To better understand work-site–based programs for influenza vaccination.

Self-administered, mailed questionnaire.

Healthcare and non-healthcare companies.

Random sample of 2,000 members of the American Association of Occupational Health Nurses.

The response rate was 55%, and 88% of the respondents were employed by companies sponsoring work-site influenza vaccination. Thirty-two percent of respondents worked for healthcare and healthcare-related services companies. Healthcare companies were more likely to sponsor worksite-based vaccination (94% vs 85%; P < .0001) compared with non-healthcare companies. Healthcare companies were also more likely to encourage vaccination of high-risk employees (70% vs 55%; P < .0001) and cover its cost (86% vs 61%; P < .0001). Multivariate logistic regression was used to determine factors associated with highly successful vaccination. Being a healthcare-related company (OR, 2.1; CI95 1.4–3.2; P < .0001), employers covering the vaccination cost (OR, 3.1; CI95, 1.4–6.6; P = .004), having more experience with work-site vaccination (OR, 1.6; CI95, 1.0–2.4; P = .036), and management encouraging vaccination (OR, 2.6; CI95, 1.4–4.9; P = .002) were associated with highly successful programs.

Most of the occupational health nurses surveyed work for employers sponsoring work-site vaccination, and 32% were employed by healthcare and related services companies. Healthcare companies were more likely to sponsor worksite–based vaccination and to vaccinate most of their employees; however, only 18% had vaccination rates higher than 50%. Strategies need to be developed to increase vaccination rates so that benefits of vaccination can be realized by employers and employees.

To analyze the efficacy of periodically changing ventilator circuits for decreasing the rate of ventilator-associated pneumonia when a heat and moisture exchanger (HME) is used for humidification. The Centers for Disease Control and Prevention recommended not changing the circuits periodically.

Randomized, controlled trial conducted between April 2001 and August 2002.

A 24-bed, medical–surgical intensive care unit in a 650-bed, tertiary-care hospital.

All patients requiring mechanical ventilation during more than 72 hours from April 2001 to August 2002.

Patients were randomized into two groups: (1) ventilation with change of ventilator circuits every 48 hours and (2) ventilation with no change of circuits. Throat swabs were taken on admission and twice weekly until discharge to classify pneumonia as endogenous or exogenous.

Three hundred four patients (143 from group 1 and 161 from group 2) with similar characteristics (age, gender, Acute Physiology and Chronic Health Evaluation II score, diagnostic group, and mortality) were analyzed. There was no significant difference in the rate of pneumonia between the groups (23.1% vs 23.0% and 15.5 vs 14.8 per 1,000 ventilator-days). There was no significant difference in the incidence of exogenous pneumonia per 1,000 days of mechanical ventilation (1.71 vs 1.25). There was no difference in the distribution of microorganisms causing pneumonia.

Circuit change using an HME for humidification does not decrease pneumonia and represents an unnecessary cost.

Studies have found residency in long-term–care facilities (LTCFs) a risk factor for influenza and pneumonia and have demonstrated that vaccinations against these diseases reduce the risk of disease. However, rates are below Healthy People 2010 goals of 90% for LTCFs. During 1999–2002, a multi-state demonstration project was conducted in LTCFs to implement standing orders programs for immunizations.

Identify nursing home resident–specific characteristics associated with vaccination coverage at baseline.

Facility-level data were collected from self-reported surveys of selected nursing homes in 14 states and from the On-line Survey and Certification Reporting System. Resident-level data, including demographics and physical functioning, were obtained from the Centers for Medicare & Medicaid Services' Minimum Data Set; 2000–2001 vaccination status was obtained by chart review. Influenza vaccination status reflected a single season, whereas pneumococcal vaccination status reflected vaccination in the past. Multilevel analysis was used to control for facility-level variation.

Of 22,188 residents sampled in 249 LTCFs, complete data were obtained for 20,516 (92%). The average coverage for immunizations was 58.5% ± 0.7% for influenza and 34.6% ± 0.3% for pneumococcal. On bivariate analyses, residents with cognitive, psychiatric, or neurologic problems were more likely to be vaccinated; those with accidental injuries, unstable conditions, or cancer were less likely to receive either vaccine. On multilevel analysis, the strongest resident characteristics associated with receipt of immunizations, controlling facility variation, were cognitive deficits and psychiatric illness.

The variation in baseline vaccination coverage associated with LTCF resident characteristics supports the need for strategies to increase vaccination coverage in LTCFs.