国家住院患者免疫接种模式：疫苗类型之间的实践和政策差异。
National Inpatient Immunization Patterns: Variation in Practice and Policy Between Vaccine Types.
机构信息
Division of Hospital Medicine and
Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California.
出版信息
Hosp Pediatr. 2021 May;11(5):462-471. doi: 10.1542/hpeds.2020-002634. Epub 2021 Apr 5.
BACKGROUND
Many hospitalized children are underimmunized, yet little is known about current systems supporting inpatient vaccination. We aim to describe national pediatric inpatient immunization practices and determine if variation exists among adolescent, childhood, and influenza vaccines.
METHODS
An electronic survey regarding hospital vaccination practices was sent to physician, nurse, and pharmacy leaders via the Pediatric Research in Inpatient Settings Network in spring 2019. Hospitals reported the presence of various practices to support inpatient vaccination stratified by vaccine type: tetanus, diphtheria, and acellular pertussis, meningococcal, human papillomavirus, childhood series, and influenza. One-way analysis of variance testing compared differences in numbers of practices and χ tests compared proportions of sites reporting each practice between vaccine types. Qualitative responses were evaluated via content analysis.
RESULTS
Fifty-one of 103 eligible hospitals completed the survey (50%). Standardized policies existed in 92% of hospitals for influenza, 41% for childhood, and 29% for adolescent vaccines. Hospitals identified an average of 5.1 practices to deliver influenza vaccines, compared with 1.5 for childhood; 0.9 for tetanus, diphtheria, and acellular pertussis; 0.7 for meningococcal; and 0.6 for human papillomavirus vaccines ( < .001). Standardized screening tools, visual prompts, standing orders, nurse- or pharmacy-driven screening or ordering, staff education, and quality improvement projects were reported more often for influenza vaccines than other vaccine types ( < .01 for all comparisons). Common barriers to delivery included communication difficulties, lack of systems optimization, and parent and provider discomfort with inpatient immunization.
CONCLUSIONS
Existing hospital infrastructure supports influenza vaccine delivery over other vaccine types, potentially creating missed inpatient vaccination opportunities.
背景
许多住院儿童的免疫接种率较低，但目前关于支持住院患者疫苗接种的系统知之甚少。我们旨在描述全国儿科住院患者的免疫接种实践，并确定青少年、儿童和流感疫苗的接种情况是否存在差异。
方法
2019 年春季，通过儿科住院患者研究网络向医生、护士和药剂师负责人发送了一份关于医院疫苗接种实践的电子调查。医院根据疫苗类型（破伤风、白喉和无细胞百日咳、脑膜炎球菌、人乳头瘤病毒、儿童系列和流感）报告了各种支持住院患者疫苗接种的实践。通过单因素方差检验比较了不同疫苗类型之间实践数量的差异，通过 χ 检验比较了报告每种实践的医院比例。通过内容分析评估了定性反应。
结果
103 家符合条件的医院中有 51 家（50%）完成了调查。92%的医院对流感、41%的医院对儿童疫苗、29%的医院对青少年疫苗制定了标准化政策。医院确定了 5.1 种用于接种流感疫苗的方法，而用于接种儿童疫苗的方法为 1.5 种；破伤风、白喉和无细胞百日咳疫苗为 0.9 种；脑膜炎球菌疫苗为 0.7 种；人乳头瘤病毒疫苗为 0.6 种（<0.001）。与其他疫苗类型相比，标准化筛查工具、视觉提示、常规医嘱、护士或药剂师驱动的筛查或医嘱、员工教育和质量改进项目更多地用于流感疫苗（所有比较均<0.01）。提供疫苗接种的常见障碍包括沟通困难、系统优化不足以及父母和提供者对住院患者免疫接种的不适。
结论
现有的医院基础设施支持流感疫苗的接种，而其他疫苗类型的接种机会可能被错过。
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