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Increasing hospital employee participation in an influenza vaccine program
AJIC
Letters to the editor 3 6 7
Volume 26, Number 3
REPLY
To the Editor: We a p p r e c i a t e d the t h o u g h t f u l c o m m e n t s regarding our article on the use of tap water for gastrointestinal e n d o s c o p i c p r o c e d u r e s . The major issue brought forth by Patton is the potential for deposits forming on or around the opening of the air/water opening at the tip of the endoscope. We agree that occlusion of this very small opening m a y lead to scope malfunction and possibly the need for m i n o r repair. Clearly, even a m i n o r repair to an endoscope could outweigh the cost of sterile water or deionized water as suggested. Although this concern is not unreasonable, we know of no evidence that this even occurs. In o u r cumulative experience of more than 20 years of endoscopic nursing and clinical practice, we know of no time that "deposits" occluded the air/water jet. In contrast, we do have experience with occlusion of this port by debris such as blood or even lint from cleaning the endoscope with towels. In addition, given the use of sterilizing equipment that flushes the channels, it seems unlikely that, even if small deposits develop, they could b e c o m e clinically significant. We believe that the m a j o r issue of using tap w a t e r is a practical one given that o u r data suggest that the infection risk is minimal. Using w h a t e v e r w a t e r is available is a p r a g m a t i c issue, especially in b u s y e n d o s c o p y units w h e n procedures are done outside of the unit, such as in the intensive care units. If the w a t e r bottle runs out, do we hold the p r o c e d u r e while we look for sterile water? I hope not. We w e l c o m e f u r t h e r studies on the use of tap w a t e r and the potential for deposit f o r m a t i o n on the air/water opening. Until such time that this has b e e n s h o w n or o u r clinical experience proves wrong, we will c o n t i n u e with o u r current infection control practices. C. Mel Wilcox, M D Associate Professor of Medicine Chief of Endoscopy J e a n e t t a Blakely, RN, BSN Nurse Manager, Endoscopy University Hospital Birmingham, Alabama
I N C R E A S I N G H O S P I T A L E M P L O Y E E PARTICIPATION IN A N I N F L U E N Z A V A C C I N E P R O G R A M
To the Editor: Each year 10% to 20% of Americans are infected with influenza, and approximately 20,000 die of the disease or its complications.~ The Centers for Disease Control and Prevention r e c o m m e n d s
I
Fig. 1. The air/water jet on the end of the endoscope has an extremely small opening, approximately 30-gauge size.
that health care workers be i m m u n i z e d against influenza to prevent infection and s u b s e q u e n t transmission to high-risk patients in health care settings. 2 In spite of this, immunization rates a m o n g health care workers remain low. 3,4 Even after large outbreaks a m o n g patients and staff members, rates seldom exceed 40%. 5.6 The University of Kentucky Hospital offers the influenza vaccine annually to hospital workers at no charge. From 800 to approximately 1300 (34% to 55% of eligible health care workers), have been immunized each year during the past 4 years. We wanted to increase the n u m b e r of persons immunized and instituted an aggressive, multifaceted immunization campaign for that purpose. Beginning 2 weeks b e f o r e actually administering the vaccine, 100 posters, supplied by C o n n a u g h t L a b o r a t o r i e s ( S w i f t w a t e r , Pa.), were placed in highly traveled areas througho u t the hospital along with a schedule of w h e n and w h e r e vaccinations w o u l d be available. These p o s t e r s e m p h a s i z e d the i m p a c t influenza could have on a person's w o r k and social life. All e-mail users were notified of the u p c o m i n g campaign, and e d u c a t i o n a l materials were dist r i b u t e d t h r o u g h d e p a r t m e n t heads. The i m m u n i z a t i o n c a m p a i g n w a s k i c k e d off at the Infection Control Fair, held in the hospital as part of national Infection Control Week sponsored by APIC. The fair was held in the hospital a u d i t o r i u m on a S u n d a y a f t e r n o o n and all of the next Monday. The fair included banners, decorations, movies, a n d g a m e s designed to teach infection control principles, and the vaccine was administered. P o p c o r n was p r e p a r e d and the d o o r s of the r o o m were kept o p e n to ensure that the a r o m a m a d e its w a y d o w n near-
AJIC June 1998
3 6 8 Letters to the editor
by h a l l w a y s . Vaccine r e c i p i e n t s received a c o u p o n for a free slice of pizza at the hospital cafeteria a n d were eligible to e n t e r a d r a w i n g for several prizes. The g r a n d prize was two tickets to a Wildcats basketball g a m e a n d a University of K e n t u c k y s t a d i u m jacket. The c a m p a i g n was c o n t i n u e d t h r o u g h the next w e e k a n d on a m a k e u p date 2 weeks later in a small area located n e a r the cafeteria. In addition to these activities, n u r s i n g units could take a d v a n t a g e of a "Flu Vaccine Cart" if t h e y wanted to i m m u n i z e a d d i t i o n a l persons. The success of the c a m p a i g n exceeded our expectations. Fully 1958 individuals received vaccine. This was a 51% increase in the n u m b e r of vaccinations c o m p a r e d with 1995 (1297). The total cost of incentives a m o u n t e d to $3568. We calculate t h a t the p r o g r a m will pay for itself if it prevents 17 days of sick leave. Others have s h o w n that i m m u n i z i n g h e a l t h y working adults against influenza is beneficial. In one study, i m m u n i z e d adults h a d 25% fewer upper-respiratory illnesses, 43% fewer days of lost work, and 44% fewer visits to physicians t h a n those who h a d not been i m m u n i z e d . 7 Preventing influenza is even m o r e i m p o r t a n t in the health care setting where t r a n s m i s s i o n to vulnerable patients can occur. A n u m b e r of strategies have b e e n p r o p o s e d to i n c r e a s e i m m u n i z a t i o n rates a m o n g health care workers, ranging from c o m p u t e r - g e n e r a t e d reminders to m a k i n g the vaccine m a n d a t o r y 2 We recently analyzed the i m p a c t of influenza on patients a n d decided that a vigorous c a m p a i g n with incentives was the best m e t h o d . 9 The very favorable response to our efforts suggests that, for us, "the carrot is better t h a n the stick." With the recomm e n d a t i o n by the J o i n t C o m m i s s i o n on Accreditation of Healthcare Organizations to focus on prevention of disease transmission, 1~
we believe our added emphasis on this p r o g r a m was very worthwhile. Kathleen L. Hall, RN, BSN, ClC Sharon S. Holmes, RN, MSN Martin E. Evans, MD University of Kentucky Hospital Lexington, Kentucky
References 1. Centers for Disease Control and Prevention. Influenza information: overview of surveillance. Atlanta (GA): CDC; 1996. Document 361101:1-2. 2. Centers for Disease Control and Prevention. Prevention and control of influenza. Recommendations of the advisory committee on immunization practices (ACIP). MMWR Morbid Mortal Weekly Rept 1996;45:1-22. 3. Pachucki CT, Lentino JR, Jackson GG. Attitudes and behavior of health care personnel regarding the use and efficacy of influenza vaccine. J Infect Dis 1985; 151:1170-1. 4. Lewy R. Immunizations among hospital personnel. J Occnp Med 1987;29:433-6. 5. Pachucki CT, Walsh Pappas SA, Fuller GF, Krause SL, Lentino JR, Schaaff DM. Influenza A among hospital personnel and patients. Implications for recognition, prevention, and control. Arch Intern Med 1989;149:77-80. 6. Adal KA, Flowers RH, Anglim AM, Hayden FG, Titus MG, Coyner B J, et al. Prevention of nosocomia] influenza. Infect Control Hosp Epidemiol 1996; 17:641-8. 7. Nichol KL, Lind A, Margolis KL, Murdoch M, McFadden R, Hauge M, et al. The effectiveness of vaccination against influenza in healthy, working adults. N Engl J Med 1995;333:889-94. 8. Herwaldt LA. Greek philosophy, medical ethics, and the influenza vaccine. Infect Control Hosp Epidemiol 1993;14:15-6. 9. Evans ME, Hall KL, Berry SE. Influenza control in acute care hospitals. Am J Infect Control 1997;25:357-62. 10. Joint Commission on Accreditation of Healthcare Organizations. Surveillance, prevention, and control of infection; 1996 comprehensive accreditation manual for hospitals: the official handbook. Oakbrook Terrace (IL): JCAHO 1996;IC:I-26.
Letters to the editor 3 6 7
Volume 26, Number 3
REPLY
To the Editor: We a p p r e c i a t e d the t h o u g h t f u l c o m m e n t s regarding our article on the use of tap water for gastrointestinal e n d o s c o p i c p r o c e d u r e s . The major issue brought forth by Patton is the potential for deposits forming on or around the opening of the air/water opening at the tip of the endoscope. We agree that occlusion of this very small opening m a y lead to scope malfunction and possibly the need for m i n o r repair. Clearly, even a m i n o r repair to an endoscope could outweigh the cost of sterile water or deionized water as suggested. Although this concern is not unreasonable, we know of no evidence that this even occurs. In o u r cumulative experience of more than 20 years of endoscopic nursing and clinical practice, we know of no time that "deposits" occluded the air/water jet. In contrast, we do have experience with occlusion of this port by debris such as blood or even lint from cleaning the endoscope with towels. In addition, given the use of sterilizing equipment that flushes the channels, it seems unlikely that, even if small deposits develop, they could b e c o m e clinically significant. We believe that the m a j o r issue of using tap w a t e r is a practical one given that o u r data suggest that the infection risk is minimal. Using w h a t e v e r w a t e r is available is a p r a g m a t i c issue, especially in b u s y e n d o s c o p y units w h e n procedures are done outside of the unit, such as in the intensive care units. If the w a t e r bottle runs out, do we hold the p r o c e d u r e while we look for sterile water? I hope not. We w e l c o m e f u r t h e r studies on the use of tap w a t e r and the potential for deposit f o r m a t i o n on the air/water opening. Until such time that this has b e e n s h o w n or o u r clinical experience proves wrong, we will c o n t i n u e with o u r current infection control practices. C. Mel Wilcox, M D Associate Professor of Medicine Chief of Endoscopy J e a n e t t a Blakely, RN, BSN Nurse Manager, Endoscopy University Hospital Birmingham, Alabama
I N C R E A S I N G H O S P I T A L E M P L O Y E E PARTICIPATION IN A N I N F L U E N Z A V A C C I N E P R O G R A M
To the Editor: Each year 10% to 20% of Americans are infected with influenza, and approximately 20,000 die of the disease or its complications.~ The Centers for Disease Control and Prevention r e c o m m e n d s
I
Fig. 1. The air/water jet on the end of the endoscope has an extremely small opening, approximately 30-gauge size.
that health care workers be i m m u n i z e d against influenza to prevent infection and s u b s e q u e n t transmission to high-risk patients in health care settings. 2 In spite of this, immunization rates a m o n g health care workers remain low. 3,4 Even after large outbreaks a m o n g patients and staff members, rates seldom exceed 40%. 5.6 The University of Kentucky Hospital offers the influenza vaccine annually to hospital workers at no charge. From 800 to approximately 1300 (34% to 55% of eligible health care workers), have been immunized each year during the past 4 years. We wanted to increase the n u m b e r of persons immunized and instituted an aggressive, multifaceted immunization campaign for that purpose. Beginning 2 weeks b e f o r e actually administering the vaccine, 100 posters, supplied by C o n n a u g h t L a b o r a t o r i e s ( S w i f t w a t e r , Pa.), were placed in highly traveled areas througho u t the hospital along with a schedule of w h e n and w h e r e vaccinations w o u l d be available. These p o s t e r s e m p h a s i z e d the i m p a c t influenza could have on a person's w o r k and social life. All e-mail users were notified of the u p c o m i n g campaign, and e d u c a t i o n a l materials were dist r i b u t e d t h r o u g h d e p a r t m e n t heads. The i m m u n i z a t i o n c a m p a i g n w a s k i c k e d off at the Infection Control Fair, held in the hospital as part of national Infection Control Week sponsored by APIC. The fair was held in the hospital a u d i t o r i u m on a S u n d a y a f t e r n o o n and all of the next Monday. The fair included banners, decorations, movies, a n d g a m e s designed to teach infection control principles, and the vaccine was administered. P o p c o r n was p r e p a r e d and the d o o r s of the r o o m were kept o p e n to ensure that the a r o m a m a d e its w a y d o w n near-
AJIC June 1998
3 6 8 Letters to the editor
by h a l l w a y s . Vaccine r e c i p i e n t s received a c o u p o n for a free slice of pizza at the hospital cafeteria a n d were eligible to e n t e r a d r a w i n g for several prizes. The g r a n d prize was two tickets to a Wildcats basketball g a m e a n d a University of K e n t u c k y s t a d i u m jacket. The c a m p a i g n was c o n t i n u e d t h r o u g h the next w e e k a n d on a m a k e u p date 2 weeks later in a small area located n e a r the cafeteria. In addition to these activities, n u r s i n g units could take a d v a n t a g e of a "Flu Vaccine Cart" if t h e y wanted to i m m u n i z e a d d i t i o n a l persons. The success of the c a m p a i g n exceeded our expectations. Fully 1958 individuals received vaccine. This was a 51% increase in the n u m b e r of vaccinations c o m p a r e d with 1995 (1297). The total cost of incentives a m o u n t e d to $3568. We calculate t h a t the p r o g r a m will pay for itself if it prevents 17 days of sick leave. Others have s h o w n that i m m u n i z i n g h e a l t h y working adults against influenza is beneficial. In one study, i m m u n i z e d adults h a d 25% fewer upper-respiratory illnesses, 43% fewer days of lost work, and 44% fewer visits to physicians t h a n those who h a d not been i m m u n i z e d . 7 Preventing influenza is even m o r e i m p o r t a n t in the health care setting where t r a n s m i s s i o n to vulnerable patients can occur. A n u m b e r of strategies have b e e n p r o p o s e d to i n c r e a s e i m m u n i z a t i o n rates a m o n g health care workers, ranging from c o m p u t e r - g e n e r a t e d reminders to m a k i n g the vaccine m a n d a t o r y 2 We recently analyzed the i m p a c t of influenza on patients a n d decided that a vigorous c a m p a i g n with incentives was the best m e t h o d . 9 The very favorable response to our efforts suggests that, for us, "the carrot is better t h a n the stick." With the recomm e n d a t i o n by the J o i n t C o m m i s s i o n on Accreditation of Healthcare Organizations to focus on prevention of disease transmission, 1~
we believe our added emphasis on this p r o g r a m was very worthwhile. Kathleen L. Hall, RN, BSN, ClC Sharon S. Holmes, RN, MSN Martin E. Evans, MD University of Kentucky Hospital Lexington, Kentucky
References 1. Centers for Disease Control and Prevention. Influenza information: overview of surveillance. Atlanta (GA): CDC; 1996. Document 361101:1-2. 2. Centers for Disease Control and Prevention. Prevention and control of influenza. Recommendations of the advisory committee on immunization practices (ACIP). MMWR Morbid Mortal Weekly Rept 1996;45:1-22. 3. Pachucki CT, Lentino JR, Jackson GG. Attitudes and behavior of health care personnel regarding the use and efficacy of influenza vaccine. J Infect Dis 1985; 151:1170-1. 4. Lewy R. Immunizations among hospital personnel. J Occnp Med 1987;29:433-6. 5. Pachucki CT, Walsh Pappas SA, Fuller GF, Krause SL, Lentino JR, Schaaff DM. Influenza A among hospital personnel and patients. Implications for recognition, prevention, and control. Arch Intern Med 1989;149:77-80. 6. Adal KA, Flowers RH, Anglim AM, Hayden FG, Titus MG, Coyner B J, et al. Prevention of nosocomia] influenza. Infect Control Hosp Epidemiol 1996; 17:641-8. 7. Nichol KL, Lind A, Margolis KL, Murdoch M, McFadden R, Hauge M, et al. The effectiveness of vaccination against influenza in healthy, working adults. N Engl J Med 1995;333:889-94. 8. Herwaldt LA. Greek philosophy, medical ethics, and the influenza vaccine. Infect Control Hosp Epidemiol 1993;14:15-6. 9. Evans ME, Hall KL, Berry SE. Influenza control in acute care hospitals. Am J Infect Control 1997;25:357-62. 10. Joint Commission on Accreditation of Healthcare Organizations. Surveillance, prevention, and control of infection; 1996 comprehensive accreditation manual for hospitals: the official handbook. Oakbrook Terrace (IL): JCAHO 1996;IC:I-26.