Stevenson C*, McArthur MA, Zivnickova H, Abraham E, Naus M, McGeer AJ, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; Ontario Ministry of health and Long Term Care, Ontario, Canada.

Objective: To assess influenza (FLU) and pneumococcal (PNE) vaccine use and antiviral prophylaxis in Canadian long term care facilities (LTCF)s.

Design: Cross-sectional surveys in 1991, 1995, and 1999 of Canadian residential LTCFs with >25 beds. Vaccination (VAC) rates over time were compared in LTCFs responding to all surveys.

Results: Response rates were 88% in 1991, 84% in 1995 and 76% (380/498) in 1999.In 1999, 95% of responding LTCFs provided resident FLU VAC rates, 85% staff FLU VAC rates, and 87% resident PNE VAC rates. Mean reported FLU VAC rates in 1998 were 86.1% for residents and 39.6% for staff, significant increases over 1991, when 78.5% of residents were vaccinated and 81% of facilities reported staff VAC rates of <25%. Rates increased in all provinces; differences between provinces persisted. The mean PNE VAC rate among residents was 70.5%, significantly increased over 1991 and 1995. Higher resident FLU VAC and PNE VAC rates were reported from LTCFs with an infection control practitioner (ICP) (P<0.001 for both), and those obtaining consent for VAC on admission (P=0.03 and P=<0.001, respectively). Predictors of higher staff VAC rates included smaller size of facility (P<0.001), and presence of an ICP (P=0.007). Resident VAC rates were not associated with the frequency of FLU outbreaks. Facilities without FLU outbreaks reported higher staff FLU VAC rates (P=NS). In the 1998/9 season, 44% of LTCFs with staff FLU VAC rates <25% reported at least one FLU outbreak, compared to 39 with rates of 25-49%, 35% with rates of 50-74% and 28% with rates >75% (P=NS). LTCFs with ICP were more likely to have a policy on amantadine use (77% compared to 23%, P=0.001). Of those LTCFs reporting FLU A outbreaks, amantadine was ordered for residents in 86% of outbreaks in 97/8 and 92% of outbreaks in 98/9; 65% of LTCF's offered amantadine to staff in 97/8 and in 98/9. Amantadine was discontinued due to side effects in 2.7% of residents.

Conclusion: VAC rates are increasing but remain suboptimal. Staff VAC reduces the risk of FLU outbreaks. The presence of an ICP is associated with increased VAC rates and antiviral prophylaxis.

Presented at:

4th Decennial - International Conference on Nosocomial & Healthcare Associated Infections. Atlanta, GA, March 5-9, 2000.