• with cochlear implants or a cerebrospinal fluid leak (escape of the fluid that surrounds the brain and spinal cord). • who smoke cigarettes. VACCINATION
Vaccination is the optimal approach for preventing pneumococcal disease. Two types of vaccines are available: the PPSV23 and the pneumococcal conjugate vaccine (PCV13). The CDC provides specific recommendations regarding which types of vaccine should be offered to nursing home residents, and when to offer them.5 The Centers for Medicare & Medicaid Services requires each nursing home resident be offered the appropriate pneumococcal vaccine. 6,7 Patients of all ages are required to receive Vaccine Information Statements prior to vaccination.8 Both types of pneumococcal vaccine should be maintained in a proper refrigerator for storing medications, not a “dormitory style” unit.9 Penicillin and its derivatives are effective for treating pneumococcal infections when used against susceptible isolates.10 However, penicillin resistance has been increasing. Pneumococcus has been reported to be resistant to one or more antibiotics in three out of every 10 cases.11 Alternative antibiotics may have to be administered. Steven Schweon, RN, MPH, MSN, CIC, HEM, FSHEA, FAPIC, is an infection prevention consultant with a specialized interest in acute care/ long-term care/behavioral health/ambulatory care infection challenges, including outbreaks.
3. The Centers for Disease Control and Prevention. Pneumococcal disease. Risk factors and transmission. https://www.cdc.gov/ pneumococcal/about/risk-transmission.html. Accessed November 2017. 4. Siegel JD, Rhinehart E, Jackson M, et al. 2007 Guidelines for isolation precautions: Preventing transmission of infectious agents in healthcare settings. https://www.cdc.gov/infectioncontrol/ pdf/guidelines/isolation-guidelines.pdf. Accessed November 2017. 5. Centers for Disease Control and Prevention. Immunization schedules. Recommended immunization schedule for adults aged 19 years or older, by vaccine and age group. https://www.cdc.gov/ vaccines/schedules/hcp/imz/adult.html. Accessed February 2018. 6. Centers for Medicare & Medicaid Services. Pub. 100-07 State Operations Provider Certification. March 2017. https:// www.cms.gov/Regulations-and-Guidance/Guidance/ Transmittals/2017Downloads/R168SOMA.pdf. Accessed January 2018. 7. The Society for Post-Acute and Long-Term Care Medicine. Pneumococcal vaccination guidance. 2016. https://paltc.org/ publications/pneumococcal-vaccination-guidance. Accessed November 2017. 8. Immunization Action Coalition. You must give your patients current Vaccine Information Statements (VISs) - It’s federal law! http:// www.immunize.org/catg.d/p2027.pdf. Accessed November 2017. 9. Immunization Action Coalition. Storage and handling. Vaccine storage units. http://www.immunize.org/askexperts/storagehandling.asp. Accessed November 2017. 10. Nieves Prado CA. Pneumococcal infections (Streptococcus pneumoniae) medication. Medscape. Pneumococcal infections medication. https://emedicine.medscape.com/article/225811medication#2. Accessed February 2018. 11. Centers for Disease Control and Prevention. Pneumococcal disease. Diagnosis and treatment. https://www.cdc.gov/pneumococcal/ about/diagnosis-treatment.html. Accessed November 2017.
“Patients of all ages are required to receive Vaccine Information Statements prior to vaccination.”
Additional resource The Society for Post-Acute and Long-Term Care Medicine. https:// paltc.org.
READ MORE ABOUT PNEUMOCOCCAL PNEUMONIA IN THE AMERICAN JOURNAL OF INFECTION CONTROL
References 1. Kuroki T, Ishida M, Suzuki M, et al. Outbreak of Streptococcus pneumoniae serotype 3 pneumonia in extremely elderly people in a nursing home unit Kanagawa, Japan, 2013. J Am Geriatr Soc 2014;62(6):1196-1197. 2. National Foundation for Infectious Diseases. Pneumococcal disease. http://www.adultvaccination.org/pneumococcal. Accessed November 2017.
Risk factors for hospital-acquired pneumonia outside the intensive care unit: A casecontrol study. Sopena N, Heras E, Casas I, et al., American Journal of Infection Control, Volume 42, Issue 1, 38–42.
TAKE-HOME MESSAGE Invasive pneumococcal disease (an infection of a normally sterile body site, e.g., meningitis or bacteremia) is reportable to your local health department. Partner with your clinical laboratory to ensure that the health department is notified. Whenever an outbreak, or possible outbreak, occurs, your local health department or other infectious disease experts can provide invaluable guidance on operational, management, and control issues.
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