JCAHO Update for Infection Control

JCAHO urges flu, pneumonia prevention in long-term care

Documented vaccination programs required

The Joint Commission on Accreditation of Healthcare Organizations has set a 2005 patient safety goal for long-term settings to reduce the risk of influenza and pneumococcal disease. ICPs in such settings should develop and implement a protocol for administration and documentation of both the influenza vaccine and the pneumococcal vaccine. Protocols also should be put in place to identify new cases of influenza and to manage an outbreak. The Joint Commission provides the following answers to some common questions about the new patient safety goal:

Q. Who are the vaccines recommended for?

A. According to the CDC, influenza and pneumococcal vaccinations are recommended for people age 65 years and older and for people of any age who have medical conditions that place them at high risk for complications from influenza. While influenza vaccinations are administered annually, the pneumococcal vaccine generally is a once-in-a-lifetime vaccination that can be given at any time. Both influenza and pneumococcal vaccinations are covered preventive service benefits under Medicare Part B. Although coverage of immunizations for adults is an optional service under Medicaid, virtually all states cover immunizations for high-risk groups such as residents of nursing facilities. (Go to www.cdc.gov/.)

Q. Why are nursing home residents at greater risk for influenza and pneumococcal disease?

A. Nursing home residents, because of their age, underlying health conditions, and closed environment, are especially vulnerable to influenza and pneumococcal disease. During influenza outbreaks in nursing homes, more than half of the residents may become ill; and in some outbreaks, as many as one-third of infected residents have died. Pneumococcal bacterium is the leading cause of serious pneumonia in Medicare beneficiaries and in our most vulnerable high-risk populations. The pneumococcal polysaccharide vaccine (PPV) is effective in preventing pneumococcal bacteremia, an often-fatal complication of pneumococcal pneumonia in adults. Studies indicate that influenza and pneumococcal vaccines are underutilized in institutional settings.

Q. What should organizations do if they are unsure if the resident already received either influenza vaccine or PPV?

A. Current recommendations from the Advisory Committee on Immunization Practices and Epidemiology (ACIP) are to administer vaccine when the person is unsure as to whether he or she has received the vaccine or not. Much of the concern about re-immunizing residents relates to concern about complications from re-immunizing residents. However, several studies have examined this issue and found little data to support any significant increase in complications for people re-immunized with either the influenza or pneumococcal vaccines. According to current Centers for Disease Control recommendations, providers "should not withhold vaccination in the absence of an immunization record or complete medical record. The patient’s (or family’s) verbal history should be used to determine prior vaccination status. When indicated, the vaccine should be administered to patients who are uncertain about their vaccination history." Re-vaccination within five years after initial PPV immunization results in a slightly greater incidence of local reactions, but has not been associated with any increased risk of systemic reactions or serious complications.