Immunization: Strategies That Work
Long-term Care Strategies
Dayton's Bluff Community
Care Center, St. Paul, MN
CDC's Basic Strategy
Dayton's Bluff Community Care Center, part of the Health Dimensions network of Long
Term Care facilities, has 183 beds. Ninety-nine percent of its residents are aged 65 or
older. Infection Control Practitioner Candi Shearen is a lead member of the facility's
Quality Assurance Committee, who updates the facility's prevention strategies yearly,
based on the previous year's data.
Utilizes standing orders for influenza immunizations and provides it
to all residents for whom it is indicated.
Encourages staff to receive influenza vaccine to protect residents and
gives vaccine free of charge.
Encourages visitors to receive influenza vaccine from their own health
Promotes influenza vaccine via newsletter articles, posters, and
letter to residents and families from Medical Director and Infection Control Nurse.
Infection Control Nurse speaks directly with residents who refuse the vaccine.
Solicits assistance of residents to promote and explain the vaccine to
other residents, both at resident gatherings and by "spreading the word."
Investigates resident "egg allergy" to verify authenticity.
Gives pneumococcal vaccine as part of admission orders, after nurse
investigates and asks for physician orders. Medical records clerk follows up. Will assess
patients to determine the need for revaccination.
Gives a tetanus-diphtheria series to all residents with nosocomial and
pre-existing stage 3 and 4 pressure ulcers and, assisted by a tickler file maintained by
the pressure ulcer nurse, ensures the entire series is administered. (Note: CDC recommends
that ALL residents be assessed for tetanus-diphthera toxoids, since some probably never
received the series.)
Includes a tuberculin skin test as part of admission process, in order
to avoid exposing other residents.
Keeps complete immunization records on every resident.
Obtained support of Administrator and Director of Nursing.
Involved Quality Assurance Committee, especially the Medical Director.
Wrote Policies and Procedures and educated staff, using consultants as
The Infection Control Nurse, who is salaried, must have a designated amount of time
allotted for infection control, in addition to his or her other responsibilities. Candi
Shearen says the Infection Control Nurse must "take ownership in the program and
'sell' it to others."
The major barrier is some physicians who do not support the program because of what Ms.
Shearen calls "old knowledge," and cost in time. The cost in Infection Control
Nurse time to write Policies and Procedures, implement, promote, and maintain the program,
the cost in nursing staff time to administer vaccines and educate residents, staff, and
families, and the cost in billing department time to process insurance and Medicare
reimbursement for influenza immunizations, is more than made up in savings to the facility
from these preventive efforts. Prevention "keeps the beds full for long term care,
administratively speaking," according to Candi Shearen.
Influenza immunization rates increased from 80% of all residents in 1991 to 97% in
1996. Procedures and Policies were in place in 1992 when an influenza outbreak occurred in
the facility, with a resulting zero deaths. Pneumococcal vaccine has been given to 87% of
residents. The facility has 100% compliance with tetanus-diphtheria and tuberculin skin
testing, with no tetanus seen and two cases of suspected TB discovered within 48 hours of
admission last year.
CDC Recommends this Basic
- Obtain support of key individuals and all physician and non-physician personnel
- Establish system changes to assure all clients are offered vaccination services that are
indicated: intake procedures, standing orders, evaluation
- Use reminder systems and cues
- Establish Continuous Quality Improvement systems.