Impact of NHAP guideline implementation intervention on staff and resident vaccination rates.
OBJECTIVE
Determine whether a comprehensive approach to implementing national consensus guidelines for nursing home acquired pneumonia (NHAP), including influenza and pneumococcal vaccination, improves resident subject and staff vaccination rates.


METHODS
Quasi-experimental, mixed-methods multifaceted intervention trial conducted at 16 nursing homes (NHs) from 1 corporation (8 in metropolitan Denver, Colorado; 8 in Kansas and Missouri) during 3 influenza seasons, October to April 2004 to 2007. Residents with 2 or more signs and symptoms of systemic lower respiratory tract infection (LRTI) and NH staff and physicians were eligible. Subjects' NH records were reviewed for vaccination. Each director of nursing (DON) completed a questionnaire assessing staffing and the number of direct care staff vaccinated against influenza. DONs and study liaison nurses were interviewed after the intervention. Bivariate analysis compared vaccination outcomes and covariates between intervention and control homes, and risk-adjusted models were fit. Qualitative interview transcripts were analyzed using content coding.


RESULTS
No statistically significant relationship between the intervention and improved resident vaccination rates was found, so other factors associated with improved rates were explored. Estimated direct patient care staff vaccination rates were better during the baseline and improved more in the intervention NHs. Qualitative results suggested that facility-specific factors and national policy changes impacted vaccination rates.


CONCLUSIONS
External factors influence staff and resident vaccination rates, diluting the potential impact of a comprehensive program to improve care for NHAP on vaccination.
Denver VA Medical Center, Denver, CO 80220, USA. evelyn.hutt@ucdenver.edu
Evelyn
E
Hutt
Tiffany A
TA
Radcliff
Kathleen S
KS
Oman
Regina
R
Fink
J Mark
JM
Ruscin
Sunny
S
Linnebur
Doug
D
Fish
Debra
D
Liebrecht
Ron
R
Fish
Monica
M
McNulty
D000368:Aged; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D017589:Immunization Programs / Q000706:statistics & numerical data*; D007251:Influenza, Human / Q000517:prevention & control*; D007407:Interviews as Topic; D015146:Midwestern United States; D009735:Nursing Homes; D009740:Nursing Staff; D010361:Patients; D011795:Surveys and Questionnaires