Meier-Stephenson Vanessa, McNeil Shelly, Kew Andrea, Sweetapple Jennifer, Thompson Kara, Slayter Kathryn
MD, PhD, was, at the time of manuscript preparation, an Internal Medicine resident with the Faculty of Medicine, Dalhousie University, and the Department of Medicine, Capital Health, Halifax, Nova Scotia. She is currently completing an Infectious Diseases residency at the University of Calgary, Calgary, Alberta.
MD, is with the Faculty of Medicine, Dalhousie University, and the Department of Medicine and Division of Infectious Diseases, Capital Health, Halifax, Nova Scotia.
Can J Hosp Pharm. 2014 Jul;67(4):262-7. doi: 10.4212/cjhp.v67i4.1369.
Overwhelming postsplenectomy infection is a serious potential outcome for patients who have undergone resection of the spleen and is associated with a high mortality rate. The most common bacterial causes are the encapsulated organisms Streptococcus pneumoniae, Neisseria meningitidis, and Hemophilus influenzae type B, all of which are vaccine-preventable. Current guidelines recommend vaccination against these 3 bacteria, but adherence to these guidelines is less than ideal. In 2007, a "perisplenectomy vaccination kit" was introduced at the authors' institution to improve compliance with immunization guidelines by making the vaccines and necessary information for patients and providers more readily available.
To evaluate and compare vaccination rates for patients who underwent splenectomy before and after introduction of the perisplenectomy vaccination kit and, secondarily, to identify any characteristics unique to those who did not receive appropriate perisplenectomy vaccinations.
In this observational study, performed at the QEII Health Sciences Centre of Capital Health in Halifax, Nova Scotia, data were reviewed for patients who underwent splenectomy between 2008 and 2011. Vaccination rates and other descriptive statistics were calculated and compared with data for a 3-year period before implementation of the program.
Vaccination rates in the 3-year period following implementation of the perisplenectomy vaccination kit were 100% against S. pneumoniae, 97% against N. meningitidis, and 93% against H. influenzae type B. The corresponding rates in the 3 years before introduction of the kit were 91%, 75%, and 68%, respectively. No characteristics predicting inadequate immunization were identified in univariate or multivariate analysis.
Introduction of a pharmacy-driven perisplenectomy vaccination kit program improved rates of appropriate vaccination for patients who underwent splenectomy.
脾切除术后暴发性感染是脾切除患者严重的潜在后果，且死亡率很高。最常见的细菌病因是包膜菌肺炎链球菌、脑膜炎奈瑟菌和B型流感嗜血杆菌，所有这些都是可通过疫苗预防的。当前指南建议针对这三种细菌进行疫苗接种，但对这些指南的依从性并不理想。2007年，作者所在机构引入了“脾切除术前疫苗接种套件”，通过使疫苗以及患者和医护人员所需信息更易于获取，来提高对免疫指南的依从性。
评估和比较引入脾切除术前疫苗接种套件前后接受脾切除术患者的疫苗接种率，其次，确定未接受适当脾切除术前疫苗接种者的任何独特特征。
在新斯科舍省哈利法克斯市首都健康的QEII健康科学中心进行的这项观察性研究中，对2008年至2011年间接受脾切除术的患者数据进行了回顾。计算了疫苗接种率和其他描述性统计数据，并与该项目实施前三年的数据进行了比较。
实施脾切除术前疫苗接种套件后的三年中，肺炎链球菌疫苗接种率为100%，脑膜炎奈瑟菌疫苗接种率为97%，B型流感嗜血杆菌疫苗接种率为93%。引入套件前三年的相应接种率分别为91%、75%和68%。单因素或多因素分析均未发现预测免疫接种不足的特征。
引入由药房驱动的脾切除术前疫苗接种套件计划提高了接受脾切除术患者的适当疫苗接种率。
