Project protect: pneumococcal vaccination in Washington State nursing homes

Pneumonia is the third most frequent cause of hospitalization among Medicare beneficiaries in Washington State. While a vaccine against pneumococcal disease has been available since 1977, the 1999 Behavioral Risk Factor Surveillance System estimates that less than 60% of adults aged 65 years and older in Washington State have been vaccinated.

To assess the prevalence of pneumococcal vaccination policies, we surveyed all Washington nursing homes in 1999 and again in 2001 to assess changes during the intervening period. Following the policy surveys, to estimate the pneumococcal vaccination rate, we conducted assessments of a random sample of residents of Washington nursing homes.

Use of standing orders/written pneumococcal vaccination policies by nursing homes increased by 14% from 58% in 1999 to 72% in 2001. The pneumococcal vaccination rate for residents of nursing homes increased from 47% in 2000 to 61% in 2002. Both increases were statistically significant. The odds of a resident receiving a pneumococcal polysaccharide vaccine (PPV) in a nursing home having standing orders or other written guidelines are estimated to be two-and-a-half times greater than for residents in facilities without any PPV guidelines (2000: OR = 2.59; 95% CI, 1.54-4.34; 2002: OR = 3.19; 95% CI, 1.68-6.01).

Increased use of standing orders/written policies has contributed to higher rates of pneumococcal vaccination in Washington State nursing homes.