A Multi-Level Approach to Preventing Colds and Flu

on CampusSherry Bell, M.Ed.

Charlotte Katzin, B.S.N., R.N.

Objectives• Describe the planning, implementation, and

evaluation of a low-cost, campus-wide poster campaign to reduce the transmission of colds and flu.

• List the barriers to getting a flu shot and initiating other cold and flu prevention measures as well as ways to overcome them.

• Discuss the considerations to be made in implementing efficient, campus flu shot clinics.

Annual Economic Impact of Colds and Flu

• Colds cost the nation $39.5 billion in direct and indirect costs

• Flu costs the nation $87 billion in direct and indirect costs

Prevalence of Colds and Flu

5 – 20% of people in the US get the flu each year (CDC)

72% of survey respondents reported having at least one cold in the previous year (Univ. of Michigan Health Systems)

Top 20 Diagnoses at UHS in 2008

Top 20 Diagnoses at UHS in 2008

Colds/Flu/Sore Throats: Academic Impact

Within the last school year, have any of the following affected your academic performance?

•28% colds / flu / sore throats

•9.3% sinus infections / ear infection /

bronchitis / strep throatSpring 2008 NCHA National Reference Group

Data

Colds/Flu/Sore Throats: Academic Impact

• 11.7% reported experiencing asthma in the last 12 months

• 16.8% reported ever having been diagnosed with asthma

Spring 2008 NCHA National Reference Group Data

Photo courtesy of CDC

Prevention for Colds and Flu

• Hand washing

• Cough covering

• Flu shots

Poster Campaign Budget

• 2,500 copies

• cost = $566.40

• $.23 per poster

Poster Campaign Evaluation

From 1/18/08 – 2/18/08• 427 hits to black & white flyer• 363 hits to color flyer

Number of posters distributed • 230 due to email to administrators• 260 in residence halls• 120 sent to Greek houses

Cover Your Cough / Clean Your Hands Campaign

Female

Male

TOTAL

Did not see posters/flyers 245 208453  

(39.9%)Saw posters/flyers

Did not change either behavior

127 71198   (17.5%)

Increased hand washing only 81 51132  (11.7%)

Increased covering coughs only

37 31 68  

(6%)

Changed both behaviors 205 77282  

(24.9%)

Total 695 4381133 (100%)

NCHA Spring 2008 Survey Evaluation Data

Of the 680 (60%) who had seen the posters:

• 132 (19.4%) were encouraged to clean hands

• 68 (10%) were encouraged to cover coughs

• 282 (41.5%) were encouraged to both cover coughs and clean hands

• 70.9% were encouraged to do one or both

Non-Personnel Costs of Campaign

610 posters x $.23 each = $140.30

Postal/supply costs = 35.00

$175.30

A LOVE LETTER 

I will seek and find you.

I will take you to bed and have my way with you.

I will make you ache, shake, & sweat until you moan

& groan.

I will make you beg for me to stop.

I will exhaust you to the point that you will be

relieved when I'm finished with you.

And, when I’ve had my way with you, you will be

weak for days.

All my love,

The Flu

Barriers to Getting a Flu Shot

• Misinformation

• Cost

• Inconvenience

Barrier: Misinformation

• I got a flu shot last year.

• I’m healthy, I never get the flu.

• I know people who got the shot and got the flu anyway.

• My friend got the shot and it gave him the flu.

2008 Cost• GSK Fluarix

$12.00/dose (9,755 doses)

• Sanofi Pasteur Fluzone$15.63/dose (2,400 doses)

Average total vaccine cost per dose = $12.71

True cost to administer each vaccine = $14.72 for students $16.98 for

faculty/staff

Determining True CostCosts directly associated with each

shot

• Vaccine• Safety needles• Alcohol preps• Band-aids• Cotton balls• Consent forms• Vaccine Information Statements

Determining True Cost

Costs averaged over total number of shots

• Salaries/fringe (planning & implementation)

• Advertising• HIPAA statements, receipts, pens,

stickers• Sharps containers, gloves, hand

sanitizer, Wypalls, thermometer probe covers, etc.

• Site set up/rental fees• Staff lunches/parking

Barrier: Cost• $5 for students/$10 for faculty/staff

• $34,000 subsidy from the Office of the President for faculty/staff

• Accept departmental vouchers

• Approximately $70,000 in non-recouped expenses

Barrier: Inconvenience• Twelve 4-hour clinics

• Noon – 4:00 pm

• 4 clinics in Student Services Building

• 8 clinics at various campus sites

Clinic Size and Pace• 5 – 14 immunization stations per

clinic

• Averaged 957 shots/clinic 2008

o 1,118 shots at largest clinic (12 stations)

o 93 shots/clinical staff/4 hours

o One shot every 2.5 minutes

Clinic Staffing• Clinic Coordinator• Assistant Clinic Coordinator• Courier/Driver• Line/Crowd Manager• 4 Cashiers • Number Caller • Nurse Manager • 5 Nurses to start• Nursing/Pharmacy students to

staff up to 11 stations (if we have 14 stations)

Keeping Up the PaceWell in advance of the clinics• Buy pre-filled, single-dose syringes• Peel band-aids• Separate alcohol preps and needles• Pre-print lot numbers on consent

formsDay of the clinic• Take vaccine out of packaging and re-

package trays in gallon zip-lock bags

Sample Site Layout

Sample Site Layout

Nurses’ Vaccine Reconciliation# of doses at the station at start of

shift+

#of doses received during the shift=

# of spoiled doses+

# of consent forms+

# of doses left at end of shift

Clinic Vaccine Reconciliation

Total # of consent forms from the clinic

+Total #of spoiled vaccine at the clinic

+# of doses returned to the fridge

= # of doses signed out from the fridge

Safety Considerations

• Needle safety

• Sharps container

• Hand sanitizer

• Needlestick Policy & Procedure

Adverse Reactions

• Fainting

• Allergic Reaction

Things to consider when working with students

• Begin planning well in advance

• Identify goals for UHS and for students

• Identify coordinators from School of Nursing and College of Pharmacy

• Sufficient supervision

• Training of students

Training Materials• VIS

• Needle safety device

• IM injection instructions

• Consent form

• Competency check-off sheet

Images courtesy of the Immunization Action Coalition

Immunization Resources

Immunization Action Coalitionimmunize.org

Centers for Disease Control and Prevention

www.cdc.gov/flu

Hand Sanitizer

• Start-Rite, Inc.P.O. Box 148Bohemia, NY 11716www.startriteinc.comPHONE 631-205-1900FAX 631-205-159340z bottles/$.72 ea

cases of 96 bottles

To request permission to use CDC’s Cover Your Cough poster:

www.cdc.gov/flu/protect/covercough.htm

For supplemental information for this presentation, including procedures and forms:www.healthyhorns.utexas.edu/ACHA09.html

Sherry Bell, MEdSenior Program CoordinatorThe University of Texas at Austin512/475-8458s.bell@uhs.utexas.edu

Charlotte Katzin, BSNNurse Manager, Allergy/Immunization ClinicThe University of Texas at Austin512/475-8330c.katzin@uhs.utexas.edu