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BackgroundImmunocompromised patients are vulnerable to severe or complicated influenza infection. Vaccination is widely recommended for this group. This systematic review and meta-analysis assesses influenza vaccination for immunocompromised patients in terms of preventing influenza-like illness and laboratory confirmed influenza, serological response and adverse events.Methodology/Principal FindingsElectronic databases and grey literature were searched and records were screened against eligibility criteria. Data extraction and risk of bias assessments were performed in duplicate. Results were synthesised narratively and meta-analyses were conducted where feasible. Heterogeneity was assessed using I2 and publication bias was assessed using Begg's funnel plot and Egger's regression test. Many of the 209 eligible studies included an unclear or high risk of bias. Meta-analyses showed a significant effect of preventing influenza-like illness (odds ratio [OR] = 0.23; 95% confidence interval [CI] = 0.16–0.34; p<0.001) and laboratory confirmed influenza infection (OR = 0.15; 95% CI = 0.03–0.63; p = 0.01) through vaccinating immunocompromised patie nts compared to placebo or unvaccinated controls. We found no difference in the odds of influenza-like illness compared to vaccinated immunocompetent controls. The pooled odds of seroconversion were lower in vaccinated patients compared to immunocompetent controls for seasonal influenza A(H1N1), A(H3N2) and B. A similar trend was identified for seroprotection. Meta-analyses of seroconversion showed higher odds in vaccinated patients compared to placebo or unvaccinated controls, although this reached significance for influenza B only. Publication bias was not detected and narrative synthesis supported our findings. No consistent evidence of safety concerns was identified.Conclusions/SignificanceInfection prevention and control strategies should recommend vaccinating immunocompromised patients. Potential for bias and confounding and the presence of heterogeneity mean the evidence reviewed is generally weak, although the directions of effects are consistent. Areas for further research are identified.

ObjectivesTo estimate the annual health economic impact of healthcare-associated infections (HCAIs) to the National Health Service (NHS) in England.DesignA modelling study based on a combination of published data and clinical practice.SettingNHS hospitals in England.Primary and secondary outcome measuresAnnual number of HCAIs, additional NHS cost, number of occupied hospital bed days and number of days front-line healthcare professionals (HCPs) are absent from work.ResultsIn 2016/2017, there were an estimated 653 000 HCAIs among the 13.8 million adult inpatients in NHS general and teaching hospitals in England, of which 22 800 patients died as a result of their infection. Additionally, there were an estimated 13 900 HCAIs among 810 000 front-line HCPs in the year. These infections were estimated to account for a total of 5.6 million occupied hospital bed days and 62 500 days of absenteeism among front-line HCPs. In 2016/2017, HCAIs were estimated to have cost the NHS an estimated £2.1 billion, of which 99.8% was attributable to patient management and 0.2% was the additional cost of replacing absent front-line HCPs with bank or agency staff for a period of time. When the framework of the model was expanded to include all NHS hospitals in England (by adding specialist hospitals), there were an estimated 834 000 HCAIs in 2016/2017 costing the NHS £2.7 billion, and accounting for 28 500 patient deaths, 7.1 million occupied hospital bed days (equivalent to 21% of the annual number of all bed days across all NHS hospitals in England) and 79 700 days of absenteeism among front-line HCPs.ConclusionThis study should provide updated estimates with which to inform policy and budgetary decisions pertaining to preventing and managing these infections. Clinical and economic benefits could accrue from an increased awareness of the impact that HCAIs impose on patients, the NHS and society as a whole.

Objectives: To evaluate a type five electronic monitoring system (EMS) for hand hygiene (HH) adherence with respect to accuracy and ability to avoid the Hawthorne effect. Design: HH events were observed manually and electronically. The agreement between the two observation methods was evaluated. Continuous electronic measurement was made throughout the study. Setting: An acute 31-bed medical ward in a National Health Service trust in London, United Kingdom. Participants: Staff working or attached to the ward. Intervention: A newly developed type five EMS that can measure disinfectant dispenser usage as well as continuous movements of health workers throughout the ward with arm-length precision and analyse HH adherence was installed at the ward. Results: A total of 294 HH events were observed in five sessions by an observer previously unknown to the ward. There was concordance between HH adherence assessed by manual observer and the EMS on 84% (79.1%–89.9%) of the occasions. During the five observation sessions, the observed HH adherence increased from 24% to 76% while the EMS measurements immediately before the arrival of the observer remained constant for all sessions. Conclusion: The 84% agreement between the EMS and the manual observation suggest a high level of precision for the evaluated system. The Hawthorne effect (higher rate of HH performance) was clearly seen in the increase by a factor of three in the manually observed adherence from session to session as the health workers became more aware of them being observed. The EMS was able to avoid the Hawthorne effect when the observer was not present.

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Vaccination of immunocompromised patients is recommended in many national guidelines to protect against severe or complicated influenza infection. However, due to uncertainties over the evidence base, implementation is frequently patchy and dependent on individual clinical discretion. We conducted a systematic review and meta‐analysis to assess the evidence for influenza vaccination in this patient group. Healthcare databases and grey literature were searched and screened for eligibility. Data extraction and assessments of risk of bias were undertaken in duplicate, and results were synthesised narratively and using meta‐analysis where possible. Our data show that whilst the serological response following vaccination of immunocompromised patients is less vigorous than in healthy controls, clinical protection is still meaningful, with only mild variation in adverse events between aetiological groups. Although we encountered significant clinical and statistical heterogeneity in many of our meta‐analyses, we advocate that immunocompromised patients should be targeted for influenza vaccination.