Slide 1: Hello and welcome. Thank you for joining us. In this presentation, we are reviewing the targeted, streamlined approach for healthcare facilities to capture influenza and COVID-19 vaccination status of healthcare personnel and reporting vaccination rates to NHSN.
Slide 2: NSHN launched the Healthcare Personnel Safety Component in 2009 as a way for healthcare organizations and public health agencies to monitor and report trends in fluid exposures, impact of preventative measures, and monitor influenza vaccination coverage among healthcare personnel (HCP). Additionally, it has allowed the CDC to monitor national trends to identify emerging hazards to healthcare providers and assess the risk of occupational exposure and infection. In December 2020, with the introduction of the COVID-19 vaccine, NHSN launched the weekly COVID-19 module to help monitor vaccination trends and assess for gaps. This module will address specifically the NHSN reporting standards and requirements for healthcare personnel influenza and COVID-19 vaccination. The presentation is approximately 10 minutes in length and will provide links and resources for further information and review. This is a narrated PowerPoint presentation that may be viewed as needed.
Slide 3: After viewing this module, the learner will be able to identify how to accurately capture healthcare personnel influenza and COVID-19 vaccination status as well as how and when to report vaccination rates to NHSN.
Slide 4: The influenza virus can be highly contagious, even when people are pre-symptomatic. Infected healthcare providers can transmit influenza to others without knowing, including too vulnerable hospital patients. Putting patients at risk for infection is a significant safety concern and can lead to poor health outcomes. Additionally, studies show that that influenza vaccination among healthcare personnel is associated with reduced risk for illness, reduced work absenteeism, reduced medical visits and reduced antibiotic use.
Slide 5: At the start of 2020, the world experienced the major outbreak of the highly contagious COVID-19 virus, which spread rapidly and caused a global pandemic. Vaccines were introduced in December 2020, in limited quantities, to targeted populations, including healthcare personnel. Healthcare personnel are encouraged to vaccinate as one part of several measures to stop the spread of COVID-19 and reduce risk to hospitalized patients.
Slide 6: The links and documents provided on this slide cover all of what we will be reviewing today. If possible, it would be beneficial to your learning and comprehension to have them open and available as you continue this module. Be sure to save, bookmark, and download all pages and documents for future use and reference.
Slide 7: Let’s talk about tracking and reporting influenza and COVID-19 vaccination. The flu season runs October 1 thru March 31. Healthcare personnel should receive and document their flu vaccination during that time each year. At this point in time, the COVID-19 vaccine series and boosters are offered year-round. Healthcare personnel should receive and document their vaccination when available. NHSN developed specific definitions and guidelines to assist facilities in monitoring and tracking vaccination rates among their care providers. Additionally, NHSN definitions, guidelines, and protocols are designed to ensure vaccine coverage and reporting is consistent and comparable across facilities and organizations.
Slide 8: Settings for monitoring healthcare personnel vaccination are all units and departments in CMS certified acute care and critical access hospitals. This includes any inpatient rehabilitation and inpatient psychiatric units or outpatient units or departments that share the same CMS certification number as the hospital.
Slide 9: The denominator for influenza vaccination tracking purposes consists of all healthcare personnel who are physically present in the healthcare facility for a least one working day between October 1 and March 31. For COVID-19 tracking, the denominator should include all HCP who are scheduled to work in the facility at least one day every week. For both, be sure to include all full-time, part-time, and PRN staff.
Slide 10: Let’s review the denominator categories. The first three categories are mandatory to report. The fourth category is optional, but highly encouraged. Employee HCP includes all staff who are listed on the facility’s direct payroll, regardless of clinical responsibility or patient contact. There are two separate and distinct non-employee HCP categories. One – licensed independent practitioners who are contracted to practice at the facility. For example, physicians, nurse practitioners, or physicians’ assistants. Two – adult students and/or trainees, (nursing students, medical students, etc.) and volunteers. The optional category – contracted personnel – includes contracted staff who provide direct and indirect patient care, such as agency nurses and nurse aides, patient transporters, central supply staff, housekeeping staff, or security staff. A full list of possible contracted and vendor healthcare personnel can be found in appendix A of both the influenza and the COVID-19 vaccination protocol documents. Facility NHSN reporters should consider all individuals who work in the hospital and place them in the appropriate denominator tracking category.
Slide 11: Let’s look at the influenza vaccination numerator categories. Please note – denominator and numerator categories are mutually exclusive. Meaning facilities will report the data for each numerator category separately for each denominator category. All numerator categories are mandatory. The categories are: one – vaccinated. All HCP who received influenza vaccine through the facility OR who provides appropriate documentation of having received vaccination at an alternate location. Two – clinical contraindications. For continuity and consistency, NHSN only accepts the following to be placed in this category – any HCP who has a severe allergic reaction to eggs or to any other component of the vaccine OR any HCP with a history of Guillain-Barré Syndrome within six weeks of a previous influenza vaccine. Three – declinations. This category will include all HCP who declined the vaccine through the facility and did not provide any documentation of having received the vaccine at an alternate location; all HCP who declined vaccination for religious or philosophical reasons; all HCP who continued to defer vaccination throughout the reporting period of October 1 – March 31. Also, please note, facilities may accept other medical conditions as contraindications to the vaccine. However, again, to ensure data is comparable across different facilities, these exceptions should be recorded in the declination category. Additionally, facilities should have a written policy outlining the appropriate conditions accepted as a contraindication. And four – unknown status. This category will include HCP with no known discernable status or who do not meet any of the above category definitions.
Slide 12: Here are the numerator categories for COVID-19 vaccination. Again, denominator and numerator categories are mutually exclusive. Facilities will report the data for each numerator category separately for each denominator category. All numerator categories are mandatory. The categories are: one – vaccinated. All HCP who received COVID-19 vaccine through the facility OR who provides appropriate documentation of having received vaccination at an alternate location. Two – clinical contraindications. For continuity and consistency, NHSN only accepts the following to be placed in this category – all HCP with a severe and/or immediate allergic reaction after a previous dose or an allergy to a component of the vaccine. Three – declinations. This category will include all HPC who decline the COVID-19 vaccine for any reason. And four – unknown status. Included in this category are HCP who did not meet definitions for above categories or who reported to have received vaccine at an alternate location but did not provide appropriate written documentation.
Slide 13: So where would you find all the data to complete mandatory reporting? Denominator and numerator data can be in management and personnel files, such as those in Payroll or Human Resources or in medical and occupational health records, such as those in Employee Health departments. If an HCP reports to have received the influenza or COVID-19 vaccine at an alternate location, they must provide written documentation that includes the date of vaccination and the location of where it was received. Verbal statements are not accepted. However, HCPs may provide either written or verbal communication of medical contraindication and declination.
Slide 14: Facilities are required at the minimum to report cumulative influenza vaccination data only once at the end of the reporting period. Data can be entered more frequently, for example monthly, and is encouraged as a way for facilities to have the greatest impact on their flu vaccination activities. However, please note, regardless of how often data is reported to NHSN, only cumulative data should be recorded. Additionally, each time new data is entered, it will overwrite previously entered information. Facilities wanting to keep track of its monthly numbers should maintain its own record of monthly summary reports as it will not be able to review previously entered data in NHSN. For COVID-19 HCP vaccination, as of June 2022, facilities are no longer required to submit a monthly reporting plan to NHSN. However, facilities are encouraged to gather data and report on a weekly basis as defined by Monday-Sunday. Please note, to ensure continuity, the weekly data is reported under the month that the weekend falls. For example, the week of Monday, August 28 – Sunday, September 3 will be reported for September.
Slide 15: The links on this slide are documents that will help track, monitor, and report influenza and COVID-19 vaccination of HCP in your facility. Be sure to save, bookmark, and download all pages and documents for future use and reference.
Slide 16: Explore these additional resources for further and more in-depth strategies for effective implementation of antibiotic stewardship activities and interventions.
Slide 17: Remember, you can contact NHSN anytime with questions and clarifications at nhsn@cdc.gov. Let’s get to work!