Know Your Wire

By Albert Koroloff

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Lately the Oregon VFC program has noticed an increase in provider calls about wild temperature fluctuations on continuous tracking logs.

Usually these types of calls lead us to suspect a bad compressor or fan, but not even the worst equipment failure could explain a drop to -150C in less than 10 minutes. No…these temperature anomalies seem to be coming from the data loggers themselves.

Through some keen investigational work (e.g. calling the vendor) we found that thermocouple wires bundled with some loggers are too fragile for commercial use. These thin wires tend to kink in the refrigerator/freezer door which leads to reading errors, most often presenting as impossibly large temperature jumps or dips.

Check to see if you’re using this style of wire by closely inspecting the outer sheath. If it’s a thin, loosely woven white nylon material, you win the prize. Unfortunately, the prize in this case is the recommendation to upgrade to a more robust wire. 

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Better thermocouple probes can be purchased from many online vendors including Control Soultions at 888-311-0636.

If you’re a VFC clinic experiencing abnormal temperature events, take immediate action to secure your vaccine stock and then call your VFC health educator. We will help you troubleshoot the issue and rule out/in equipment failure as a cause.  

 Happy logging!  

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April 15, 2014 · 10:05 pm

New Adult Standards

by Jeanine Whitney, RN, MSN, NHE-C

The National Vaccine Advisory Committee (NVAC), not to be confused with the Advisory Committee on Immunization Practices (ACIP), has issued revised adult immunization standards geared specifically to healthcare providers who see adults.

NVAC made recommendations September 10, 2013 that updated and changed the approach relating to adults’ vaccine access and education.

The recommendations are available at:  http://www.hhs.gov/nvpo/nvac/reports/nvacstandards.pdf

Yes, it’s 14 pages long.

Here’s a summary:

  1. Adult immunization standards should be applied to all providers of care to adults, those who do and do not vaccinate.
  2. All providers of health care to adults should:
    1. Routinely assess patient’s status for all recommended vaccines;
    2. Educate and counsel the patient on recommended vaccines and strongly recommend needed vaccines;
    3. Ideally, provide the recommended vaccines at the same visit, or for providers that do not stock the recommended vaccine, refer the patient to a vaccinating provider.

What is a provider of adult care?

All healthcare professionals in the public and private sectors who provide care for adults

Key Messages:

  1. Emphasize immunization in all patient encounters and incorporate immunization needs assessment into every clinical encounter
  2. Recommend, administer needed vaccine or refer to a provider who can immunize
  3. Routinely assess patients’ immunization status , recommend needed vaccines and refer patient to an immunizing provider
  4. Establish referral relationships with immunizing providers
  5. Follow up to confirm patient receipt of recommended vaccine(s)

Immunization partners? There are the local health departments as well as your local immunizing pharmacist right down the street. Most children arrive for a visit with an adult. Some pediatric practices are giving adult vaccines.

Meeting these new standards is easy here in Oregon. The ALERT immunization information system (IIS) can provide access to a client’s immunization history, helps to determine what they need today, and gives the practitioner a place to record vaccine(s) given.

All in all, the new standards are not so new for Oregon providers. It’s more of a gentle reminder of the high quality of care that we provide.

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Your Top Ten Nonmedical Exemption Questions, Answered

by Sara Beaudrault and Stacy de Assis Matthews

As of March 1, 2014, Oregon parents must submit documentation that they’ve received education about vaccines in order to sign a nonmedical exemption for their child.

Since March 1, the Oregon Immunization Program has been collecting questions about this new requirement from healthcare providers, clinic staff, and school staff. It’s clear from the thoughtful questions we’ve received that these groups are committed to finding the best way to help families and their staff meet the new requirements.

Do you have questions about nonmedical exemptions? Keep reading for the Top Ten Questions we’ve received, answered.

Question 10: To whom does the new law apply?

Parents whose child falls into one of the categories below will need to show documentation that they’ve received education before signing a nonmedical exemption.

-          Children entering a child care, preschool, or Head Start program

-          Children starting school for the first time, such as kindergarten

-          Entering students who have never been in an Oregon school before

-          Students starting college

-          Children and students whose exemptions change

Religious exemptions signed before March 1st do not need to be signed again unless the child falls into one of the above categories.

Question 9: For how long is a nonmedical exemption valid?

The nonmedical exemption is valid while the child is at school or child care.

Documentation of nonmedical exemptions transfers between schools in Oregon.

Parents whose child moves from child care to school (typically at kindergarten), will need a new nonmedical exemption. 

Question 8: Before claiming an exemption, do parents need to watch the online module and get a signature from a healthcare practitioner?

Parents will meet the education requirement by talking to a healthcare practitioner or watching the online module.

If a parent talks to a healthcare practitioner to fulfill the vaccine education requirement, the practitioner will provide a Vaccine Education Certificate.

If a parent watches the online vaccine education module, the parent will print a Vaccine Education Certificate at the end of the module.

The parent will turn the Vaccine Education Certificate in at their child’s school, along with the completed Certificate of Immunization Status.

Question 7: Who is a “healthcare practitioner” that can sign the Vaccine Education Certificate?

A practitioner with the authority to order immunizations can sign the Vaccine Education Certificate. This includes medical doctors, osteopaths, naturopaths, nurse practitioners and physician assistants.

Registered nurses working under the direction of an MD, DO, ND, or NP can also sign the Vaccine Education Certificate.

Question 6: The healthcare practitioners at the clinic where I work are concerned about signing nonmedical exemptions. What should I tell them?

Great question! The form that practitioners sign – the Vaccine Education Certificate – simply documents that the practitioner has educated the parent about vaccine benefits and risks. It does not mean that the practitioner agrees with the parent’s decision to claim a nonmedical exemption. This law does not require practitioners to sign nonmedical exemptions.

The parent claims a nonmedical exemption by signing this section of the Certificate of Immunization Status that is maintained at their child’s school or child care.

Question 5: What information do healthcare practitioners have to cover to sign the Vaccine Education certificate?

Practitioners must discuss benefits and risks of immunization, using information that is consistent with what is published by CDC. Unlike the requirement to provide a Vaccine Information Statement when vaccines are administered, this nonmedical exemption law does not require the use of specific materials or resources. Practitioners can decide what materials to use, or to simply have a conversation with parents.

We encourage practitioners and clinic staff to view the online vaccine education module to learn what information is communicated through the online module. Practitioners can provide similar information before signing the Vaccine Education Certificate.

Question 4: Can my clinic create a customized Vaccine Education Certificate to give to parents after education is provided by their healthcare practitioner?

Short answer: Clinics must use the Vaccine Education Certificate available at www.healthoregon.org/vaccineexemption or an identical version.

Long answer: School and child care staff are required to review every immunization record, which includes confirming that there is a valid Vaccine Education Certificate for every nonmedical exemption signed after March 1, 2014. School and child care staff use caution when doing these reviews and keep their eyes open for anything that might be a forgery. If a parent submits a Vaccine Education Certificate that the school staff does not recognize, the parent will likely be required to do additional work to confirm that the certificate is valid. In a worst case scenario, a student may be kept out of school while this happens.

If your clinic feels that they have a valid reason to use a customized Vaccine Education Certificate (for example, you wish to create an identical certificate that preprints your clinic’s name), please contact Sara Beaudrault at sara.beaudrault@state.or.us prior to proceeding.

Question 3: Staff at my clinic want a refresher on communicating effectively about vaccines with parents who have concerns about vaccinating their child. What resources are available?

Excellent resources and materials have been developed in the past few years. Some cover the essential skills to use when talking to parents about vaccines. Others provide simple, accurate answers to the questions that parents ask most often.

Links to materials and materials are available at http://public.health.oregon.gov/PreventionWellness/VaccinesImmunization/VaccineSafety/Pages/Providers.aspx

We commend the staff at your clinic for taking this opportunity to enhance their vaccine communication skills. Healthcare providers are a trusted source of information for most parents, and parents will usually follow their recommendations.

Question 2: After thinking it through, my clinic has decided to refer parents to the online vaccine education module. Is there anything else we need to be thinking about?

Yes. This is the perfect time to think about what process your staff will follow when a parent calls to find out how to get a Vaccine Education Certificate. Some questions you might ask are:

-          Will you provide a customized letter with instructions for parents and a link to the online vaccine education module?

-          Do your front desk staff have the information they need to answer parents’ questions?

-          Will your staff document this in a patient’s medical record?

Looking for resources to share with parents? An information sheet for parents and a graphic of the process for claiming a nonmedical exemption are available at www.healthoregon.org/vaccineexemption

Question 1: Is the online module available in other languages?

Alternative formats will be available upon request. To request materials in an alternate format, contact the Oregon Immunization Program at (971) 673-0300.

We truly appreciate the thoughtfulness of questions that healthcare providers, clinic staff, and school staff are asking. It’s apparent that these groups are concerned about nonmedical exemption rates, and believe that the new nonmedical exemption process will help us decrease nonmedical exemption rates and increase immunization coverage in Oregon.

Additional information is available at www.healthoregon.org/vaccineexemption. Or, call the Oregon Immunization Program at (971) 673-0300.

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Yamhill County’s Immunization Coordinator Retires after Nearly 30 Years in Public Health

by Yuliya Goldman

Bev Fristad, Yamhill County’s Immunization Coordinator, will retire after a nearly 30 year public health career. Bev started in public health in 1985 as a Public Health Nurse at Crook County Health Department.  She oversaw several public health programs including immunization, WIC, STD, Family Planning, and well-child visits. 

Next, Bev worked in Southwest District Public Health in Caldwell, Idaho before moving back to Oregon. Prior to starting at Yamhill, Bev briefly worked at Oregon School for the Deaf and Oregon School for the Blind and Polk County Public Health. She’s been at Yamhill County Public Health the last five years.

Before starting her public health work, Bev worked as a hospital nurse. Originally, she had not intended to go into public health, taking the job as a Public Health Nurse only because it was a nursing job close to home. However, Bev fell in love with her job. “I felt like I found my niche,” Bev said.

Bev values making an impact with her work. She enjoys the education and preparedness aspects of her work. Bev said that she will miss her patients the most and that her work has became a part of her.

Her dedication is apparent to those who have had the opportunity to work closely with her. “Bev has been a joy to work with!” said Tuesday Graham, VFC Health Educator. “She is an incredibly hard worker, doing whatever it takes to make sure her community is protected from vaccine preventable diseases.”

Throughout the years, Bev has worked in a number of public health areas, often simultaneously. However, she has been involved in immunization in some capacity through her entire public health career. Bev has seen the vaccine schedule evolve throughout the years from just a few vaccines to the vaccines recommended today.

After retirement, Bev plans to move to Vancouver, WA to help take care of her grandchildren. While in Vancouver, she would also like to get involved with the local women’s ministries. The public health community is grateful to Bev for all her contributions to the field and wishes her the best in all her upcoming adventures!

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When it Comes to Exemptions, Let’s Not be Special

by Sara Beaudrault

In Oregon, we celebrate all the little things that make us special. We have more ghost towns than any other state in the country. We’re one of only two states where someone still pumps our gas for us. And we’re the only state in the nation that has an official state nut. (It’s the hazelnut, by the way).

But when we’re talking about our children’s health, there’s one fact about Oregon that makes us worry, not celebrate. In Oregon, more parents of kindergartners sign exemptions to school- and childcare-required vaccines than in any other state in the nation.

Exemption rates in Oregon have steadily crept up over the past decade, with greater than six percent of kindergartners having an exemption to at least one vaccine during the 2012-13 school year. Some counties have exemption rates as high as 15 percent! People in these communities are at risk, should a vaccine-preventable disease strike their area.

A new law went into effect on March 1, 2014. The hope is that it will slow this trend.

This new nonmedical exemption law changes the process for parents who choose to exempt their child from vaccines required for school and childcare attendance. Parents now must provide documentation that they have received information about vaccine risks and benefits before signing an exemption. Oregon is among the first states in the nation to strengthen existing exemption laws by requiring parents to review science-based immunization information before signing an exemption.    

“We want to make sure parents and guardians receive science-based information about the benefits and risks of vaccine,” said Stacy de Assis Matthews, school law coordinator for the Oregon Health Authority’s Public Health Division Immunization Program. “There is a lot of misinformation out there.”

The nonmedical exemption law gives parents two choices for receiving vaccine education. They can talk to a healthcare practitioner, who can sign a Vaccine Education Certificate. Or parents can view an online vaccine education module and print a vaccine Education Certificate at the end of the module. Whichever option they choose, parents must turn the Vaccine Education Certificate in at their child’s school or childcare, along with the Certificate of Immunization Status.

 “We hope this law serves to strengthen existing relationships between parents and their healthcare providers,” says Lydia Emer, Oregon Immunization Program manager. “Most parents trust their child’s healthcare provider, and will follow their recommendations. This law provides another opportunity for parents who have concerns about vaccines to talk to their provider.”

The online vaccine education module is a great option for parents who would prefer to receive their Vaccine Education Certificate online, or whose healthcare provider does not supply this Certificate. Although the online module has only been available since March 1, early feedback from parents and clinic staff has been overwhelmingly positive.

Oregon’s new nonmedical law affects so many in Oregon: parents, students, people who can’t be vaccinated, and babies too young to be vaccinated. If all of us who work in schools, healthcare settings, or more broadly in the field of immunizations pull together, Oregon’s nonmedical exemption law will effectively reduce our state’s exemption rates. Because when it comes to exemption rates, we don’t want to be so special.  

Want to learn more about the new nonmedical exemption process? Information and resources for parents, healthcare providers, and school and childcare staff are available at www.healthoregon.org/vaccineexemption. And stay tuned for next week’s ImmiNews article for the “Top 10 Questions About Nonmedical Exemptions, Answered.”

 

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Got a Cold or the Flu? Antibiotics won’t work for you!

by Tessa Jaqua, AWARE Program Coordinator

Colds and the flu are hitting the northwest particularly hard this year. We are all seemingly surrounded by a cacophony of sniffling, sneezing, and yes, even some snorting. Individuals are eager to have everyone feel better and calm restored to immune systems everywhere. Out of all remedies that people try there is one often requested remedy not only that won’t help anyone feel better faster, but could also put you at risk of a more serious illness later: antibiotics. 

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(Image Courtesy of http://weknowmemes.com/2013/01/batman-on-flu-season/)

It’s true that antibiotics are miracle drugs, capable of battling once fatal or crippling bacterial infections. Yet, antibiotics are only good for just that: bacterial infections. Antibiotics do not work for viral infections and colds and the flu are both caused by viruses. Yet, providers continue to prescribe antibiotics for these infections and patients continue to ask for them even though they will have little to no effect on their symptoms. In fact, flu researchers in Boston found that from 1995 through 2002, a 26 percent of patients who were diagnosed with flu were prescribed antibiotics (Linder et al. 2005). This excluded people whose diagnosis could include a bacterial infection, such as pneumonia, the only plausible reason to prescribe antibiotics when they have the flu. While these numbers may not seem huge by themselves, if you do the math there are anywhere from 2 to 4 million people who visit doctors’ offices for flu every year. That means when you add these together that there are 500,000 to 1 million antibiotic prescriptions every year with no possible benefit to patients.

This many unnecessary antibiotic prescriptions for cold or flu patients each year puts a strain on our already weakened antibiotic efficacy.  Each time an antibiotic is used improperly there is a risk of killing important “commensal” or healthy bacteria. This leaves the body open to  resistant bacterial strains multiplying if/when bacterial infections, like pneumonia, actually do strike.

There are ways to combat antibiotics overuse, starting with individuals. No one enjoys being sick and our schedules don’t allow us a lot of time to recover, but the best ways to prevent and lessen the duration of colds and the flu start at home.

How do I stop a cold or the flu from starting?

  • Wash your hands!  Remember to wash for 20 seconds and dry hands thoroughly. 
  • Get your flu vaccination every year.
  • Avoid close contact with others with colds and the flu.

How can I treat my cold or the flu?

  • TIME! Colds last 7 to 14 days
  • Drink plenty of fluids (water, juice, clear broth, warm water with honey)
  • 8 hours or more of sleep a night
  • Breathe steam from shower or bath to loosen mucus
  • Rinse inside of nose with saline nasal rinse
  • Avoid cigarette smoke
  • Take acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) as directed for fever or pain
  • If necessary, take a decongestant to relieve cold symptoms (only for those over 6 years of age)

Every time antibiotics are used incorrectly it puts all at risk of developing a resistant infection and diminishes antibiotic effectiveness in the future.  We all have a role to play in preserving our antibiotic resources. Patients, healthcare providers, hospital administrators, industry, policy makers and the general public can work together to promote appropriate antibiotic use – ultimately saving lives. So this cold and flu season, think twice before asking for or prescribing antibiotics, so we can all feel better today, tomorrow, and in the future.  

 

For more information on antibiotic resistance or cold and flu prevention visit: www.healthoregon.org/antibiotics  or flu.oregon.gov.

 

References:

Gelband, Helen. “http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2009/rwjf64483.”Robert Wood Johnson Foundation. Extending The Cure, 01 Oct 2009. Web. 18 Feb 2014.

 

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Registration for Bend and Seaside Immunize Oregon Round Tables Now Open!

The Immunize Oregon 2014 Round Tables will take place in Seaside, Oregon on March 18th and in Bend, Oregon on April 22nd. These are free, daylong conferences on immunization and health infrastructure, policy and resources. We encourage clinicians and clinic staff, health care administrators, nursing and pharmacy students, health advocates, immunization coordinators, health students, and other immunization stakeholders to attend! Registration for both the Seaside and Bend Round Tables is open! The events will cover the same or similar material, so we only recommend registering for one event.  

To get more information, including a draft agenda, please visit www.healthoregon.org/immunizeoregon

To register for the Seaside Round Table, please visit https://www.surveymonkey.com/s/ImmOrSeasideRT

To register for the Bend Round Table, please visit https://www.surveymonkey.com/s/ImmOrBendRT

If you have any questions, please contact katherine.h.mcguiness@state.or.us

Employment Opportunities
To share any employment opportunities, please email katherine.h.mcguiness@state.or.us
Washington County is seeking a Community Health Nurse-Immunization Coordinator. Please click here to find out more information.

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