and Long Term Care
Public Health Policyand Programs Branch / Seasonal Influenza Immunization Rates at Ontario Long-Term Care Homes (LTCH)* Reporting, 2011
(for the 2011/2012 Influenza Season)
Name of Long-Term Care Home
Type
Nursing Home Municipal Home for the Aged Charitable Home for the Aged
RESIDENTSImmunization coverage rate for seasonal influenza immunization should be reflected as on or before November 15, 2011.
A)Total number of residents in the home
B)Number of residents immunized with seasonal influenza vaccine
Resident Seasonal Influenza Immunization Rate = (B/A x 100)
C)Number of unimmunized residents
a) of these, the number with documented medical exemption
b) of these, the number without documented medical exemption
D)Number of residents immunized against pneumococcal disease
Resident Pneumococcal Immunization Rate = (D/A x100)
Note: This reflects cumulative pneumococcal immunization rate for the home, not
justresidents immunized in 2011
STAFFDatacollected should reflect seasonal influenza immunization status of staff as on or beforeNovember 15, 2011 and returned to the local Medical Officer of Health at the local Public Health Unit by December 1, 2011.
A)Total number of staff that work in the home
B)Number of immunized staff
Staff Seasonal Influenza Immunization Rate = (B/A x 100):
C)Number of unimmunized staff(C = A-B)
a) of these, the number with documented medical exemption
b) of these, the number without documented medical exemption
D)Number of staff whose immunization status is unknown
Definitions:
*Long-Term Care Homes (LTCH): Long-term care homes are facilities defined by the Long-Term Care Homes Act.
Medical Exemption: persons who experienced an anaphylactic reaction to a previous dose or have anaphylactic hypersensitivity to eggs which is manifested as hives, swelling of the mouth and throat, difficulty breathing, hypotension and shock.
Staff: All persons who carry on activities in the LTCH, including but not limited to employees (permanent, temporary), students, attending physicians and both health care and non-health care contract workers and any other staff (including persons with admitting/clinic privileges [MD, Mid-wives, Hearing Aid Centre); maintenance workers (e.g. janitorial, repair, etc.) or other workers who carry on activities in resident care areas or come into contact with residents (e.g. hairdressers)].
Please Note: Although the Influenza Prevention and Surveillance Protocol for Ontario Long-Term Care Facilities does not apply to volunteers, LTCHs are strongly encouraged to report immunization status of volunteers under staff category.
4798-64E (2011/09) ©Queen's Printer for Ontario, 2011Disponible en français