In this podcast, our clinical managers Patricia Howell and Daniel Pitner will discuss the top 5 actions you can take to be prepared to fight the flu in your facility this season.
- Patricia Howell, Clinical Support Manager, McKesson Medical-Surgical
- Daniel Pitner, Clinical Support Manager, McKesson Medical-Surgical
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[Patricia] Hello, listeners. This is "McKesson Clinical Connection" Talk where we talk about regulatory issues and changes in the health-care environment that has the potential to affect the clinical and financial outcomes for our customers.
I'm your host Patricia Howell, clinical support manager on the McKesson Clinical Resource Team. I'm excited to tell you about our guest speaker today, my fellow clinician Daniel Pitner, also a clinical support manager on the McKesson Clinical Resource Team. And Daniel is passionate about educating health-care organizations and getting their staff and residents vaccinated in support of flu prevention.
As you're aware, Daniel, every year millions of people get sick, and hundreds of thousands are hospitalized and thousands to tens of thousands of people die from the flu. With your help today, we're going to discuss five actions that our customers can take to help protect themselves, their residents and their staff from the flu.
[Daniel] Well, thanks, Pat. I'm actually really excited to be joining you on the call today, as this is a very important topic to talk about. The first action that our customers can take is to maintain compliance with existing state and federal regulation. Now, in particular, I want to focus on the F-883 influenza and pneumonia immunizations.
This regulation intends to help minimize each resident's risk of acquiring, transmitting, or experiencing complications for either influenza or pneumococcal disease. Lowering your resident population's risks lowers your staff's risk as well.
Because flu season is right around the corner, I'd like to spend today focusing on the flu. Daniel, can you share with us the intent of this regulation as it relates to the flu?
Certainly. We can focus on the flu. So, particularly, the F-833 tag is intended to help minimize the risk of patients acquiring, transmitting or experiencing complications from influenza disease, and it does that by ensuring that each resident has the following treatment.
First, that they're informed about the benefits and the risk of immunization. Second, that they have the opportunity to receive influenza and pneumococcal vaccines unless it's medically contraindicated, refused or they've already been immunized. Third, it ensures the documentation is made in the resident's medical record as the information or education that's provided regarding the benefit and the risks of immunization and the administration or the refusal of or medical contraindication to the vaccine.
Also, surveyors will conduct record review, and they'll be looking for several things. First, they'll be looking to see that the resident or the representative is provided with education on both the benefits and potential side effects of the immunization. The resident or representative should be provided with the opportunity to refuse.
For influenza, residents can be offered the immunization between the dates of October 1st and March 31st on an annual basis unless the resident has already been immunized during that time frame or is medically contraindicated. Last, the regulatory guidance notes that the centers for disease control recommends administrating the influenza vaccine when it becomes available rather than on a specific day.
Okay. So, the next action, that is for staff and residents to get vaccinated. Daniel, what can you tell us about the types of flu vaccines on the market for residents, patients and staff?
Well, Pat, the first thing I can tell you is that this is probably the most difficult question and sometimes can cause the most confusion. And, you know, as there are just so many different types of vaccines. But to clarify, there's three general presentations. You're going to have intranasal, multidose vials, and prefilled syringes.
The multidose vial presentation, it contains preservatives by default whereas the intranasal sprays and prefilled syringes are preservative free. Also, there's two general culture media. They could be egg-based or cell and DNA-based. Until recently, poultry egg was the most prevalent and most cost-effective, and an example of an egg-based vaccine is Afluria.
But now, with cell and recombinant DNA cultures, some have shown increased effectiveness, and this is because the virus has no opportunity to interact with poultry egg which can reduce effectiveness. An example of those types would be either Flublok or Flucelvax.
Third, flu vaccines are formulated to target two general populations, either the general population or geriatric patients. The general population is defined as anyone from ages 6 months and up and the vaccines that are in that category would be Afluria, Fluarix, and FluLaval, Flublok and Fluzone Quad, as all of those target the general population.
Flu vaccines that target the geriatric population is focused on anyone above the age of 65, 65 and up really. And those are specially formatted to address compromised immune systems by either using a higher dose concentration or adding an adjuvant that helps to create a stronger immune response.
Daniel, when it comes to employee participation, things can get a bit challenging. What do you recommend to facilities to help increase vaccination rates of staff?
Yes. Well, that is a tough one. And I think, you know, at heart, our clinicians are health-care workers because they want to help heal and protect their patients, and I think maybe if we can focus on that, that generally can help increase the vaccinations among staff.
But to give a few bullet points, I think there's a couple of ways that we can do that. First, we can share the benefits of vaccination. We can also let them know that the flu vaccine does not cause the flu. We can also highlight influenza prevalence. For example, we can use the 2019 or 2020 season as an example. You know, if staff believe that influenza is not serious, that's when we can share hospitalization statistics, and we can also highlight the symptoms and even bring in the costs that are associated with those infections.
And if they believe that the influenza vaccine causes illness or side effects, in that instance, we can increase their comfort level by noting extensive research on the vaccine benefits, and we can address their safety concerns.
Thank you. Now, let's talk about storage. We don't want any of our customer's flu vaccines going to waste. Daniel, what would you suggest are storage best practices for refrigerated vaccines such as the influenza vaccine?
You know, Pat, that's a great question, and historically, in the past, that is something that, you know, customers of mine have had to deal with. And so, to address those things, I've tried to come up with a few just helpful dos and don'ts that I think can be something that can help structure the storage process. So, first, do overcommunicate with your flu vaccine provider as the date for the vaccine delivery approaches.
McKesson specifically, we have flu connections and flu specialists, and they've developed a refined system of contacting customers upon vaccine shipment, and they give detailed descriptions of the arrival times. Second, do designate a single individual or a small group of employees as designated vaccine handlers who will take receipt of vaccine from delivery professionals.
And coming off of that, do not allow unspecified staff to sign for vaccines, and also, do not allow received vaccine to stay in non-refrigerated areas longer than necessary. Also, do keep vaccines in a dedicated refrigerator, and preferably with a thermometer with an external display to visualize the current temperature.
Specifically, McKesson provides temperature data loggers that are specifically designed for this type of temperature control, but per CDC, they do recommend that you use a thermometer with an external display. Also, do keep those vaccines in the target maintenance temperature that the CDC recommends which is 36 to 46 degrees Fahrenheit.
Also, do provide a consistent organization model for vaccine storage. And so, the CDC recommended things like using separate bins or shelves for each vaccine, or keeping them stocked according to their expiration date beginning with the batches closest to expiration at the front so that they get used before they expire.
And then, last, the really simple is they come in these original small boxes, keep them in the boxes as that helps prevent light exposure that can prematurely damage the vaccine.
- I love those dos and don'ts. I think they're very helpful. To help ensure the safe delivery of care during vaccination visits, providers should have administrative protocols in place for vaccine administration, right? So, Daniel, what are the basic administrative policies and procedures that should be in place before administering vaccines?
- That's a great question, Pat. You know, I think when we're thinking about principles of administration policies, they'll vary. In general, we want to review the resident's vaccination history as they may have received the flu vaccine before being admitted to a facility. We want to screen those patients also for contraindications and precautions before the vaccine is administered, even if the same vaccine was administered previously.
Patient's health status or the recommendations for contraindications and precautions may have changed since the last time a dose was given. Also, health-care personnel should be prepared to provide comprehensive vaccine information to the resident and the resident representative. So, every flu season, vaccine information statements or VISs for short are produced by the CDC, and these are information sheets that explain the benefits and the risk of a vaccine.
Just remember that VISs must be given first to anyone receiving a vaccine or to that person's parent or caregiver every time a dose of vaccine is administered even if the patient has received that vaccine or VIS in the past. And third, before administering the vaccine to allow time for questions. You know, we want to, after educating those residents, it's time to give the vaccine and just, we want to stress nurses should be the one preparing the vaccines.
As proper preparation, it's critical for maintaining the integrity of the vaccine during transfer from the vial to the syringe. They should always use aseptic technique, and they should follow infection prevention guidelines when prepping those vaccines. Proper vaccine administration guidelines should be followed. So, each vaccine has a recommended administration route and site, and that information is generally included in the manufacturer's package insert for each vaccine.
But deviation from those recommended routes may reduce the vaccine efficacy, and it can increase the local adverse reactions. So, after the vaccine is administered, the nurses should monitor the patients for side effect such as injection site pain, fever, or fussiness. And of course, Pat, health-care providers are required by law to record the vaccination administration and education in the patient's medical record, and that record can either be in electronic or in a paper form.
- Mm-hmm. Very good. Daniel, we understand that unfortunately, getting the flu vaccine isn't a guarantee that the person won't get the flu, but it is thought to provide at least partial immunity. If a person does catch the flu despite getting the vaccine, their symptoms may be milder, and they can be treated, right?
So, can you tell us about antiviral treatment?
- You know, Pat, I'm glad you bring that up because, you know, when a resident is experiencing flu-like symptoms, they should be tested to confirm the flu, but the CDC actually recommends starting the antiviral as soon as possible, not waiting for the confirmation of the flu. You know, the antiviral works best when it's started within the first few days of symptoms.
So, if an outbreak is determined, all residents in the facility should receive antiviral chemoprophylaxis as soon as an outbreak of flu is determined. We should encourage your customers to have enough infection control supplies on hand in case of an outbreak, and that includes antiviral treatment. McKesson specifically sells several different antiviral medications.
So, for more information about what's available to our customers, we would encourage them to contact their local account manager.
Thank you. Daniel, there's one additional type of customer population I'd like you to talk about and that is correctional facilities. What general prevention recommendations would you make for that type of facility?
Hmm. That's a good question. And, you know, Pat, specifically on this, I would say this is going to be more along the lines of principles because correctional facilities vary in their administrative policies, or in state regulations or there's so many factors, but these will just be some principles.
So, first, we want to encourage all persons within the facility to cover their cough or sneeze with a tissue. We want to throw those tissues in the trash after each use. We want to maintain good hand hygiene by washing with soap and water or using an alcohol-based hand sanitizer, especially after coughing or sneezing.
Of course, we want to avoid touching the eyes, nose and mouth without cleaning their hands. And for more information on that, the CDC has a helpful document that's called interim guidance for infection control for the care of patients with confirmed or suspected novel influenza A or H1N1 virus infection in a health-care setting that we would encourage our listeners to see. Second, we want to make the means for appropriate hand cleansing readily available in the facility.
And that's going to include in intake areas where inmates are booked and processed, visitor entries and exits, visitation rooms, common areas, and staff-restricted areas in addition to laboratories, and food prep and dining areas. The means for hand cleansing are ideally running water, soap and hand drying machines or paper towels and wipe baskets.
But alternatively, except in laboratories and food prep areas, alcohol-based hand sanitizers may be used as well. Third, we want to clean all common areas within the facility routinely and immediately when visibly soiled with the cleaning agents normally used in those areas. Eating utensils should be washed either in the dishwasher or by hand with water and soap, and cups and utensils should not be shared until after washing.
Last, respiratory hygiene and cough etiquette should be implemented beginning at the first point of contact with a potentially infected person to prevent the transmission of all respiratory tract infections in the correctional setting.
- That's great information. McKesson has a plethora of resources for our customers. Before we sign off today, Daniel, can you tell us what does McKesson have to share with customers to support their flu efforts for flu prevention?
You know, Pat, I'm actually very excited to talk about this because at McKesson, we take the flu disease seriously, and we take the safety of our customers and their patients seriously. And so, because of that, McKesson has actually created the FluWise program which it's a comprehensive year-round program that gives our customers access to a large variety of professional flu products, promotional offers and support with McKesson's dedicated Flu Connection Team.
Also, the monthly "FluWise" e-newsletters are full of important market updates, trends and best practices for flu season, and you can access the "McKesson Clinical Connection" webinar series with key topics like flu prevention, hand hygiene and infection prevention.
- Daniel, thank you so much for sharing your expertise with us today and for this helpful information. This has really been a great episode of "McKesson Clinical Connection" talk. If you would like to learn more about the upcoming flu season or order your flu vaccine, please, go to mms.mckesson.com/fluwise.
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