immunization education are vaccines safe and effective?
TRANSCRIPT
IMMUNIZATION EDUCATION
Are Vaccines Safe and Effective?
IMMUNIZATION EDUCATION
Pam Strohfus, RN, MA
Associate Chair of Pre-Licensed Baccalaureate Program
Boise State University
Central District Health Department Teresa Collins, RN – Immunization Program Manager
Boise State University Faculty Gail Gerding, PhD, Bonnie Lind, PhD
Acknowledgements cont…..
Boise State University-Senior Nursing StudentsLaury Roper, RN, Whitney Gochnour, RN, Jessica Ferguson, RN, Jeanette McCown, RN, Heidi Massengale, RN, Amy Ransom, RN, Alyson Logan, RN, Victoria Lewis, RN, Terry Woychik, RN, Lisa Hines, RN, Sue Oaks, RN, Cara Williamson, RN, Carmen Garnier, RN, Laura Hein, RN, Victor Hernandez, RN, Amber Marsh, RN, Cheryl Suhr, RN, JoRae Thorne, RN, Melissa Blazer, RN, Gaylene Monroe, RN, Amanda Crutchfield, RN, Carissa Baron, RN, Becky Crawford, RN, Angela Morgan, RN, Vicki Williams, RN, Sheri Gates, RN, Taryn Hoffman, RN, Larisa Kogan, RN, Monica Mendoza, RN, Ainoa Autele Douglass, RN, Chantell Nelson, RN, and Rebekah Canfield, RN.
Partnership between Boise State University & Central District Health Department
Enhance safe immunization practices Healthy People 2010 - 90% immunization coverage
rates in the State of Idaho Increase accountability and safe immunization
delivery: Promoting legislative changes to follow the ACIP’s
immunization recommendations Educating physicians, nurses, medical assistants,
school nurses, and child care providers, many of whom are responsible for the administration and delivery of immunizations
Problem Identification
Idaho is 49th in the US for immunization coverage!
Why is Idaho so low?
What if the vaccines we give are ineffective?
Increase the risk of disease Decrease immunization coverage Inappropriately stored vaccine results in
less vaccine availability Cost for vaccine to re-immunize 1 million
children = $20 million to $36 million
Invalid Immunizations:Literature Review
Common immunization errors: Injection of the wrong vaccine, improper time interval
between doses, and route of administration, and missed opportunities resulting in a late or missing immunization (Mell, et al., 2005; Stokely, Maurice, Smith, & Klevens, 2004)
Medical office personnel each give 6-20 vaccines per day
Vaccines to triple by the year 2020
10.5% of all children nationally receive at least one invalid dose
12% or more of Idaho children receive at least one invalid dose
Invalid Immunizations - Midwest USA
In Iowa, 224 children received Varivax inappropriately stored.
Titers & reimmunized 42% of the children 6% had evidence of chicken pox like rash on
their medical records but not diagnosed as such
32 occasions of incorrect storage Cost = $750,000 (Welte, 2007)
Invalid Immunizations cont…..
30% of vaccine errors resulted from inappropriate scheduling (CDC, 2007)
Out of 16,211 children only 9% received immunizations at recommended ages
(Lumin, McCauley, Stokely, Chu, and Pickering. 2002)
53-82% of all vaccine shipments in the world are compromised in some way (Techathawat, Varinsathien, Rasdjarmrearnsook, & Tharmaphornpilas, 2007)
Forty five percent of all immunizations expire before they are used (JAMC, 2004)
Invalid Immunizations cont…..
Storage and handling issues are directly related to the personnel managing vaccines in the medical offices
(Bell, Hogue, Manning, & Kendal, 2001; Welte, 2007)
Failure to adhere to recommended specifications for storage and handling can reduce vaccine potency, resulting in inadequate immune response in the recipient
(Kroger, Atkinson, Marcues, & Pickering, 2006)
Craig (2008) reports diminished potency of the vaccine affects natural immune response, inadequately protects against diseases, and increases risk of adverse reactions
Research Questions
Research question(s):
1. What proportion of health care providers in Idaho have adequate knowledge regarding administration and storage of the MMR (measles, mumps, rubella) vaccines?
2. Are there significant differences among health care provider types in the proportion with adequate knowledge regarding administration and storage of the MMR (measles, mumps, rubella) vaccine?
Survey Conducted in August 2009 N=344
Cross-sectional study Survey hard copy Distributed by mailings to 350 volunteer
VFC provider offices in Idaho Sample size of 740 344 Respondents
23 questions Benchmark set at 82% or 5 wrong
Methodology
Descriptive study utilizing assessment research methods in order to evaluate knowledge related to the delivery and storage of the MMR immunization. Descriptive statistics used to describe the sample. Means examined to determine level of knowledge among respondents; ANOVAs and t-tests used to determine differences between groups. SPSS used for data analysis.
Reliability
•Idaho Survey •N = 344•Chronbach Alpha .794
Age Group of Personnel
0
5
10
15
20
25
30
20-29 30-39 40-49 50-59 > 60
Age of Personnel
Years of Education
Survey Participant Percent by Job Title
27%29%
26%
10% 9%
0%
5%
10%
15%
20%
25%
30%
35%
Mas LPNs RNs MDs/NPs Other,
Practice Type by Job Title
MA0
20
40
60
80
100
Family Practice
Pediatrics Other
MA
LPN
RN
MD/NP
Other
Self Proclaimed Knowledge Level about MMR (p<.001)
0%10%20%30%40%50%60%70%80%90%
A little Some Sufficient Above Average
Expert
nonPassPass
Gender Self Proclaimed Knowledge Level
60% Competency in MMR Delivery(Cronback Alpha .731)
0
10
20
30
40
50
60
70
Passed Not Passed
Health Care Personnel
Health Care Personnel
Survey Participants Passed vs. non Passed (Asymp Sig .001)
0
10
20
30
40
50
60
70
MAs LPNs RNs MD/NP
nonPassedPassed
Categories pass/non pass
0
20
40
60
80
100
nonpass
pass
Route(Asymp. Sig. .000)
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
LPN/MA RN MD/NP/Other
Percent 2/3 Wrong
Storage
Schedule(Asymp. Sig. 020)
0102030405060708090
% Right
MAsLPNsRNsMDs/NPsOther
Health Districts
Health District 6
Central District (4)
District nonPass/Pass
Results of Immunization Survey
Educational opportunities: Route Storage
Physicians, Nurse Practitioners and “other” category, i.e., pharmacists, require the most information and education
Immediate access to timely information is essential
Increased understanding increases compliance and greater immunization coverage
Recommendations for Further Study…
Research disease outbreaks & causes Connect to storage and administration
Standardize immunization education & training Change Idaho legislation to follow ACIP
recommendations Nationwide study on health care personnel
administering immunizations Peer education interventions to significantly
improve provider immunization knowledge and behaviors (Boom, et. al, 2007)
Immunization Education Program through Central District Health Department
Identify individual personnel educational needs, urban vs. rural educational needs, district educational needs
Education and training will be provided to 30 medical offices compared to 30 offices without training over the next 2 years
Grants received Jekker Trust Fund - $20,000 Regence Foundation – $49,000 Central District Health Department - $20,000
QUESTIONS?
References
Bell, K.N., Hogue, C.J.R., Manning, C., Kendal, A.P. (2001). Risk factors for improper vaccine storage and handling in private providers offices. Pediatrics. 107(6).
Bird, S. (2006, September). Medication errors: immunization. Australian Family Physician. 35, (9).
Boom, A.J., Nelson, C.S., Laufman, L.E., Kohrt, A.E., Kozinetz, C.A. (2007). Improvement in provider immunization knowledge and behaviors following a peer education intervention. Clinical Pediatrics. 46 (8), 706-717.
Centers for Disease Control and Prevention (CDC). (2010). Department of Health and Human Services. Retrieved January 10, 2010 from: www.cdc.gov .
Centers for Disease Control and Prevention (2008). Morbidity and Mortality Weekly Report. 57(35). 961-966. Retrieved on December 30, 2009 from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5735a1.htm.
Centers for Disease Control and Prevention (2008). National Immunization Survey July 2007 - June 2008 (Excel spreadsheet). Retrieved on December 30, 2009 from www.cdc.gov/vaccines/stats-surv/imz-coverage.htm#nis.
Centers for Disease Control. (2009). Epidemiology and prevention of vaccine-preventable diseases. Atkinson, W., Hamborsky, J., McIntyre, L., Wolfe, C., (Eds). (9th ed.). Washington DC: Public Health Foundation.
References
Centers for Disease Control and Prevention. (2010). Estimated vaccination coverage with individual vaccines and selected vaccination series among children 19-35 months of age by state – US, National Immunization Survey, A1/2005-Q4/2005 [Data file]. Available from National Immunization program Web site, http://www.cdc.gov/nip/coverage/NIS/05/tab03_antigen-state.xls
Central District Health Department, (CDHD), (2010). Retrieved February, 2010 from http://www.cdhd.idaho.gov
Craig, L. (2008). Keeping it cool: Maintaining the vaccine cold chain. Practice Nurse. November 21, 2008. Retrieved on 3/31/2009 from CINALH database through Albertson’s Library, Boise Idaho.
Cohen, N.J., Lauderdale, D.S., Shete, P.B., Seal, J.B., & Daum, R.S. (2003, May). Physician knowledge of catch-up regimens and contraindications for childhood immunizations. Pediatrics 3, (5).
Kroger, A.T., Atkinson, W.L., Marcuse, E.K., & Pickering, L.K. (2006). General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR, 55(RR-15); 1-48.
Lumin, E.T., McCauley, M.M., Stokely, S., Chu, S.Y., and Pickering, L.K. (2002). Timeliness of childhood immunizations [Electronic version]. Pediatrics, 110(5), 95-939.
Mell, L.K., Ogren, D.S., Davis, R, L., Mullooly, F.P., Black, S.B., Shinefield, H.R., et al. (2005). Compliance with national immunization guidelines for children younger than 2 years,
References
Petridou, E., Kouri, N., Vadala, H., Dalamaga, M., & Sege, R. (2004). Frequency and nature of recorded childhood immunization-related errors in Greece. Journal of Toxicology. 42(3), 273-276.
Phillips, T, Strohfus, P., Deckys, C, Thorne, J, Hernandez, V, Marsh, A, Suhr, C, Blaser, M,
(2008). “SHOT LINE” Reveals unregulated & unsafe practices. Presentation at the National Immunization Conference, Atlanta, Georgia.
Pickering, L., Wallace, G., & Rodewald, L. (2006). Too hot, too cold: issues with vaccine
storage. Pediatrics. 118, 1738-1739. Pigott, N., Novelli, V., Pooboni, S., Firmin R., Goldman A (2002). "The
importance of herd
Immunity against infection". The Lancet (British edition), 360(9333), p. 645. Preventing cold chain failure: vaccine storage and handling. (2004). JAMC,
2004, 171(9), 1050. 1996-1999 [electronic version]. Pediatrics, 115(2), 461-467. Shefer, A., Santoli, J., & Singleton, J. (2007). Measuring vaccination coverage:
Where are we now and where are we going? Journal of Public Health Management and Practice. Nov-Dec, 13 (6), 541-543.
References
Stokely, S., Maurice, E., Smith, P.J., and Klevens, R. M. (2004). Evaluation of invalid vaccine doses. (Electronic version]. American Journal of Preventive Medicine, 26(1), 34-40 Strohfus, P. (2008). Shot Line: An Immunization Resource. RN Idaho, 31(1), 17-18.
Strohfus, P., Gerding, A, Collins, T., & Lind. (2009). Idaho Immunization
Knowledge Assessment Tool survey. Manuscript in preparation. Techathawat, S., Varinsathien, P., Rasdjarmrearnsook, A., Tharmaphornpilas,
P. (2007). Exposure to heat and freezing in the vaccine cold chain in Thailand. Vaccine. 25, 1328-1333.
Welte, M. (2007). Poorly refrigerated vaccines force parents to get new shots for their children. North County Times. Retrieved January 10, 2010 from: http://www.nctimes.com/lifestyles/health-med-fit/article_37d633f4-e2a6-55e3-8d0c-5e4007ba8566.html
US Department of Health and Human Services, (DOH). Healthy People 2010: Understanding and Improving Health, (2nd edition). Washington, DC. US Government Printing Office, November 2000.
Varricchio, F. (2002) Medication errors reported to the vaccine adverse event reporting system (VAERS) [Electronic version]. Vaccine, 20(2002), 3049-051.