Immunizations in long-term care facilities: Policies and practice

PURPOSE: The present study was conducted to assess the policies and practices of nursing homes in regard to immunizations for residents and employees. METHODS: A 20-item, cross-sectional survey was mailed to all 445 Minnesota nursing homes from May through July 1993. Questions asked were about facility characteristics and their policies, practices, and attitudes regarding immunizations for residents and employees. Second and third mailings were sent to nonresponding institutions. RESULTS: The median size of the 399 (90%) responding institutions was 88 beds and 110 employees. The median number of residents on December 1, 1992, was 84. Although 99% of the facilities had an influenza vaccination program, only 69.3% had written policies. The mean influenza vaccination rate for residents was 84%, with higher rates in institutions having written policies, facility-wide standing orders for vaccine administration, and in institutions that did not require written consent for vaccination. One-third of the facilities had written policies for pneumococcal vaccination, and 16.3% had policies for tetanus/diphtheria. Twelvemonth immunization rates for these vaccines were 11.9% and 2.9%, respectively. Most facilities had an influenza vaccination program for employees with a mean vaccination rate of 33%. These rates were higher if the facility offered vaccine onsite, free of charge, and provided special inservice education to employees. Employee 12-month vaccination rates for hepatitis B and tetanus/diphtheria were 23.2% and 1.7%, respectively. Few of the institutions included evaluation of immunization activities in their quality assurance programs. CONCLUSION: Many long-term care facilities have inadequate policies and practices for ensuring their residents and employees immunity to important vaccine preventable diseases. These institutions, as caretakers for a vulnerable population, should develop and implement organized programs to immunize their residents and employees. By doing so, they will be able to take advantage of important opportunities to prevent illness and protect the health of their residents and employees.