Association of standing-order policies with vaccination rates in dialysis clinics: a US-based cross-sectional study.
BACKGROUND
Patients with end-stage renal disease are at increased risk of morbidity and mortality because of infection. Quality improvement efforts for this patient population include assessment of institutional policies and practices that may increase vaccination rates for influenza, hepatitis B, and pneumococcal disease.


METHODS
A survey of vaccination practices, beliefs, and attitudes was sent to all dialysis centers in End-Stage Renal Disease Networks 6, 11, and 15.


METHODS
Of 1,052 dialysis facilities considered, 683 returned the survey, reported vaccination rates for 2005 to 2006, and had 20 or more patients.


METHODS
Standing-order policy of the dialysis facility, categorized as facility-wide orders, preprinted admission orders for each patient (chart orders), physician-specific orders, and individual orders.


RESULTS
Vaccination rates for influenza, hepatitis B (full or partial series), hepatitis B, and pneumococcal vaccine.


METHODS
Patient vaccination, given at or outside the center.


RESULTS
Overall vaccination rates were 76% +/- 18% (SD) for influenza, 73% +/- 22% for hepatitis B full or partial series, 62% +/- 25% for hepatitis B full series, and 44% +/- 34% for pneumococcal vaccine. Compared with individual orders, facility-wide standing orders and chart orders were not associated with greater vaccination rates for influenza (0.4%; confidence interval, -4 to 5; and 1.27%; confidence interval, -3 to 5, respectively), but were associated with greater vaccination rates for hepatitis B full or partial series (9%; confidence interval, 3 to 15; and 11%; confidence interval, 5 to 17, respectively), hepatitis B full series (11%; confidence interval, 4 to 17; and 13%; confidence interval, 7 to 19, respectively), and pneumococcal disease (21%; confidence interval, 14 to 29; and 20%; confidence interval, 13 to 27, respectively).


CONCLUSIONS
Data are cross-sectional, and vaccinations outside the center were self-reported.


CONCLUSIONS
Existing facility-wide or chart-based order programs may be effective in promoting vaccination against hepatitis B and pneumococcal disease.
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA. tcbond@emory.edu
T Christopher
TC
Bond
Priti R
PR
Patel
Jenna
J
Krisher
Leighann
L
Sauls
Jan
J
Deane
Karen
K
Strott
Shelley
S
Karp
William
W
McClellan
D003430:Cross-Sectional Studies; D003625:Data Collection; D007722:Health Knowledge, Attitudes, Practice; D006509:Hepatitis B / Q000517:prevention & control; D017325:Hepatitis B Vaccines / Q000276:immunology / Q000627:therapeutic use*; D006515:Hepatitis B virus / Q000276:immunology; D006801:Humans; D007252:Influenza Vaccines / Q000276:immunology / Q000627:therapeutic use*; D007251:Influenza, Human / Q000517:prevention & control; D007676:Kidney Failure, Chronic / Q000150:complications / Q000276:immunology / Q000628:therapy*; D009975:Orthomyxoviridae / Q000276:immunology; D022242:Pneumococcal Vaccines / Q000276:immunology / Q000627:therapeutic use*; D011018:Pneumonia, Pneumococcal / Q000517:prevention & control; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D006435:Renal Dialysis; D013296:Streptococcus pneumoniae / Q000276:immunology; D014481:United States
D017325:Hepatitis B Vaccines; D007252:Influenza Vaccines; D022242:Pneumococcal Vaccines