilled Syringes 61 09: Pandemic or Avian Influenza 62 10: Medication Reconciliation 62 06 Influenza Vaccine Documentation in the VA Computerized Patient Record System (cprs) 67 07 Appendices 71 A: How to Administer Influenza Vaccines 75 B: Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practices (acip). mmwr. August 8, 2008/57 81 C: Pneumococcal Vaccine Information 151 D: Prevention and Treatment of Influenza with Antiviral Drugs 157 E: Vaccine Management: Recommendations for Storage and Handling of Selected Biologicals—November 2007 161 F: Resources, References, and Web sites 185 G: Acknowledgements 195 IV VA Influenza Manual 2008 / 2009 Section Goes Here V Foreword. A Message from the Under Secretary for Health . Your efforts exemplify the “power of performance” that drives our health care system to be a national model of excellent care. To VHA Flu Coordinators, Occupational Health them operational, and to prevent the Clinicians, Infection Control Professionals, transmission of influenza within the Pharmacists, and other staff who make our work setting or at home. annual influenza vaccination campaign a national model: You practice progressive leadership. You thank you! Your efforts exemplify the are responsible, accountable, and innovative. “power of performance” that drives our • The pages of this manual are a testa- health care system to be a national model ment to your leadership—I suggest you of excellent care, including important review the sections on best practices for Michael J. Kussman. preventive measures, such as annual vac- improving employee vaccination rates MD, MS, MACP. cination against influenza, the “flu.” and for increasing veteran vaccination Under Secretary for Health rates. Reflected here are many great You put patient care first. ideas from throughout the VA health • In terms of flu vaccination, that means system for encouraging and support- working to prevent influenza and its ing effective vaccination programs. complications in our patients, offering We have gathered these from the most them flu vaccination when they come successful programs and offer them as a for an outpatient visit or if they are foundation to continue to build on. inpatients or residents in a nursing • You are also heeding the call to encour- home care unit. Besides continuing our age flu vaccination in fall, winter, and energetic promotion of flu vaccination spring, reminding patients and staff of patients in general, we will continue of the clinical benefits of flu vaccine to put special emphasis on making sure throughout the entire flu season. that women veterans are vaccinated at • Our innovative VA researchers are pub- the same rate as men and that certain lishing key studies, such as the October populations, such as spinal cord injury 2007 New England Journal of Medicine patients, are also protected against the (Nichol. et. al) article that showed flu through vaccination. influenza vaccination was associated • Putting patient care first also means with significant reductions in the risk vaccinating our employees, volunteers, of hospitalization for pneumonia or in- and other staff so that they can stay fluenza and in the risk of death among healthy to continue to provide high- community–dwelling elderly persons. quality clinical and administrative services in our medical facilities, to keep VA Influenza Manual 2008 / 2009 Foreword: A message from the Under Secretary for Health VI You enable effective business practices. The country’s national medical leaders • You may not associate flu vaccination in influenza vaccination, our partners with “good business practices,” but in at the Centers for Disease Control and reality it is one of the most effective Prevention (CDC), are regularly expanding prevention practices we have available the indications for flu vaccination and I to us. would remind you that the current broad • The few minutes it takes to receive categories are: this relatively inexpensive vaccine are • All persons at risk for medical minimal compared to the potential of complications from influenza; feeling miserable for days, losing work • Those more likely to require and family time, and sometimes, being medical care; hospitalized or worse. • Persons who live with or care for • The effective flu vaccination programs persons at high risk for influenza- that you run enable our patients and related complications; and staff to avoid illness. • Individuals who wish to be vaccinated You excel at Performance Measures. These four categories cover almost • Thank you for continuing to work to every one of our patients, employees, meet our performance goal of 75% of volunteers, and other staff. In this era influenza-targeted patient populations of emerging infectious diseases, both (i.e. related to age and diagnosis); in potential (pandemic influenza as well many cases you exceed that patient goal as epidemics of seasonal influenza) with 80% or higher rates. and (ongoing MRSA, West Nile virus, • VHA leads the nation in the percent of and many others), preventing disease health care workers vaccinated against and its transmission is of the utmost seasonal influenza. The employee vac- importance. Thank you again for all you cination goal for 2007–08 was 60%. I do to reach patients and employees by am proud to report that in this period, keeping sustained interest in prevention 65% of VHA employees were vaccinated of flu and its many and sometimes deadly against seasonal influenza. Whether consequences. employees receive this at VA or you make note that they have received it elsewhere, flu vaccination is an essen- tial part of our health care and disease prevention programs. VHA eventually wants to move our employee vaccina- tion rate to 80%. VII Introduction . A Message from Dr. Kristin Nichol. In FY 08 we achieved our goals of vaccinating at least 75% of our patients and at least 60% of our employees. Preparing for an influenza pandemic disease, or heart disease; residents of remains an important goal for VA, other long–term care facilities; people who have federal agencies, and other organizations conditions that compromise their abil- in the United States and worldwide. ity to handle respiratory secretions; and In fact, during the week of June 23, VA pregnant women. held a national 2008 VHA exercise model- Influenza vaccination has long been ing pandemic influenza, its impact on recognized as the most important means VA, and our response. We all learned available for preventing and controlling much from participating in this exercise. influenza. And vaccination does work. Kristin Nichol. However, one of the most effective ways Among healthy adults under age 65, MD, MPH, MBA. that we can be prepared for a pandemic vaccination can prevent 70% to 90% of Associate Chief of Staff is to have a strong seasonal influenza influenza cases. Among working adults, for Research. prevention and control program with vaccination also reduces the likelihood Minneapolis VA Medical influenza vaccination at the center. of work loss due to influenza as well as Center. Why is this so important for us in VA? health care use. In the elderly, vaccina- Because influenza can be a serious and tion not only reduces the risk of influenza even deadly disease for our patients. illness, also reduces the risk of hospital- Influenza illness is common, affecting ization and death due to complications 10% to 20% of the US population annu- from influenza. A recently published ally. Classic influenza is characterized by study evaluating data from VA’s External the abrupt onset of fever, headache, sore Peer Review Program showed that, as throat, cough, muscle aches and malaise, influenza and pneumococcal vaccination and symptoms can last up to a week or rates for elderly veterans increased across longer. However, it is the serious compli- VA over a several-year time period, pneu- cations of influenza such as pneumonia or monia hospitalization
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