Strategies associated with COVID-19 vaccine coverage among nursing home staff.

BACKGROUND: After the first of three COVID-19 vaccination clinics in U.S. nursing homes (NHs), the median vaccination coverage of staff was 37.5%, indicating the need to identify strategies to increase staff coverage. We aimed at comparing the facility-level activities, policies, incentives, and communication methods associated with higher staff COVID-19 vaccination coverage. METHODS: Design. Case-control analysis. SETTING: Nationally stratified random sample of 1338 U.S. NHs participating in the Pharmacy Partnership for Long-Term Care Program. PARTICIPANTS: Nursing home leadership. MEASUREMENT: During February 4-March 2, 2021, we surveyed NHs with low (<35%), medium (40%-60%), and high (>75%) staff vaccination coverage, to collect information on facility strategies used to encourage staff vaccination. Cases were respondents with medium and high vaccination coverage, whereas controls were respondents with low coverage. We used logistic regression modeling, adjusted for county and NH characteristics, to identify strategies associated with facility-level vaccination coverage. RESULTS: We obtained responses from 413 of 1338 NHs (30.9%). Compared with facilities with lower staff vaccination coverage, facilities with medium or high coverage were more likely to have designated frontline staff champions (medium: adjusted odds ratio [aOR] 3.6, 95% CI 1.3-10.3; high: aOR 2.9, 95% CI 1.1-7.7) and set vaccination goals (medium: aOR 2.4, 95% 1.0-5.5; high: aOR 3.7, 95% CI 1.6-8.3). NHs with high vaccination coverage were more likely to have given vaccinated staff rewards such as T-shirts compared with NHs with low coverage (aOR 3.8, 95% CI 1.3-11.0). Use of multiple strategies was associated with greater likelihood of facilities having medium or high vaccination coverage: For example, facilities that used ≥9 strategies were three times more likely to have high staff vaccination coverage than facilities using <6 strategies (aOR 3.3, 95% CI 1.2-8.9). CONCLUSIONS: Use of designated champions, setting targets, and use of non-monetary awards were associated with high NH staff COVID-19 vaccination coverage.

The BNT162b2 vaccine is associated with lower new COVID-19 cases in nursing home residents and staff.

BACKGROUND/OBJECTIVES: The effectiveness of the BNT162b2 vaccine on preventing the spread of COVID-19 and deaths in nursing homes (NH) is unknown. DESIGN: We used zero-inflated negative binomial mixed effects regressions to model the associations of time since the vaccine clinic ending the week of December 27, 2020 (cohort 1), January 3, 2021 (cohort 2), or January 10, 2021 (cohort 3) controlling for county rate of COVID-19, bed size, urban location, racial and ethnic census, and level of registered nurses with resident cases and deaths of COVID-19 and staff cases of COVID-19. SETTING AND PARTICIPANTS: All 2501 NHs who held a vaccine clinic from the first 17 states to initiate clinics as part of the Pharmacy Partnership for Long-Term Care Program. MAIN OUTCOME(S) AND MEASURE(S): Adjusted Incidence Rate Ratio (IRR) for time in 3, 4, 5, and 6 weeks after the first vaccine clinic for resident cases and deaths of COVID-19 and staff cases of COVID-19. RESULTS: Resident and staff cases trended downward in all three cohorts following the vaccine clinics. Time following the first clinic at 5 and 6 weeks was consistently associated with fewer resident cases (IRR: 0.68 [95% CI: 0.54-0.84], IRR: 0.64 [95% CI: 0.48-0.86], respectively); resident deaths (IRR: 0.59 [95% CI: 0.45-0.77], IRR: 0.45 [95% CI: 0.31-0.65], respectively); and staff cases (IRR: 0.64 [95% CI: 0.56-0.73], IRR: 0.51 [95% CI: 0.42-0.62], respectively). Other factors associated with fewer resident and staff cases included facilities with less than 50 certified beds and high nurse staffing per resident day (>0.987). Contrary to prior research, higher Hispanic non-white resident census was associated with fewer resident cases (IRR: 0.42, 95% CI: 0.31-0.56) and deaths (IRR: 0.18, 95% CI: 0.12-0.27). CONCLUSIONS: The BNT162b2 vaccine is associated with decreased spread of SARS-CoV-2 in both residents and staff as well as decreased deaths among residents.

Predictors of Mortality and Outcomes of Acute Severe Cardiogenic Shock Treated with the Impella Device.

The Impella (Abiomed, Danvers, Massachusetts) device is increasingly used for mechanical circulatory support (MCS) to treat acute severe cardiogenic shock (CS). Initial and continued determination of the appropriate degree of MCS is challenging. This study evaluates predictors of mortality in patients treated with the Impella for acute severe CS and outcomes associated with prolonged Impella use. This retrospective single-center study included 204 patients treated with the Impella 2.5, Impella CP, or Impella 5.0 from 2011 to 2018 for acute severe CS. The primary end point was all-cause in-hospital mortality. All-cause in-hospital mortality was 45.1%. Nonsurvivors had a lower initial pH (7.24 vs 7.32, hazard ratio [HR] 1.03, p <0.0001), lower serum CO2 (19.1 vs 21.3 mmol/L, HR 1.08, p = 0.002), higher lactate (6.8 vs 3.3 mmol/L, HR 1.17, p <0.0001), and used a greater number of vasopressors and inotropes (4.3 vs 2.6, HR 1.44, p <0.0001). Patients with the Impella >4 days (n = 45) had a longer intensive care unit stay (12.6 vs 6.9 days, p <0.001), longer total hospital stay (16.4 vs 11.6 days, p = 0.03), longer mechanical ventilation use (7.8 vs 4.4 days, p = 0.002), and trend toward increased mortality (57.8 vs 41.5%, p = 0.051). In conclusion, in patients treated with the Impella for acute severe CS, initial biochemical parameters and need for vasopressors and inotropes are significant predictors of mortality that can serve as valuable indicators of whether the Impella or higher level of MCS is more appropriate. Patients treated with the Impella beyond 4 days have poorer outcomes and may benefit from escalation of care.