Annals of Long Term Care

CLINICAL INVESTIGATIONS

Effect of Influenza Vaccination of Nursing Home Staff on Mortality of Residents: A Cluster-Randomized Trial

Magali Lemaitre, MPH, Thierry Meret, MD, Monique Rothan-Tondeur, PhD, Joel Belmin, MD, Jean-Louis Lejonc, MD, Laurence Luquel, MD, François Piette, MD, Michel Salom, MD, Marc Verny, MD, PhD, Jean-Marie Vetel, MD, Pierre Veyssier, MD, and Fabrice Carrat, MD, PhD

OBJECTIVES: To evaluate the effect of staff influenza vaccination on all-cause mortality in nursing home residents.

DESIGN: Pair-matched cluster-randomized trial.

SETTING: Forty nursing homes matched for size, staff vaccination coverage during the previous season, and resident disability index.

PARTICIPANTS: All persons aged 60 and older residing in the nursing homes.

INTERVENTION: Influenza vaccine was administered to volunteer staff after a face-to-face interview. No intervention took place in control nursing homes.

MEASUREMENTS: The primary endpoint was total mortality rate in residents from 2 weeks before to 2 weeks after the influenza epidemic in the community. Secondary endpoints were rates of hospitalization and influenza-like illness (ILI) in residents and sick leave from work in staff.

RESULTS: Staff influenza vaccination rates were 69.9% in the vaccination arm versus 31.8% in the control arm. Primary unadjusted analysis did not show significantly lower mortality in residents in the vaccination arm (odds ratio=0.86, P=.08), although multivariate-adjusted analysis showed 20% lower mortality (P=.02), and a strong correlation was observed between staff vaccination coverage and all-cause mortality in residents (correlation coefficient=−0.42, P=.007). In the vaccination arm, significantly lower resident hospitalization rates were not observed, but ILI in residents was 31% lower (P=.007), and sick leave from work in staff was 42% lower (P=.03).

CONCLUSION: These results support influenza vaccination of staff caring for institutionalized elderly people. J Am Geriatr Soc Soc 2009;57(9):1580-1586.

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BRIEF REPORTS

Pilot Testing of Intervention Protocols to Prevent Pneumonia in Nursing Home Residents

Vincent Quagliarello, MD, Manisha Juthani-Mehta, MD, Sandra Ginter, RN, Virginia Towle, M Phil, Heather Allore, PhD, and Mary Tinetti, MD

OBJECTIVES: To test intervention protocols for feasibility, staff adherence, and effectiveness in reducing pneumonia risk factors (impaired oral hygiene, swallowing difficulty) in nursing home residents.

DESIGN: Prospective study.

SETTING: Two nursing homes.

PARTICIPANTS: Fifty-two nursing home residents.

INTERVENTION: Thirty residents with impaired oral hygiene were randomly assigned to manual oral brushing plus 0.12% chlorhexidine oral rinse at different frequencies daily. Twenty-two residents with swallowing difficulty were randomly assigned to upright feeding positioning, teaching swallowing techniques, or manual oral brushing. All protocols were administered over 3 months.

MEASUREMENTS: Feasibility was assessed monthly and defined as high if the protocol took less than 10 minutes to administer. Adherence was assessed weekly and defined as high if full staff adherence was demonstrated in more than 75% of assessments. Effectiveness for improved oral hygiene (reduction in oral plaque score) and swallowing (reduction in cough during swallowing) was compared at baseline and 3 months.

RESULTS: Daily manual oral brushing plus 0.12% chlorhexidine rinse demonstrated high feasibility, high staff adherence, and effectiveness in improving oral hygiene (P<.001 vs baseline); this combination administered twice per day showed the highest plaque score reduction.