Prevalence and predictors of influenza vaccination in long-term care homes: a cross-national retrospective observational study

Influenza vaccination for healthcare workers who care for people aged 60 or older living in long-term care institutions

RATIONALE

People who work in long-term care institutions (LTCIs), such as doctors, nurses, other health professionals, cleaners and porters (and also family visitors), may have substantial rates of influenza during influenza seasons. They often continue to work when infected with influenza, increasing the likelihood of transmitting influenza to those in their care. The immune systems of care home residents may be weaker than those of the general population; vaccinating care home workers could reduce transmission of influenza within LTCIs.

OBJECTIVES

To assess the effects of vaccinating healthcare workers in long-term care institutions against influenza on influenza-related outcomes in residents aged 60 years or older.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (via Cochrane Library), MEDLINE (via Ovid), Embase (via Elsevier), Web of Science (Science Citation Index-Expanded and Conference Proceedings Citation Index - Science), and two clinical trials registries up to 22 August 2024.

ELIGIBILITY CRITERIA

In this version of the review we restricted eligibility to randomised controlled trials (RCTs) of influenza vaccination of healthcare workers (HCWs) caring for residents aged 60 years or older in LTCIs. Previously we included cohort or case-control studies.

OUTCOMES

Outcomes of interest were: influenza (confirmed by laboratory tests) and its complications (lower respiratory tract infection; hospitalisation or death due to lower respiratory tract infection), all-cause mortality, and adverse events.

RISK OF BIAS

We used version one of the Cochrane risk of bias tool for RCTs.

SYNTHESIS METHODS

Two review authors independently extracted data and assessed the risk of bias. We used risk ratios (RRs) with 95% confidence intervals (CIs) to summarise the effects of vaccination on our outcomes of interest. We accounted for clustering by dividing events and sample sizes for each study by an assumed design effect as part of a sensitivity analysis. We used GRADE to assess the certainty of evidence for our outcomes of interest.

INCLUDED STUDIES

We did not identify any new trials for inclusion in this update. Four cluster-RCTs from Europe (8468 residents) of interventions to offer influenza vaccination for HCWs caring for residents ≥ 60 years in LTCIs provided outcome data that addressed the objectives of our review. The average age of the residents was between 77 and 86 years, and most were female (70% to 77%). The studies were comparable in their intervention and outcome measures. The studies did not report adverse events. The principal sources of bias in the studies related to attrition, lack of blinding, contamination in the control groups, and low rates of vaccination coverage in the intervention arms, leading us to downgrade the certainty of evidence for all outcomes due to serious risk of bias.

SYNTHESIS OF RESULTS

Offering influenza vaccination to HCWs based in LTCIs may have little or no effect on the number of residents who develop influenza compared with those living in care homes where no vaccination is offered (from 5% to 4%) (RR 0.87, 95% CI 0.46 to 1.63; 2 studies, 752 participants; low-certainty evidence). We rated the evidence to be low from one study of 1059 residents showing a slight reduction in lower respiratory tract infection from HCW vaccination (6% versus 4%) (RR 0.70, 95% CI 0.41 to 1.2). The confidence interval is compatible with both a meaningful reduction and a slight increase in infections when illustrated as an absolute effect; 2% to 7%. Taking account of clustering for this outcome increased the confidence interval further, and we rated the evidence as very low-certainty accordingly (RR 0.72, 95% CI 0.28 to 1.85). HCW vaccination programmes may have little or no effect on the number of residents admitted to hospital for respiratory illness (RR 1.02, 95% CI 0.82 to 1.27; 1 study, 3400 participants; low-certainty evidence). There is insufficient evidence to determine whether HCW vaccination impacts on death due to lower respiratory tract infections in residents: 2% of residents in both groups died from lower respiratory tract infections based on the RR of 0.82 (95% CI 0.45 to 1.49; 2 studies, 4459 participants; very low-certainty evidence). HCW vaccination probably leads to a reduction in all-cause deaths from 9% to 6% (RR 0.69, 95% CI 0.60 to 0.80; 4 studies, 8468 participants; moderate-certainty evidence).

AUTHORS' CONCLUSIONS

The effects of HCW vaccination on influenza-specific outcomes in older residents of LTCIs are uncertain. The reduction in all-cause mortality in people observed could not be explained by changes in influenza-specific outcomes. This review did not find information on co-interventions with HCW vaccination: hand washing, face masks, early detection of laboratory-proven influenza, quarantine, avoiding admissions, antivirals and asking HCWs with influenza or influenza-like illness not to go to work. Better studies are needed to give greater certainty in the evidence for vaccinating HCWs to prevent influenza in residents aged 60 years or older in LTCIs. Additional studies are needed to further test these interventions in combination.

FUNDING

This review update received no dedicated funding. Previous versions of this review were supported by grants from the National Institute of Health Research (UK), and the National Health and Medical Research Council (Australia).

REGISTRATION

Protocol (2005): 10.1002/14651858.CD005187.pub Original review (2006): 10.1002/14651858.CD005187.pub2 Update (2010): 10.1002/14651858.CD005187.pub3 Update (2013): 10.1002/14651858.CD005187.pub4 Update (2016): 10.1002/14651858.CD005187.pub5.

Characteristics and factors of repeated influenza vaccination among elderly individuals in Shanghai, China from 2020 to 2022

Elderly individuals face a high risk of hospitalization and death related to influenza, thus prioritizing them for influenza vaccination. Due to variations in the influenza virus and waning protective antibodies, annual influenza vaccination is recommended. However, research on repeated influenza vaccination among elderly individuals in China is limited. From 2020 to 2022, the average influenza vaccination coverage among registered elderly individuals in Shanghai was 4.1%, showing a declining trend over time. In 2020, the rate of repeated influenza vaccination among elderly individuals was 28.35%, which rose to almost two-thirds both in 2021 and 2022. No increased risk of adverse events following immunization was observed after repeated influenza vaccination during this period. Our study also found that elderly individuals with Shanghai household registration, managed by community clinics, and older age tended to receive more doses of repeated influenza vaccination throughout the period from 2020 to 2022. Increasing influenza vaccine coverage among elderly individuals in Shanghai is both urgent and challenging. Health authorities should intensify educational and promotional campaigns to encourage uptake of annual repeated influenza vaccination among elderly individuals.

Improving Data-Informed Care in New Brunswick Long-Term Care Homes: A Qualitative Study on an Educational Intervention for interRAI Coordinators

Background/Objectives: InterRAI is a globally validated platform aimed at improving care for individuals with disabilities and complex medical needs, particularly in long-term care settings. This study explores the experiences of interRAI coordinators in New Brunswick, Canada, and their perceptions of an educational intervention designed to enhance their ability to effectively use interRAI data for quality care. Methods: The study recruited interRAI coordinators from 73 New Brunswick long-term care homes for an educational intervention. Nine coordinators participated in interviews about their experiences. A qualitative descriptive approach was used to analyze field notes and interview transcripts with thematic analysis. Results: Nine interviews and six sets of field notes were collected over one year, focusing on the roles of interRAI coordinators. Participants (all female, averaging 54 years old) expressed positive perceptions of the intervention, noting increased knowledge and collaboration. Key themes included the context of the interRAI coordinator role, the use of interRAI data for quality indicators, and recommendations for future educational initiatives. Conclusions: The findings emphasize the critical role of interRAI coordinators in improving quality care in long-term care settings through effective data use and collaboration. Participants reported that the educational intervention significantly improved their understanding and application of interRAI data. Recommendations for ongoing training and broader engagement stress the importance of continuous support to advance care quality in long-term care homes.

Implementation of a centralized, web-based surveillance for healthcare associated infections among residents of long-term care facilities in Italy

Objective

The Italian National Action Plan to contrast AMR identified among its objectives the development and implementation of a national Healthcare-Associated Infection (HAI) surveillance system based on European Centre for Disease Prevention and Control (ECDC) indications, through point prevalence surveys (PPS) of HAIs and antibiotic use in acute-care hospitals and long-term care facilities (LTCFs). We aimed to assess feasibility and appropriateness of proposed tools for a national surveillance system of HAIs and antibiotic use in LTCFs.

Study design

Point prevalence survey.

Methods

A pilot PPS was conducted between May-June 2022, among 15 LTCFs of 7 Italian regions. Data were collected in a single day in each LTCF, at the LTCF, ward, and resident levels, using a web-based data collection tool developed ad hoc. Data collector teams of each facility were invited to complete a questionnaire investigating opinions on the proposed tools.

Results

Among 1025 included residents, the prevalence of residents with at least one HAI was 2.5% (95% CI 1.7%-3.7%) considering all HAIs and 2.2% (95% CI 1.3%-3%) without considering SARS-CoV-2 infections. The prevalence of antimicrobial use was 3% (95% CI 0.2%-4.3%). Overall, most respondents were satisfied with the web-based software, training and protocol, even though some difficulties were reported.

Conclusions

A national surveillance network was established, which will facilitate future surveillance efforts. Further studies are necessary to evaluate the impact of the pandemic on HAI transmission and antibiotic use in LTCFs.

An evaluation of influenza, pneumococcal and herpes zoster vaccination coverage in Australian aged care residents, 2018 to 2022

BACKGROUND

For older persons, vaccination mitigates the harmful impact of vaccine preventable infections. Our study objectives were to evaluate in the Victorian public sector residential aged care services (PSRACS) (1) the existence of local vaccination policies and admission assessment practices, (2) the current documented status of resident influenza, pneumococcal and herpes zoster vaccination uptake and (3) changes in documented resident vaccination uptake over time.

METHODS

Standardised data were annually reported by all PSRACS between 2018 and 2022. The influenza, pneumococcal and herpes zoster vaccination status of each resident was classified as vaccinated, declined, contraindicated or unknown. Annual trends in vaccination status were assessed using Spearman's correlation.

RESULTS

In 2022, most PSRACS reported an influenza immunisation policy existed (87.1%) and new residents were assessed for their influenza vaccination status (97.2%); fewer PSRACS reported the same for pneumococcal disease (73.1% and 78.9%) and herpes zoster (69.3% and 75.6%). The median resident influenza, pneumococcal and herpes zoster (70-79 years old) vaccination uptake was 86.8%, 32.8% and 19.3% respectively. The median unknown status was 6.9%, 63.0% and 76.0% respectively. Statistical evidence of an increase in annual uptake was observed for the herpes zoster (all resident) surveillance module (rs = 0.900, p = 0.037).

CONCLUSIONS

Our study showed local influenza vaccination policies and practices exist and influenza vaccination uptake was consistently high. Pneumococcal and herpes zoster vaccination uptake were lower. Quality improvement strategies that at least determine the status of those residents classified as unknown are required.

The Implementation of Integrated Health Information Systems - Research Studies from 7 Countries Involving the InterRAI Assessment System

Introduction

In the past years, governments from several countries have shown interest in implementing integrated health information systems. The interRAI Suite of instruments fits this concept, as it is a set of standardised, evidence-based assessments, which have been validated for different care settings. The system allows the electronic transfer of information across care settings, enabling integration of care and providing support for care planning and quality monitoring. The main purpose of this research is to describe the recent implementation process of the interRAI instruments in seven countries: Belgium, Switzerland, France, Ireland, Iceland, Finland and New Zealand.

Methods

The study applied a case study methodology with the focus on the implementation strategies in each country. Principal investigators gathered relevant information from multiple sources and summarised it according to specific aspects of the implementation process, comparing them across countries. The main implementation aspects are described, as well as the main advantages and barriers perceived by the users.

Results

The seven case studies showed that adequate staffing, appropriate information technology, availability of hardware, professional collaboration and continuous training are perceived as important factors which can contribute to the implementation of the interRAI instruments. In addition, the use of electronic standardised assessment instruments such as the interRAI Suite provided evidence to improve decision-making and quality of care, enabling resource planning and benchmarking.

Conclusion

In practice, the implementation of health information systems is a process that requires a cultural shift of policymakers and professional caregivers at all levels of health policy and service delivery. Information about the implementation process of the interRAI Suite in different countries can help investigators and policymakers to better plan this implementation. This research sheds light on the advantages and pitfalls of the implementation of the interRAI Suite of instruments and proposes approaches to overcome difficulties.

Using ELEFIGHT® QR Codes for Quick Access to Information on Influenza Burden and Prevention: A Pilot Study in Lyon University Hospital

(1) Background: The Vaccine Coverage Rate of influenza remains low and omnichannel efforts are required to improve it. The objective was to evaluate the feasibility and outcomes of a QR Code nudging system in outpatient departments. (2) Methods: The study was performed in 6 departments ensuring ambulatory activities in a French university Hospital between November and December 2021. By scanning QR codes, users accessed anonymously to the ELEFIGHT^® web app, which provides medical information on influenza and invites them to initiate a discussion about influenza prevention with their physicians during the consultation. (3) Results: 351 people made 529 scans with an average reading time of 1 min and 4 s and a conversion rate of 32%, i.e., people willing to engage in a discussion. (4) Conclusions: The study suggests that direct access to medical information through QR codes in hospitals might help nudge people to raise their awareness and trigger their action on influenza prevention.