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Bechini A, Lorini C, Zanobini P, Mandò Tacconi F, Boccalini S, Grazzini M, Bonanni P, Bonaccorsi G. Utility of Healthcare System-Based Interventions in Improving the Uptake of Influenza Vaccination in Healthcare Workers at Long-Term Care Facilities: A Systematic Review. Vaccines (Basel) 2020; 8:vaccines8020165. [PMID: 32260594 PMCID: PMC7348755 DOI: 10.3390/vaccines8020165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/31/2020] [Accepted: 04/03/2020] [Indexed: 12/19/2022] Open
Abstract
Healthcare workers (HCWs) in long-term care facilities (LTCFs) can represent a source of influenza infection for the elderly. While flu vaccination coverage (VC) is satisfactory in the elderly, HCWs are less likely to be vaccinated. There is no definitive evidence on which types of healthcare system-based interventions at LTCFs would be more useful in improving the vaccination uptake among HCWs. We performed a systematic review in different databases (Pubmed, Cochrane Database of Systematic Reviews, Health Evidence, Web of Science, Cinahl) to provide a synthesis of the available studies on this topic. Among the 1177 articles screened by their titles and abstracts, 27 were included in this review. Most of the studies reported multiple interventions addressed to improve access to vaccination, eliminate individual barriers, or introduce policy interventions. As expected, mandatory vaccinations seem to be the most useful intervention to increase the vaccination uptake in HCWs. However, our study suggests that better results in the vaccination uptake in HCWs were obtained by combining interventions in different areas. Educational campaigns alone could not have an impact on vaccination coverage. LTCFs represent an ideal setting to perform preventive multi-approach interventions for the epidemiological transition toward aging and chronicity.
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Affiliation(s)
- Angela Bechini
- Department of Health Sciences, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy; (A.B.); (C.L.); (S.B.); (P.B.); (G.B.)
| | - Chiara Lorini
- Department of Health Sciences, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy; (A.B.); (C.L.); (S.B.); (P.B.); (G.B.)
| | - Patrizio Zanobini
- Department of Health Sciences, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy; (A.B.); (C.L.); (S.B.); (P.B.); (G.B.)
- Correspondence: ; Tel.: +39-366-343-5179
| | - Francesco Mandò Tacconi
- Nuovo Ospedale delle Apuane, North-West Tuscany LHU, Via Enrico Mattei, 21, 54100 Massa, Italy;
| | - Sara Boccalini
- Department of Health Sciences, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy; (A.B.); (C.L.); (S.B.); (P.B.); (G.B.)
| | - Maddalena Grazzini
- Careggi, University Hospital, Largo G. Alessandro Brambilla, 3, 50134 Florence, Italy;
| | - Paolo Bonanni
- Department of Health Sciences, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy; (A.B.); (C.L.); (S.B.); (P.B.); (G.B.)
| | - Guglielmo Bonaccorsi
- Department of Health Sciences, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy; (A.B.); (C.L.); (S.B.); (P.B.); (G.B.)
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Healthcare personnel vaccination policies in michigan long-term care facilities. Infect Control Hosp Epidemiol 2018; 39:1003-1005. [DOI: 10.1017/ice.2018.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractOf the 461 licensed long-term care facilities (LTCFs) in Michigan, 129 responded to the first survey of LTCF healthcare personnel (HCP) immunization policies, coverage estimates, and perceived barriers to vaccination. Survey results suggest opportunities to improve HCP vaccination through polices, education, barrier removal, and HCP immunity status tracking in licensed LTCFs in Michigan.
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Marsteller JA, Tiggle R, Remsburg R, Shefer A, Bardenheier B. Influenza Immunization in Nursing Homes: Who Does Not Get Immunized and Whose Status Is Unknown? Infect Control Hosp Epidemiol 2016; 27:388-96. [PMID: 16622818 DOI: 10.1086/502686] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2005] [Accepted: 11/21/2005] [Indexed: 11/03/2022]
Abstract
Objective.To identify nursing home resident and facility characteristics associated with patients not receiving influenza immunization and having unknown immunization status.Design.Secondary data analysis using multinomial logistic regression of data from the National Nursing Home Survey, a nationally representative establishment-based survey.Setting.A total of 1,423 nursing facilities of all ownerships and certifications systematically sampled with probability proportional to number of beds.Patients.A total of 7,350 randomly sampled people aged 65 years or older residing in nursing homes between July and December 1999 (approximately 6 per facility).Main Outcome Measure.Immunization status of residents.Results.Fifteen percent of residents were not immunized and 19% had unknown immunization status. In multivariate analysis, lack of immunization and unknown immunization status were each separately associated with being newly admitted, with no or unknown pneumococcal immunization, and with facility failures to screen for immunization and to record inoculation in the medical record. High-risk status and staff immunization requirements had no effect. Separate analyses showed that residents with unknown immunization status are statistically significantly different from both those vaccinated and those not vaccinated.Conclusion.This study indicates that both resident and facility characteristics are associated with failure to be immunized for influenza. Facilities should consider targeting younger, newly admitted, and residential care residents for influenza immunization, since they are more likely to be missed. Further research into the barriers to immunization specific to nursing home resident choice or opportunity may be warranted.
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Affiliation(s)
- Jill A Marsteller
- Division of Health Care Statistics, National Center for Health Statistics, 3311 Toldeo Road, Hyattsville, MD 20782, USA.
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LaVela SL, Smith B, Weaver FM, Legro MW, Goldstein B, Nichol K. Attitudes and Practices Regarding Influenza Vaccination Among Healthcare Workers Providing Services to Individuals With Spinal Cord Injuries and Disorders. Infect Control Hosp Epidemiol 2015; 25:933-40. [PMID: 15566027 DOI: 10.1086/502323] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractObjective:To examine influenza vaccination status and predictors for vaccine receipt among healthcare workers (HCWs)
caring for patients with spinal cord injuries and disorders.Design:Cross-sectional, nationwide anonymous survey.Setting:Twenty-three Veterans Affairs spinal cord injury centers.Participants:One thousand five hundred fifty-six HCWs.Methods:The primary outcome was staff vaccination status. Independent variables included staff demographic and employment characteristics, health status, attitudes and beliefs about the vaccine, and implications for its use.Results:The staff vaccination rate was 51%. Leading motivators of vaccine receipt were self-protection (77%) and patient protection (49%). The most common reasons for nonreceipt were concerns about side effects (49%), preventive quality (20%), and inconvenience (14%). Logistic regression results suggested that age of 50 years or older (OR, 1.47; P = .021), male gender (OR, 2.50; P < .001), strong belief in vaccine effectiveness (OR, 19.03; P = .008), and importance of HCW vaccination (OR, 20.50; P = .005) significantly increased the probability of vaccination. Recommending the vaccine to coworkers, patients, or patients' families was also associated with HCW vaccination (OR, 3.20; P < .001). Providers who did not believe the vaccine was protective (P < .001) or effective P < .001) were less likely to recommend it to patients.Conclusions:Strategies to increase vaccination rates among HCWs should address concerns about side effects, effectiveness, and protective value of the vaccine and access to it. The impact of provider recommendations should be stressed. Vaccination and subsequent prevention of illness may limit morbidity and mortality, thus benefiting HCWs, healthcare facilities, and patients.
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Affiliation(s)
- Sherri L LaVela
- Spinal Cord Injury Quality Enhancement Research Initiative, Midwest Center for Health Services and Policy Research, Department of Veterans Affairs, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois 60141, USA
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Nichol KL. First Do No Harm: Ensuring That Healthcare Workers Vaccinate and Are Vaccinated. Infect Control Hosp Epidemiol 2015; 24:799-800. [PMID: 14649765 DOI: 10.1086/502139] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Apenteng BA, Opoku ST. Employee influenza vaccination in residential care facilities. Am J Infect Control 2014; 42:294-9. [PMID: 24581019 DOI: 10.1016/j.ajic.2013.09.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Revised: 09/16/2013] [Accepted: 09/17/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND The organizational literature on infection control in residential care facilities is limited. Using a nationally representative dataset, we examined the organizational factors associated with implementing at least 1 influenza-related employee vaccination policy/program, as well as the effect of vaccination policies on health care worker (HCW) influenza vaccine uptake in residential care facilities. METHODS The study was a cross-sectional study using data from the 2010 National Survey of Residential Care Facilities. Multivariate logistic regression analysis was used to address the study's objectives. RESULTS Facility size, director's educational attainment, and having a written influenza pandemic preparedness plan were significantly associated with the implementation of at least 1 influenza-related employee vaccination policy/program, after controlling for other facility-level factors. Recommending vaccination to employees, providing vaccination on site, providing vaccinations to employees at no cost, and requiring vaccination as a condition of employment were associated with higher employee influenza vaccination rates. CONCLUSION Residential care facilities can improve vaccination rates among employees by adopting effective employee vaccination policies.
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Affiliation(s)
- Bettye A Apenteng
- Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA.
| | - Samuel T Opoku
- Department of Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center, Omaha, NE
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Shroufi A, Copping J, Vivancos R, Slack RC. Influenza and pneumococcal vaccine uptake among nursing home residents in Nottingham, England: a postal questionnaire survey. BMC Geriatr 2008; 8:11. [PMID: 18485209 PMCID: PMC2413222 DOI: 10.1186/1471-2318-8-11] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2007] [Accepted: 05/16/2008] [Indexed: 11/29/2022] Open
Abstract
Background Previous studies have shown influenza vaccine uptake in UK nursing home residents to be low. Very little information exists regarding the uptake of pneumococcal vaccine in this population. The formulation of policies relating to the vaccination of residents has been proposed as a simple step that may help improve vaccine uptake in care homes. Methods A postal questionnaire was sent to matrons of all care homes with nursing within the Greater Nottingham area in January 2006. Non respondents were followed up with up to 3 phone calls. Results 30% (16/53) of respondents reported having a policy addressing influenza vaccination and 15% (8/53) had a policy addressing pneumococcal vaccination. Seasonal influenza vaccine coverage in care homes with a vaccination policy was 87% compared with 84% in care homes without a policy (p = 0.47). The uptake of pneumococcal vaccination was found to be low, particularly in care homes with no vaccination policy. Coverage was 60% and 32% in care homes with and without a vaccination policy respectively (p = 0.06). This result was found to be statistically significant on multivariate analysis (p = 0.03, R = 0.46) Conclusion The uptake of influenza vaccine among care home residents in the Nottingham region is relatively high, although pneumococcal vaccine uptake is low. This study shows that there is an association between pneumococcal vaccine uptake and the existence of a vaccination policy in care homes, and highlights that few care homes have vaccination policies in place.
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Affiliation(s)
- Amir Shroufi
- Norfolk PCT, St Andrew's House, St Andrew's Business Park, Northside, Norwich, NR7 0HT, UK.
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Fus AM, Kim MH, Haw JM, Trohman RG, Stephan E. A written policy increases compliance with guidelines for therapeutic anticoagulation prior to elective direct current cardioversion of atrial fibrillation. J Cardiovasc Nurs 2007; 22:417-21. [PMID: 17724424 DOI: 10.1097/01.jcn.0000287039.30810.2e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Therapeutic anticoagulation before elective direct current cardioversion (DCC) of atrial fibrillation reduces the risk of embolic stroke. Direct current cardioversion is performed by a variety of practitioners, and variable adherence to preprocedural anticoagulation guidelines is common. OBJECTIVE We assessed the impact of a written policy on guideline compliance. METHODS : Anticoagulation status and transesophageal echocardiogram (TEE) results were reviewed in 55 patients (32 men/23 women; ages 18-83 years) who underwent elective DCC during the 6-month period before a written anticoagulation policy was sent to physicians who perform, prepare, or refer patients for this procedure. The nurse assigned to each DCC was responsible for documenting anticoagulation status. In accordance with guidelines, therapeutic anticoagulation was defined as a normalized ratio range > or = 2.0 for at least 3 weeks or a negative TEE with a normalized ratio range > or = 2.0 or a partial thromboplastin time > 50 seconds at the time of DCC. Immediately after policy implementation, anticoagulation status and TEE results were reviewed in 53 patients (42 men/11 women; ages 21-84 years) and 1 year post-policy implementation. RESULTS Before policy implementation, 14 of 52 patients (27%) had DCC performed without adequate anticoagulation or a negative TEE. Immediately postimplementation, only 2 of 50 patients (4%) had DCC performed without adequate anticoagulation or a negative TEE (P = .002). One year post-policy implementation, only 4 of 48 patients (8%) had DCC performed without adequate anticoagulation or a negative TEE (P = .03). CONCLUSIONS Implementing a written policy greatly reduces the number of patients undergoing DCC without adequate anticoagulation or a negative TEE. The impact of this intervention was quickly demonstrable and persisted during follow-up. Supplementing published recommendations with guideline-driven policies may reduce variations in clinical practice and improve quality of care.
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Affiliation(s)
- Allison M Fus
- Rush University Medical Center, Chicago, IL 60612, USA.
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O'Halloran PD, Cran GW, Beringer TRO, Kernohan G, Orr J, Dunlop L, Murray LJ. Factors affecting adherence to use of hip protectors amongst residents of nursing homes—A correlation study. Int J Nurs Stud 2007; 44:672-86. [PMID: 16487529 DOI: 10.1016/j.ijnurstu.2005.12.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2005] [Revised: 12/13/2005] [Accepted: 12/20/2005] [Indexed: 11/23/2022]
Abstract
BACKGROUND Hip protectors are protective pads designed to cover the greater trochanter and attenuate or disperse the force of a fall sufficiently to prevent a hip fracture. Promising results from randomised controlled trials in nursing homes have resulted in hip protectors being widely recommended in the health care literature and in national guidelines. OBJECTIVES The objectives of the study were to identify characteristics of individual residents, and the organisational features of the homes in which they live, which may affect adherence to wearing hip protectors. DESIGN An observational, correlation study designed to identify factors related to adherence. SETTING Forty nursing and residential homes in the UK. PARTICIPANTS 1346 residents of the homes who were not confined to bed and with no pressure sore on the hip. METHODS The introduction of an evidence-based policy to offer Safehip hip protectors to residents free of charge and with support from a nurse facilitator. Adherence to wearing the hip protectors was observed over 72 weeks. RESULTS Initial acceptance of the hip protectors was 37.2%. Continued adherence was 23.9% at 24 weeks; 23.2% at 48 weeks; and 19.9% at 72 weeks. Greater adherence was associated with the following individual resident characteristics: a greater degree of dependency (95% CI 1.39-3.78) and cognitive impairment (95% CI 1.01-2.98); being male rather than female (95% CI 1.06-2.48). Greater adherence was also associated with the following organisational characteristics of homes: fewer changes of senior manager during the study period (95% CI 1.01-8.51), and being resident in a home with a resident profile showing a greater proportion of residents with a higher degree of dependency (95% CI 1.04-1.27). There was wide a variation in the degree of success in implementation between homes (adherence of 0-100% at 24 weeks). CONCLUSIONS Those implementing a policy of introducing hip protectors into nursing and residential homes should consider targeting residents with cognitive impairment. Such residents are at greater risk of hip fracture and appear to be more likely to continue wearing hip protectors. Those charged with implementing changes in practice or policy should consider how the context for implementation can be optimised to increase the likelihood of success.
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Richards CL. Preventing antimicrobial-resistant bacterial infections among older adults in long-term care facilities. J Am Med Dir Assoc 2006; 7:S89-96, 88. [PMID: 16500292 DOI: 10.1016/j.jamda.2005.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
For older adults in long-term care facilities (LTCFs), the rate of infections caused by antimicrobial resistant strains of bacteria has increased and is prompting renewed interest in investing health care resources for prevention and control of these pathogens. This document offers a simple framework to combat infections due to antimicrobial resistant bacteria in LTCF residents by providing a multi-step approach consisting of four major strategies: prevent infection, diagnose and treat infection effectively, use antimicrobials wisely, and prevent transmission. Recommendations from this multi-step approach are directed at LTCF medical directors and practicing clinicians involved with the medical care of older adult LTCF residents.
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Affiliation(s)
- Chesley L Richards
- Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Goldstein AO, Kincade JE, Resnick JE, Gamble G, Bearman RS. Policies to increase influenza and pneumococcal immunizations in chronically ill and institutionalized settings. Am J Infect Control 2005; 33:463-8. [PMID: 16216660 DOI: 10.1016/j.ajic.2005.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2004] [Accepted: 01/04/2005] [Indexed: 11/20/2022]
Abstract
BACKGROUND The objective of this study was to understand better the status of and ways to improve dissemination of influenza and pneumococcal standing-order vaccination policies to at-risk adults in health care institutions. METHODS A statewide sample of 5 different types of institutions serving at-risk elderly persons in North Carolina was surveyed. A 45-question telephone survey was administered to infection control nurses or facility directors at 267 (86% response rate) health care facilities involved in direct patient care. RESULTS A majority of respondents reported that influenza (81%) and pneumococcal (59%) diseases were important to their facility, and 63% stated that the influenza vaccine was very effective versus 47% for pneumococcal. Except nursing homes, few facilities reported adoption of standing-order policies to vaccinate routinely the at-risk adults. Over 70% of respondents stated that their facilities might consider adopting standing-order policies for influenza and pneumococcal disease. A majority of respondents also supported a state law that requires such vaccines for high-risk patients unless contraindicated or the patient refuses. CONCLUSIONS Respondents across diverse health care institutions appear interested in adopting standing-order policies to increase influenza and pneumococcal vaccination rates and are more likely to do so if provided with appropriate administrative and/or financial support for implementation.
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Affiliation(s)
- Adam O Goldstein
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, NC 27599, USA.
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Creating Artificial Barriers to Vaccinations. J Am Med Dir Assoc 2005. [DOI: 10.1097/00130535-200509000-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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deHart MP, Salinas SK, Barnette LJ, Lewis KDC, Mustin HD, Corbett C, Green PK. Project Protect: Pneumococcal vaccination in Washington State nursing homes* *A collaboration between Qualis Health, Washington State Department of Health, and the Immunization Coalition of Washington. J Am Med Dir Assoc 2005; 6:91-6. [PMID: 15871882 DOI: 10.1016/j.jamda.2005.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Pneumonia is the third most frequent cause of hospitalization among Medicare beneficiaries in Washington State. While a vaccine against pneumococcal disease has been available since 1977, the 1999 Behavioral Risk Factor Surveillance System estimates that less than 60% of adults aged 65 years and older in Washington State have been vaccinated. METHODS To assess the prevalence of pneumococcal vaccination policies, we surveyed all Washington nursing homes in 1999 and again in 2001 to assess changes during the intervening period. Following the policy surveys, to estimate the pneumococcal vaccination rate, we conducted assessments of a random sample of residents of Washington nursing homes. RESULTS Use of standing orders/written pneumococcal vaccination policies by nursing homes increased by 14% from 58% in 1999 to 72% in 2001. The pneumococcal vaccination rate for residents of nursing homes increased from 47% in 2000 to 61% in 2002. Both increases were statistically significant. The odds of a resident receiving a pneumococcal polysaccharide vaccine (PPV) in a nursing home having standing orders or other written guidelines are estimated to be two-and-a-half times greater than for residents in facilities without any PPV guidelines (2000: OR = 2.59; 95% CI, 1.54-4.34; 2002: OR = 3.19; 95% CI, 1.68-6.01). CONCLUSION Increased use of standing orders/written policies has contributed to higher rates of pneumococcal vaccination in Washington State nursing homes.
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Richards CL. Preventing antimicrobial-resistant bacterial infections among older adults in long-term care facilities. J Am Med Dir Assoc 2005; 6:144-51. [PMID: 15871891 DOI: 10.1016/j.jamda.2005.01.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
For older adults in long-term care facilities (LTCFs), the rate of infections caused by antimicrobial resistant strains of bacteria has increased and is prompting renewed interest in investing health care resources for prevention and control of these pathogens. This document offers a simple framework to combat infections due to antimicrobial resistant bacteria in LTCF residents by providing a multi-step approach consisting of four major strategies: prevent infection, diagnose and treat infection effectively, use antimicrobials wisely, and prevent transmission. Recommendations from this multi-step approach are directed at LTCF medical directors and practicing clinicians involved with the medical care of older adult LTCF residents.
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Affiliation(s)
- Chesley L Richards
- Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Parry MF, Grant B, Iton A, Parry PD, Baranowsky D. Influenza vaccination: a collaborative effort to improve the health of the community. Infect Control Hosp Epidemiol 2005; 25:929-32. [PMID: 15566026 DOI: 10.1086/502322] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The need to improve influenza vaccination delivery in our community became painfully clear during the winter of 1997-1998 when high rates of respiratory illness led to congestion in the emergency department and a critical shortage of hospital beds. In response, the local hospital and the Department of Health launched a collaborative program to increase influenza vaccine coverage in the community. METHODS The partnership was designed to increase the number of citizens receiving influenza vaccine and to moderate the severity of lower respiratory tract illness during the winter season. A variety of methods were used to increase public awareness, enhance vaccine delivery, and create a relatively seamless service for the community. RESULTS During three seasons, influenza vaccination rates increased by a relative 150%. This represented immunization of 16% of the entire community and more than 75% of residents older than 65 years. Hospital employee vaccination rates also rose from 34% to 58%. When compared with other hospitals in the county, the campaign reduced the average number of annual visits to the emergency department for all respiratory diagnoses by 34% and exacerbations of chronic obstructive pulmonary disease by 46%. CONCLUSIONS This influenza vaccination program illustrates the potential for synergy that exists between local departments of health and community hospitals in successfully increasing vaccine delivery to the community. Furthermore, it also suggests that such efforts can be successful in reducing use of the emergency department, resulting in a positive impact on the health of the community.
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Affiliation(s)
- Michael F Parry
- Division of Infectious Diseases, The Stamford Hospital, Stamford, Connecticut 06904, USA
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Verweij MF, van den Hoven MA. Influenza vaccination in Dutch nursing homes: is tacit consent morally justified? MEDICINE, HEALTH CARE, AND PHILOSOPHY 2005; 8:89-95. [PMID: 15906943 DOI: 10.1007/s11019-004-0837-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVES Efficient procedures for obtaining informed (proxy) consent may contribute to high influenza vaccination rates in nursing homes. Yet are such procedures justified? This study's objective was to gain insight in informed consent policies in Dutch nursing homes; to assess how these may affect influenza vaccination rates and to answer the question whether deviating from standard informed consent procedures could be morally justified. DESIGN A survey among nursing home physicians. SETTING & PARTICIPANTS We sent a questionnaire to all (356) nursing homes in the Netherlands, to be completed by one of the physicians. RESULTS We received 245 completed questionnaires. As 21 institutions appeared to be closed or merged into other institutions, the response was 73.1% (245/335). Of all respondents 81.9% reported a vaccination rate above 80%. Almost 50% reported a vaccination rate above 90%. Most respondents considered herd immunity to be an important consideration for institutional policy. Freedom of choice for residents was considered important by almost all. Nevertheless, 106 out of 245 respondents follow a tacit consent procedure, according to which vaccination will be administered unless the resident or her proxy refuses. These institutions show significantly higher vaccination rates (p < 0.03). CONCLUSIONS In our discussion we focus on the question whether tacit consent procedures can be morally justifiable. Such procedures assume that vaccination is good for residents either as individuals or as a group. Even though this assumption may be true for most residents, there are good reasons for preferring express consent procedures.
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Affiliation(s)
- M F Verweij
- Ethiek Instituut, Utrecht University, Heidelberglaan 2, NL-3584 CS Utrecht, The Netherlands.
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Bridges CB, Harper S. The full-court press for influenza prevention in elderly persons. Clin Infect Dis 2004; 39:465-7. [PMID: 15356806 DOI: 10.1086/422654] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2004] [Accepted: 04/20/2004] [Indexed: 11/04/2022] Open
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Dunn MK, Misra S, Habermann R, Griffin MR. Pneumococcal Vaccination in Nursing Homes: Does Policy Change Practice? J Am Med Dir Assoc 2003. [DOI: 10.1016/s1525-8610(04)70322-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Jessop AB, Hausman AJ. Pneumococcal Vaccination in Pennsylvania Nursing Homes: Factors Associated with Vaccination Level. J Am Med Dir Assoc 2002. [DOI: 10.1016/s1525-8610(04)70524-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kyaw MH, Wayne B, Holmes EM, Jones IG, Campbell H. Influenza and pneumococcal vaccination in Scottish nursing homes: coverage, policies and reasons for receipt and non-receipt of vaccine. Vaccine 2002; 20:2516-22. [PMID: 12057607 DOI: 10.1016/s0264-410x(02)00177-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A national survey was carried out to determine the coverage of influenza and pneumococcal vaccines, policies, reasons for receipt, non-receipt of vaccine and strategies to improve vaccine coverage in Scottish nursing homes. Of the 550 nursing homes, 72% (394) participated in the study. Overall coverage was 85% for influenza vaccine in 2001-2002 season and 11% for pneumococcal vaccine in the last 5-year period. Only 6% (23/394) of homes were reported to have a systematic immunization record. The most frequently stated reasons for improved coverage of both vaccines were clear immunization policies (76%), awareness and education for staff and residents (68%), and consent on behalf of the incompetent residents (66%). The presence of vaccination policies was higher for influenza vaccine than pneumococcal vaccine expressed as verbal agreement (27% versus 3%), written policies with set target (24% versus 5%) and written policies without set target (17% versus 2%). Advice from the members of the community health care team was the principal reason for the receipt of both vaccines. The predominant reasons for non-receipt of vaccine were refusal by residents and family members (both vaccines) and lack of advice from general practitioners (pneumococcal vaccine). The substantial disparity in coverage of influenza and pneumococcal vaccine reflects the lack of national recommendations and policies for reimbursements for pneumococcal vaccination. These data suggest that greater efforts are needed to improve prevention behaviors of health care professionals and the public, organized vaccine delivery strategies and systematic vaccination documents to increase influenza and pneumococcal vaccination rates in nursing homes and other long-term care facilities.
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Affiliation(s)
- Moe H Kyaw
- Department of Public Health Sciences, University of Edinburgh, Edinburgh, UK.
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Stevenson KB, McMahon JW, Harris J, Hillman JR, Helgerson SD. Increasing pneumococcal vaccination rates among residents of long-term--care facilities: provider-based improvement strategies implemented by peer-review organizations in four western states. Infect Control Hosp Epidemiol 2000; 21:705-10. [PMID: 11089654 DOI: 10.1086/501723] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate collaborative efforts and intervention strategies by peer-review organizations (PROs) and long-term-care facilities (LTCFs) for improving pneumococcal vaccination rates among residents of LTCFs. DESIGN Prospective, before-after quality improvement project. SETTING 133 LTCFs in Alaska, Idaho, Montana, and Wyoming. PATIENTS All residents of participating LTCFs. METHODS Baseline pneumococcal vaccination rates were determined by medical-record review, self-reporting by patient or family members, and review of Medicare claims information. Remeasurement of vaccination rates was accomplished from documentation of vaccination of eligible residents by each LTCF. RESULTS 133 LTCFs with 7,623 residents from Alaska, Idaho, Montana, and Wyoming participated in this quality-improvement project. This accounted for 41% (133/321) of the potential nursing homes and resident population in the participating states. Baseline overall vaccination rates were 40% (3,050/7,589). The overall vaccination rate improved to 75% (5,720/7,623, P<.001). The number of facilities meeting the Healthy People 2000 vaccination goal of 80% improved from 18% (24/133) to 62% (83/133, P<.001). Initial use of chart stickers and implementation of standing orders led to similar increases in vaccination rates, but the standing-order strategy required commitment of fewer PRO resources at a statewide level. Remeasurement of vaccination rates in a subset of participating Idaho LTCFs 1 year after initial vaccination efforts demonstrated a sustained vaccination rate of 70% in facilities enforcing a standing-order policy. CONCLUSIONS Simple and straightforward vaccination strategies implemented in LTCFs over a short period of time can have a significant impact on vaccination rates. Collaborative efforts between state PROs and LTCFs enhance implementation of these strategies and can result in the achievement of national vaccination objectives. Standing orders appear to be one intervention effective in sustaining successful vaccination efforts. Regardless of the specific interventions employed, PROs played a significant role in facilitating vaccination program development and intervention implementation.
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Boyce TG, Poland GA. Promises and challenges of live-attenuated intranasal influenza vaccines across the age spectrum: a review. Biomed Pharmacother 2000; 54:210-8. [PMID: 10872719 DOI: 10.1016/s0753-3322(00)89027-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Despite the availability of inactivated influenza vaccines, influenza continues to cause considerable mortality in the elderly, and morbidity in all age groups. Cold-adapted, live-attenuated, intranasally administered influenza vaccines, first developed in the 1960s, have been tested in more than 10,000 volunteers and have been shown to be safe, well-tolerated, and immunogenic. Recent trials suggest that efficacy in children may be superior to that of inactivated vaccines, and efficacy in healthy adults may be similar to that of inactivated vaccines, although there are limited data comparing the two vaccines directly. Advantages of the live-attenuated vaccines include acceptability, ease of administration, and the potential for mass immunization. The possibility of substantially higher vaccination rates across all age groups brings promise for the development of herd immunity and greatly improved control of influenza in the future.
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Affiliation(s)
- T G Boyce
- Department of Pediatric and Adolescent Medicine, Mayo Medical School and Foundation, Rochester, MN 55905, USA
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Briss PA, Rodewald LE, Hinman AR, Shefer AM, Strikas RA, Bernier RR, Carande-Kulis VG, Yusuf HR, Ndiaye SM, Williams SM. Reviews of evidence regarding interventions to improve vaccination coverage in children, adolescents, and adults. The Task Force on Community Preventive Services. Am J Prev Med 2000; 18:97-140. [PMID: 10806982 DOI: 10.1016/s0749-3797(99)00118-x] [Citation(s) in RCA: 376] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This paper presents the results of systematic reviews of the effectiveness, applicability, other effects, economic impact, and barriers to use of selected population-based interventions intended to improve vaccination coverage. The related systematic reviews are linked by a common conceptual approach. These reviews form the basis for recommendations by the Task Force on Community Preventive Services (the Task Force) regarding the use of these selected interventions. The Task Force recommendations are presented on pp. 92-96 of this issue.
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Affiliation(s)
- P A Briss
- Division of Prevention Research and Analytic Methods, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Schluter WW, Ralston DL, Delaney RJ, Sauaia A, Dunn TR. Increasing influenza and pneumococcal vaccination and tuberculosis screening among residents of Colorado long-term care facilities. Eval Health Prof 1999; 22:466-83. [PMID: 10623401 DOI: 10.1177/01632789922034419] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Persons residing in long-term care facilities are especially vulnerable to potentially preventable morbidity and mortality caused by influenza, S. pneumoniae, and tuberculosis. This project's objective was to increase the rates of pneumococcal vaccination, tuberculosis screening, and annual influenza vaccination. Intervention consisted of staff training videos, sample policies, and educational materials for residents and their families. At baseline during the 1995-1996 flu season, 84% of Colorado long-term care residents were vaccinated for influenza; 16% of residents had ever received pneumococcal vaccination; and 59% had been screened for tuberculosis. At remeasurement during 1997 to 1998, influenza vaccination rates were up to 89%, p = 0.006. The percentage of residents who had ever received pneumococcal vaccination increased to 48% at remeasurement, p < 0.001. Tuberculosis screening rates increased to 83%, p < 0.001. Following an educational intervention targeting both residents and staff, residents were significantly more likely to receive all three preventive services.
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Affiliation(s)
- W W Schluter
- Colorado Foundation for Medical Care, Denver, CO 80217-0300, USA.
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Bradley SF. Prevention of influenza in long-term-care facilities. Long-Term-Care Committee of the Society for Healthcare Epidemiology of America. Infect Control Hosp Epidemiol 1999; 20:629-37. [PMID: 10501266 DOI: 10.1086/501687] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Influenza is a frequent cause of epidemic and endemic respiratory illness in long-term-care facilities (LTCFs), resulting in considerable morbidity and mortality. Detection of influenza outbreaks in this setting can be difficult, because the clinical presentation in older adults is atypical and other pathogens also cause influenza-like illness (ILI) during the influenza season. Use of the standard case definition for influenza has not been effective in detecting episodes in residents of LTCFs. Alternative case-definitions that reflect the atypical presentation of influenza in this population have been recommended but not validated. The use of rapid tests for the detection of influenza in conjunction with more sensitive case definitions of ILI may lead to the earlier detection of influenza outbreaks in LTCFs, earlier initiation of infection control measures, and reduction in transmission. The definition of outbreak, eg, the number of episodes of ILI or episodes of confirmed influenza A that would result in the initiation of antiviral chemoprophylaxis, remains controversial in this setting. The use of newer antivirals could limit the side effects seen in older adults in LTCFs. However, annual vaccination of residents and staff remains the most effective way to prevent the introduction of influenza A or influenza B into LTCFs. In addition, vaccination of LTCF residents reduces rates of illness and pneumonia due to influenza, as well as cardiopulmonary exacerbation, hospitalization, and death.
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Affiliation(s)
- S F Bradley
- Department of Internal Medicine, Veterans' Affairs Health Systems, and University of Michigan Medical School, Ann Arbor 48105, USA
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McArthur MA, Simor AE, Campbell B, McGeer A. Influenza vaccination in long-term-care facilities: structuring programs for success. Infect Control Hosp Epidemiol 1999; 20:499-503. [PMID: 10432163 DOI: 10.1086/501659] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To determine which influenza vaccination program characteristics were associated with high resident vaccination rates in Canadian long-term-care facilities (LTCFs). DESIGN A cross-sectional survey consisting of a mailed questionnaire conducted in spring 1991. PARTICIPANTS All 1,520 Canadian LTCFs for the elderly with at least 25 beds. RESULTS The mean overall influenza vaccination rate in the 1,270 (84%) responding facilities was 79%. In multivariate analysis, the variables significantly associated with increased vaccination rates were: a single nonphysician staff person organizing the program, having more program aspects covered by written policies, the offering of vaccine to all residents, a policy of obtaining consent on admission that was durable for future years rather than repeating consent annually, and automatically administering vaccine to residents whose guardians could not be contacted for consent. Any encouragement to staff to be vaccinated had a significant impact on staff vaccination rates. CONCLUSION Well-organized influenza vaccination programs increase the influenza vaccination rates of residents in Canadian LTCFs. Facilities need to develop resident vaccination programs further and to focus on vaccinating staff.
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Affiliation(s)
- M A McArthur
- Department of Microbiology, Princess Margaret Hospital, Toronto, Ontario, Canada
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Nichol KL. Ten-year durability and success of an organized program to increase influenza and pneumococcal vaccination rates among high-risk adults. Am J Med 1998; 105:385-92. [PMID: 9831422 DOI: 10.1016/s0002-9343(98)00293-9] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Influenza and pneumococcal vaccines are underused. Systems approaches that incorporate administrative and organizational strategies are more successful than education of providers for improving vaccination rates. Little has been published on the long-term success and durability of such efforts. METHODS We performed a 10-year time-series study to examine the durability and success of an ongoing, multifaceted, institution-wide influenza and pneumococcal vaccination program. The program was first implemented at the Minneapolis Department of Veterans Affairs (VA) Medical Center in 1987-88 following the demonstration that a clinic-based standing order policy was much more successful than provider education for improving vaccine delivery. The program ensures that vaccine is offered to all high-risk patients followed up at the medical center, promotes convenient access for patients, and facilitates efficient administration of vaccine. Specific elements include an annual mailing to patients, standing orders for nurses, walk-in clinics, and the use of standardized, preprinted documentation forms. Initially the program targeted high-risk outpatients for influenza vaccination. It was extended to include inpatients in 1989-90. Pneumococcal vaccinations were added to the program in 1994-95. Vaccination rates are estimated each year from surveys mailed to randomly selected patients, and vaccine utilization is monitored through pharmacy logs. RESULTS The survey response rates have exceeded 75% each year. Influenza vaccination rates for all high-risk patients followed up at the medical center have increased from 58% following the 1987-88 vaccination season to 84% in 1996-97 (P < 0.001). Pneumococcal vaccination rates have also increased from 34% in 1994-95 to 63% in 1996-97 (P < 0.001). Vaccination rates are similar for inpatients and outpatients, but rates for high-risk patients < 65 years of age remain lower than for the elderly: 69% versus 89% for influenza, 1996-97 (P < 0.001); 52% versus 66% for pneumococcal, 1996-97 (P = 0.05). For elderly patients followed up at the medical center, influenza (89% versus 67%, P < 0.0001) and pneumococcal (66% versus 43%, P < 0.0001) vaccination rates significantly exceeded those for the state of Minnesota in 1996-97. The annual number of influenza vaccine doses dispensed has increased from 10,000 in 1987-88 to more than 22,000 in 1996-97; and more than 13,000 doses of pneumococcal vaccine have been administered from 1994-95 through 1996-97. CONCLUSION This simple, multifaceted program that incorporates administrative and organizational strategies to enhance influenza and pneumococcal vaccination rates has been highly durable and successful over a 10-year peroid. Similar strategies if implemented in other settings may enhance vaccination rates for the millions of high-risk patients who have yet to be immunized.
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Affiliation(s)
- K L Nichol
- VA Medical Center, and Department of Medicine, University of Minnesota, Minneapolis 55417, USA
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Kind EA, Craft C, Fowles JB, McCoy CE. Pneumococcal vaccine administration associated with splenectomy: missed opportunities. Am J Infect Control 1998; 26:418-22. [PMID: 9721395 DOI: 10.1016/s0196-6553(98)70038-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The spleen defends against infection from encapsulated organisms. Patients who have had splenectomies are at risk for the development of overwhelming pneumococcal infections. Guidelines recommend that pneumococcal vaccine be given to all patients who have splenectomies. METHODS This retrospective study was performed to evaluate compliance with the guidelines in patients from a large multispecialty group practice who had splenectomies between 1988 and 1991. Ninety-five patients were identified, and their clinic and hospital records were reviewed. RESULTS Overall, 73.7% of patients who had splenectomies received the pneumococcal vaccine. No significant differences were found in the vaccination rates over time or among the surgeons. CONCLUSIONS Improvement is needed in ensuring that patients who have splenectomies receive pneumococcal vaccine.
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Affiliation(s)
- E A Kind
- Health System Minnesota, MN 55416, USA
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