Canadian Immunization Guide
Seventh Edition - 2006

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Part 3
Recommended Immunization

Immunization of Patients in Health Care Institutions

Taking an immunization history from those admitted to hospital or attending outpatient clinics and vaccinating them before discharge provides an important opportunity to maintain up-to-date immunization for all patients. For patients without regular sources of care or those followed in specialized clinics, the only opportunities for immunization may be during clinic visits or hospitalization. There is good evidence that using provider reminders and standing orders, and evaluating vaccine coverage with feedback to providers improves vaccine uptake. Immunization status should also be verified during emergency department visits and vaccine offered as appropriate.

The admission of elderly patients and others at high risk of influenza complications or pneumococcal disease is an opportunity to ensure that these people are immunized. Effective programs to immunize such patients before discharge will guarantee that they do not miss immunization in the community during the limited influenza vaccination period.

All pregnant women should be screened for chronic hepatitis B virus (HBV) infection, and newborns of HBV-infected women should receive hepatitis B immune globulin and start a course of vaccine within 12 hours of birth. As well, administering the first dose of hepatitis B vaccine, before discharge, to other newborns at high risk of exposure to hepatitis B virus may be considered. Please refer to the Hepatitis B Vaccine chapter for more information on the timing of vaccination and on other recommended recipients.

Women susceptible to rubella or varicella should receive vaccine post-partum before discharge. Please refer to the Recent Administration of Human Immune Globulin Products chapter, for specific recommendations for women who have received Rh immune globulin post-partum. Arrangements should also be made for the parents, other adolescent or adult family members, and other caretakers of the newborn to receive, as soon as possible, one dose of pertussis-containing vaccine formulated for adolescents and adults if they have not already received one.

Residents of long-term care institutions, like members of the general population, should receive all routine immunizations appropriate for their age and individual risk status. Annual immunization against influenza is essential for residents of long-term care institutions, and robust programs to ensure that this occurs should be put in place. As well as the proven strategies of provider reminders, standing orders, and evaluation of vaccine coverage with feedback to providers, it is advisable to inform patients or their surrogate decision makers of the facility's immunization policy on admission and every effort made to obtain informed consent before the influenza season.

In both acute-care and long-term care settings, it is most important that immunization efforts be part of organized care plans within each department, with clear accountability for program planning, implementation and evaluation.

Selected references

Centers for Disease Control and Prevention. Recommendations of the Advisory Committee on Immunization Practices: programmatic strategies to increase vaccination rates - assessment and feedback of provider-based vaccination coverage information. Morbidity and Mortality Weekly Report 1996;45(10):219-20.

Task Force on Community Preventive Services. The guide to community preventive services. URL: <www.thecommunityguide.org/vaccine/default.htm>. Accessed February 5, 2006.

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