Looking for a way to save money? Consider vaccinations and immunizations. According to Katherine West, BSN, MSEd, CIC, infection control consultant for Infection Control/Emerging Concepts Inc., a simple inoculation could save your agency a significant amount of money. “Prevention up front is 60—80% less costly than one exposure,” she says.
Unfortunately, misinformation and hysteria have resulted in large groups of Americans who are under immunized, resulting in the resurgence of diseases thought to have been eradicated, including measles and mumps.
Last year, two major outbreaks of mumps in summer camps in upstate New York resulted in more than 2,000 cases. Once the outbreak was identified, the campers were sent home, infecting fellow travelers on buses, trains and planes. Healthcare workers tending to the children also came down with the mumps. “That was our clue that we needed to get immunization records [for healthcare providers],” West says.
An immunized worker who has been exposed to the mumps may continue to work, says West. They must simply watch for signs and symptoms of the disease. However, non-immunized personnel must be off the job or on work restriction for 12—26 days. Add work replacement to those costs, and a clear case can be made that vaccines save money. “Doing the cost/benefit is really easy math,” she says.
EMS agencies should consider that, very soon, hospitals won’t be reimbursed for some patients who become ill while in their care. If your employee is the cause of a patient illness, the hospital may come to you to recover their costs.
“Vaccines are the key to not getting sick,” West says.
It’s the law
West says the Society of Healthcare Epidemiologist of America, the Association for Professionals in Infection Control and Prevention (APIC) and the American Academy of Pediatrics have all recently published papers in favor of mandating that all healthcare workers receive routine vaccines, such as HBV (hepatitis B) vaccine, MMR, TDaP, chickenpox vaccine, flu vaccine and tuberculosis testing. Although the Centers for Disease Control and Prevention (CDC) produces guidelines, the Occupational Safety and Health Administration (OSHA) is enforcing those guidelines. “Therefore, they are the law of the land,” West says.
Employers will need the immunization records for all personnel, including volunteers. “It should be part of the hiring process,” West says.
Although it’s not yet a mandate to keep immunization and vaccination records on all personnel, from a risk management standpoint, it might as well be. All agencies should have immunization records for current personnel. If not, they can be obtained from high schools, training programs or previous employers. However, because immunization records legally belong to the individual, only that person can request them. All employers are required to keep these records for the duration of employment, plus 30 years.
Should an exposure occur, documented evidence of immunizations must be readily available at the work location of employment, not locked in a human resources office where it might be inaccessible should an exposure occur on a weekend or after regular business hours. The idea is to help jumpstart proper post-exposure management, West notes.
Even if EMS crews are exposed to a suspected, but not confirmed, infected patient, hospitals must notify the agency or department of a potential exposure. The disease list under the Ryan White Notification Law is being expanded to cover all reportable diseases.
According to a statement from OSHA, any employee can opt out of a vaccine for medical reasons. However, they must sign a declination form. “This is not an option,” West says.
Measles, mumps & rubella
Unfortunately, having received an MMR vaccine–the immunization shot against measles, mumps and rubella (also called German measles)–may not ensure immunization. According to the CDC, those born between 1963 and 1967 were given a killed virus and need to be revaccinated. After 1967, the vaccine administered consisted of a mixture of three live attenuated viruses. Those who received this vaccine are considered appropriately immunized. The shot is generally administered to children around the age of one year, with a second dose delivered just before the child starts school. The second dose is not a booster, but rather produces immunity in the approximately 2—5% of people who fail to develop immunity after the first dose.
Those born before 1957 most likely acquired immunity by contracting the diseases and had been considered immune due to exposure. Not anymore. Now, they must have a physician’s statement or records showing they either had the disease or received a titer. West says the titer to prove immunity costs more than the two doses of vaccine. “Just give them the vaccine,” she says.
The CDC states that agencies must counsel women who will be receiving the vaccine, telling them to avoid becoming pregnant for four weeks following each dose. If no counseling is provided, your agency could be held responsible for any potential birth defects. She suggests having the women sign a statement that they understand the counseling they received. Keep a copy in their confidential file.
Pertussis, TDaP & chickenpox
In 2011, there were more than 10,000 confirmed cases of pertussis in the U.S. Of those, 10 children died from this preventable disease. The CDC requires all healthcare workers, day care providers and parents of children receive a one-time booster of TDaP. In 2011, they revised the requirement to include all grandparents involved in the care of children. This includes grandparents over the age of 64.
The retail price of a single dose is just over $38. Public safety agencies can purchase the vaccine, without a markup, at the CDC rate of $28.54 per dose through the Public Health Department. To order, West says your medical director must write a prescription that can be taken to the Health Department. She recommends also taking a copy of the paragraph from the CDC to prove that your agency can purchase it through them.
In 2006, the CDC said that healthcare agencies must start establishing a screening process for chickenpox among personnel who provide direct patient care. Proof of immunization is required. If an employee says they’ve had the disease, they must be titered to provide the required proof. In this particular instance, West says, the titer is less expensive than the vaccine. Those who have not been immunized must be given the vaccine.
Chickenpox vaccines are administered in two doses, one month apart. The retail cost is $83.77 per dose, before any markup. The CDC sells each dose for $55.36. This is also a live virus and requires proper counseling for women who may become pregnant.
Flu vaccine
Vaccination remains the cornerstone of preventing influenza, a contagious respiratory disease caused by influenza viruses. Each year, experts from the U.S. Food and Drug Administration, World Health Organization, CDC and others in the public health community study virus samples and patterns collected worldwide to identify virus strains likely to cause the most illness during the upcoming influenza season. Based on that information and their recommendations, the strains selected for the 2011—12 influenza season are the same as the past two years. “I have never seen this happen,” West says.
The concern is that some people will not get the flu shot this year because they already had one the previous year. Everyone should be encouraged to get the vaccine, West says. Testing indicates that a significant number of people may not have built up enough immunity. “You should get the vaccine every year,” she says. “You retain protection.”
Last year, only those 6 months old and older were advised to get a flu shot. This year, the CDC’s Advisory Committee on Immunization Practices voted for “universal” flu vaccination in the U.S. to expand protection against the flu to more people. Although anyone can receive the shot, the nasal spray is approved only for healthy people as young as 2 years and up to 49 years of age. Curious about that particular age cutoff, West investigated and found that the CDC simply didn’t test the vaccine on anyone over 50.
Employers must pay for the flu shot. If an employee refuses the shot, they must sign a declination form to show the employer met its obligation under the CDC and NFPA 1581 infection control regulations. West says disciplinary action can be taken if an employee will not sign the form. She suggests that employers track the percentage of employees who were immunized each year and provide adequate training to help improve those numbers.
Much of the resistance to the flu shot centers on a single study regarding autism that has since been thoroughly disproved. “There is no link between autism and vaccines,” West says.
Some unions have been referring to the New York State case where a court determined that a hospital could not require nurses to receive a flu vaccine. West says the only reason the court ruled in favor of the nurses was that the hospital could not guarantee that they had enough vaccine for the entire workforce. “You have to read the case law to get to the truth,” she says.
New data indicates that even individuals with low-level allergies to eggs can still get the flu vaccine. Eventually, this will not be a problem because the science is moving toward a genetically generated vaccine and away from the egg-based shots of the past.
The good news is that very soon the typical shots will be replaced by the nasal spray (also called LAIV or FluMist), a skin patch and interdermal shot using a much smaller needle. Scientists are also very close to a universal flu vaccine that will last for at least five years.
Tuberculosis testing
New employees must be tested for tuberculosis (TB). However, according to West, annual testing is not required or necessary. “That should save your department money,” she says. The sole exception is California, where CAL/ADT Regulation 5199 is requiring annual testing. “This is not science-based,” she says.
Testing for TB should depend on your annual risk assessment that is performed by your Designated Officer, West says.
Providing vaccines
West suggests that agencies consider bringing in a nurse or other certified provider to administer the vaccines. “You cannot administer vaccines unless it’s in your scope of practice and listed on your drug formulary,” she says. She also says that no one should be going to the emergency department for vaccines or treatment, because the markup there is often more than 300%.
Many agencies and departments have found that getting vaccines through the Health Department is problematic because that office is not keeping the records. Further, those records are not readily available to the employer should an exposure occur.
Summary
West feels strongly that all healthcare professionals should receive all appropriate immunizations and vaccinations. “There are obligations to patients because of our profession, and that gets lost sometimes,” she says. By providing vaccines to personnel, EMS agencies can protect co-workers and save money.
