Preventing flu outbreaks in long-term care facilities

Influenza and pneumococcal pneumonia kill many elderly Canadians. This issue of CMAJ presents 3 articles that discuss the successes — and failures — of Canadian efforts to limit influenza outbreaks in Canadian long-term care facilities.

In the first article, Colin Stevenson and colleagues report the results of serial surveys of vaccination coverage and influenza outbreak management in these facilities in Canada. In 1999, the mean reported rates of influenza vaccination were 83% among residents and 35% among staff, and the mean rate of pneumococcal vaccination among residents was 71%; all 3 rates were higher than in 1991, but could be better.

Having an infection control practitioner at these facilities and obtaining consent for vaccination upon admission to them were factors associated with higher influenza and pneumococcal vaccination rates. In the second article, Margaret Russell reports that mean rates of vaccination among staff and residents at long-term care facilities in Alberta were 30% and 91% respectively; only 85 of 136 responding facilities provided staff vaccination rates. All but 2 facilities reported that staff vaccination was voluntary.

The authors conclude that staff vaccination rates in Alberta are unacceptably low and changes to vaccination programs, such as offering vaccination during night shifts, may help improve rates. The authors also suggest that eliminating the requirement for annual written consent for influenza vaccination might help improve vaccination rates among residents.

In a commentary about staff vaccinations, Drs. Elizabeth Rea and Ross Upshur discuss the balance between the right of health professionals to refuse to be vaccinated versus their obligation to help protect patients from infection.

Prevention of influenza and pneumococcal pneumonia in Canadian long-term care facilities
— C.G. Stevenson et al

Influenza vaccination in Alberta long-term care facilities
— M.L. Russell

Semmelweis revisited: the ethics of infection prevention among health care workers
— E. Rea, R. Upshur

Contacts: Dr. Allison McGeer, Department of Microbiology, Mount Sinai Hospital, Toronto
Dr. Margaret Russell, Department of Community Health Sciences, Faculty of Medicine, University of Calgary; tel. 403-220-4279, email: mlrussel@ucalgary.ca
Dr. Elizabeth Rea, University of Toronto; tel. 416 488-3125, email: e.rea@utoronto.ca