Leaders emphasize basics in light of flu vaccine shortage.



As state and city governments negotiated to obtain more flu vaccine, four flu-related deaths occurred at a Queens, N.Y., nursing home.

No doubt, there will be more deaths from flu this year, as there are every season. But the national shortage of vaccine looms over the most vulnerable population.

William Smith, president and CEO of Aging in America, Morningside House (AIAMH), said managers of the Bronx, N.Y., skilled nursing facility and Morningside's other services have reason to be concerned about flu season. "As an organization that provides services for more than 5,000 people," he said, "we have a 386-bed nursing home and we have 1,000 orders for vaccine--and we are getting zero."

According to the Centers for Disease Control and Prevention (CDC), on average, every year between 5 and 20 percent of the U.S. population gets the flu. More than 200,000 are hospitalized and 36,000 die from the illness when vaccine is widely available.

The virus can cause pandemics, however, when illness and death from flu-related complications run rampant. According to the CDC, infection rates are highest among children, but the rates of serious illness and death are highest among those 65 and older, particularly those who have medical conditions that place them at increased risk.

As chair of the American Association of Homes and Services for the Aging (AAHSA), however, Smith's concerns go beyond his facility. His message has been to use common sense to minimize exposure to potentially deadly contagions. "We have some preventative things going on," he said. "We're encouraging families early on that if you're sick, stay at home--we'll take care of mom."

Mary Leary, president and chief executive officer of Mather LifeWays in Evanston, Ill., said the most effective strategy for obtaining flu vaccine has been to work closely with existing providers. "Through close relationships with pharmacies and physicians' offices, we've been able to locate vaccine for (more than) 75 percent of our residents and many of our direct care workers," she said. "Until the vaccine becomes available, we're making a concerted effort to reinforce effective hand-washing techniques for residents and staff."

In addition, the facilities are emphasizing a wellness initiative focusing on "prevention as the key to good health," Leary said, "eat well, sleep well, exercise, etc."

Kenn Brown, president and chief executive officer of the Margaret Tietz Nursing and Rehabilitation Center in Jamaica, N.Y., said his facility has conducted in-service education about infection control, hand washing techniques and detecting early signs and symptoms related to the flu. The Tietz Center has received and administered 10 doses of vaccine, but it needs another 300.

Still others in the field have taken a wait-and-see approach to how big a problem the coming flu season might pose. Informal conversations at the recent AAHSA convention included comments such as "they always seem to find a way to work these things out," though officials were unwilling to voice such optimism.

The problem became public when the CDC announced that Chiron Corp., could not provide its vaccine because the Medicines and Healthcare Products Regulatory Agency (MHRA)in the United Kingdom (where its vaccine is produced) suspended the company's license to manufacture the product. That approximately halved the flu shots available in the United States.

From the moment the CDC announced a shortage of flu vaccine, "what if" scenarios have left leaders concerned about meeting the need as best they could. The leading associations of for-profit and non-profit facilities have banded together with the government to get a better assessment of where the greatest risks exist.

Supply and demand

According to the CDC, about 58 million flu shots would be available in the country this flu season. There are also approximately 3 million doses of LAIV (live attenuated influenza vaccine) available in the United States this season, which are administered nasally for those aged 5-49.

The CDC worked with American Health Care Association and National Center for Assisted Living (AHCA/NCAL), AAHSA, and Aventis Pasteur, which produces flu vaccine, to release a survey, which went out to thousands of LTC facilities. The CDC explained that the survey's purpose was to identify orders placed via sub-distributors or intermediaries (such as pharmacists), to get a better idea of the scope of the shortage.

Deborah Cloud, AAHSA's vice president for public affairs, said that upwards of 80 percent of the association's 5,600 members had responded to the survey. Susan Feeney, AHCA's director of public affairs, said that nearly 11,000 facilities logged onto the survey through its site, but she couldn't confirm how many of them were members.

The CDC survey results were not available at press time.

Suzanne Weiss, AAHSA's senior vice president for advocacy, said that anecdotal information has indicated that several private doctors are holding stock and are awaiting the CDC's survey results to show where the gaps are located. "(The doctors) don't know what the priority situation is," she said. "They want to know if they will need to provide more to nursing homes."

In light of the vaccine shortage, what needs to spread like a virus is basic information about flu prevention. "Please don't underestimate this," Smith said. "Even if we take all the precautions, we could have a flu epidemic in a heartbeat. It could be brought in by a resident, it could be brought in by a staff member, or by someone with a child who is in school. Everyone is very vigilant, but there's always a possibility."

This is where good old-fashioned infection control techniques are needed, said Larry Minnix, president and CEO of AAHSA. He said he spoke with a facility operator recently and asked whether the operator was worried about the shortage. "He said he didn't need to order the flu vaccine because he's already taken care of his needs (by ordering it privately). So he's not worried about it. But somebody else may be."

Hal Daub, president and CEO of AHCA/NCAL, said, "It is paramount that providers continue to do all they can to protect the health and well-being of long term care residents and the staff providing direct contact and care every day."

The CDC's recommended priority recipients for vaccination include adults aged 65 and older, residents of nursing homes and LTC facilities and health care workers involved in direct patient care. Such health care workers aren't merely your employees, it also means the emergency medical technicians or paramedics who might need to visit your facility. It's also important to recognize that children younger than two are also considered at risk, so employees with young children could be at slightly higher risk.

Smith of AIAMH said that education of the workforce is the key. "I'm not worried about them catching it (from a resident in the facility). I'm worried about their kids bringing it home with them from school."

Staffing

The potential problems of people unable to go to work should also likely be addressed through common sense. "Our infection control nurses are very much involved with our (human resources) people," Smith said of his facility. "We will have some staff who never use a sick day. We encourage them if they're sick to stay home. That's probably the best they could do."

Of course, people do have a choice in the issue, Minnix noted, and facilities should set their own policies. "Some people can choose not to take the flu vaccine," he said. "Even with the flu vaccine, some people will get the flu. There are a lot of variables here. Is there enough flu vaccine? Probably not. That's the issue we have to deal with."

Smith recounted the frequent encouragement he gave an administrator who had refused for years to get a vaccine and "lead by example." When she received the vaccine last year, however, she came down with the flu. Smith said he's not encouraging her this year, but he sees the irony. "What it says to me is, OK, you may have a sensitivity to the vaccine, but the research clearly shows that for the general public the vaccine is very helpful."

Minnix added, "That happens every winter.... The good facilities will have protocols in place (to deal with the problem)."

Rip Out This Page Copy And Post For All To See.

Efforts at preventing the flu in your facility shouldn't be much different than dealing with any other communicable disease. The challenge, of course, is the direct patient contact that is inevitable in a community.

Here are some recommended steps to prevent the flu in your facility. The suggestions come from the Centers on Disease Control and Prevention as well as from veteran facility operators.

Feel free to rip this page out, make copies, and tack them up in appropriate places in your facility.

* Keep a supply of alcohol wipes or hand sanitizer at your front desk for residents, staff, and visitors to use;

* Avoid close contact with people who are sick, and when you're the sick person, keep your distance from others;

* If you're sick and contagious, stay home. You will help prevent others from catching your illness;

* Your mother was right, cover your mouth and nose when coughing or sneezing;

* Wash your hands with soap and hot water often to help protect you from germs;

* Keep a supply of disposable tissues available at your reception area.

* Encourage your staff and residents to get a good night's sleep every night to lessen their vulnerability to infection;

* A healthy body fights off infection better than a run down body. Encourage staff and residents to keep fit;

* Avoid touching your eyes, nose or mouth. Germs are commonly spread when people touch something that is contaminated with germs and then touch these areas;

* The Centers for Disease Control (CDC) Web site at www.cdc.gov features a page of Influenza facts and tips for health care professionals, including vaccination, infection control, clinical description and diagnosis, patient and provider education, training and flu bulletins;

* Web sites for the American Medical Directors Association (AMDA) at www.amda.com, Long Term Care Pharmacy Alliance (LTCPA) at www.Itcpa.org, American College of Health Care Administrators at www.achca.org and American Association of Homes and Services for the Aging (AAHSA) at www.aahsa.org feature periodic updates on the flu vaccine shortage and how it applies to their respective memberships;

* In addition to periodic influenza vaccine alerts, the American Health Care Association (AHCA) Web site at www.ahca.org includes links to numerous flu awareness promotion materials, such as healthy habits, facts about the flu vaccine, proper infection control for flu transmission and ways not to get the flu;

* The American Society of Consultant Pharmacists (ASCP) Web site at www.ascp.com has an Influenza Vaccine Resource Page with an updated status of flu vaccine supply, positive aspects of the vaccine situation and links to other resources;

* The American Association of Retired Persons (AARP) offers a toll-free number to help members and others report suspected price gouging for flu shots.

In general, anything more than $30 excluding doctor visits and fees could be an overcharge. The number is (877) FLU-COST or (877) 358-2678. More information is available at www.aarp.org;

* USAToday's Web site at www.usatoday.com includes a special section on the flu vaccine crisis, identifying state-by-state shortage areas and priority recipients, and a offering flu primer with Q & A items.

--MS, AN

Senior Editor Alan Naditz also contributed to this story.

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