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Pneumococcal Vaccinations: Overcoming Barriers to Increase Vaccination Rates

Streptococcus pneumoniae, or pneumococcus, can cause severe bacterial infections like pneumonia, meningitis and bacteremia. According to the Centers for Disease Control and Prevention (CDC), pneumococcal pneumonia causes about 150,000 hospitalizations in the United States, and about 1 in 20 people will die from pneumococcal meningitis. The death rate is higher in adults aged 65 years and older. Other common infections caused by streptococcus pneumoniae include otitis media and sinusitis.

While everyone is at risk of developing a pneumococcal disease, adults 65 years and older face an increased risk. Comagine Health has created an educational flyer that facilities can share with their residents and family members.  The flyer lists three strong reasons adults should get the pneumonia vaccine, especially if they have certain risk factors, such as:

  • Alcoholism
  • Chronic heart, lung, kidney or liver disease
  • Cochlear implant
  • Diabetes
  • Weakened immune system
  • Nephrotic syndrome
  • Sickle cell disease, a damaged spleen or no spleen
  • Smoking
  • Chronic lung diseases

There are three major barriers to increasing pneumococcal vaccination rates. First, some LTPAC providers may be skeptical about the benefits of the pneumococcal vaccine (PPV). To help clarify the facts, The Society for Post-cute and Long-Term Care Medicine (AMDA) has released a policy statement that strongly supports pneumococcal vaccines in the LTPAC population. Second, accurate vaccine histories are difficult to obtain. Make sure to spend time during the admission and discharge processes to document the resident’s vaccination status thoroughly. Also make sure your facility has access to your state Immunization Information System (IIS) to help determine what vaccines have been given previously. Third, the PPV vaccination schedule is extremely complex. To help address this barrier, Comagine Health recommends using the CDC's comprehensive summary of the schedule for adults 65 years or older.

All the above barriers can be resolved. But there is one very simple way to increase vaccinations: Implement and use vaccination standing orders. In 2002, the Department of Health and Human Services (HHS) approved the use of standing orders for influenza and pneumococcal vaccines.  Comagine Health has created an Adult Immunizations Toolkit, which includes tools and additional resources for clinicians, patients and staff education.

Take time this week to check if your facility has an active standing order program. If the answer is yes, ask your leadership team if staff are using them appropriately. If not, take time within the next 2-4 weeks and create a Process Improvement Team to develop and implement standing orders for pneumococcal vaccinations. 

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