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Immunization Coalition of Los Angeles County
                     A Project of Community Partners

    

Resources


Contact Information
Immunization Coalition of Los Angeles County (ICLAC)
Wendy Berger
3530 Wilshire Blvd. Suite 700
Los Angeles, CA 90010
Phone: 213-351-7800
Fax: 213-351-2780
wberger@ph.lacounty.gov
Health Care Worker (HCW) Influenza Immunization Toolkit
DocumentDescription
Stakeholders Letter Letter from ICLAC to Stakeholders describing the HCW Influenza Immunization Tool-kit
Adult Immunization Schedule Adult Immunization schedule as recommended by the Advisory Committee on Immunization Practices
Call-to-Action: Influenza Immunization Among Health Care Workers Fact sheet describing the problem of low influenza immunization coverage rates among health care workers in the United States
Joint Commission Infection Control Standard, June 2006 New Joint Commission immunization standard/requirement for health care workers
Health and Safety Code Section 1288.5 - 1288.9 California law requiring acute care hospitals to offer influenza immunization and monitor influenza declinations among their health care workers
Influenza Declination Form (individual)
(Sample English  Spanish)
A sample declination form to be signed by HCW and filed in the HCWs personnel file
Declination Roster (print orientation Landscape) A sample roster to quantify and manage all staff who decline the influenza vaccine. For patient confidentiality purposes, this roster is to be created and maintained only by the employee health department and should never be accessible to the hospital employees or non-employee health hospital management because of the personal health information contained thereon
Vaccination Tracking Roster (print on legal size paper in Landscape) A tool intended to document and track Health Care Worker influenza immunization coverage rates. For patient confidentiality purposes, this roster is to be created and maintained only by the employee health department and should never be accessible to the hospital employees or non-employee health hospital management because of the personal health information contained thereon.
Vaccine Information Statement (VIS)

Trivalent Inactivated Influenza Vaccine (TIV) "Flu Shot"

Live, Attenuated Intranasal Influenza Vaccine (LAIV) "FluMist"
It is mandatory to provide each patient with a VIS of the current vaccine information, because its a Federal Law! To obtain a current VIS, call 800.232.2522 or visit www.immunize.org/vis
Talking Points for Management Talking points intended to guide influenza communication with the health care worker
Resource List Immunization website resources
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