The first wave of vaccines targets large-scale public health efforts. These are being implemented at the state level for deployment to target health care workers and residents of long-term care facilities. These efforts need to be clearly multidisciplinary in order to have effective design and ideas that bring creativity to solve the problem of how you can dispense millions of doses of vaccine that require treatment parameters and very special storage.
For example, the Pfizer-BioNTech vaccine requires ultra-cold storage and is dispensed in large dosage numbers, requiring large group vaccinations over a short period of time. The teams must include suppliers, pharmacists, public health, health care facilities leadership, emergency management, and other local leaders. It seems that members of these groups have not worked closely together in the past on such a large scale. It will be essential to work with a hospital incident management system to keep the organization moving forward with the same goals and fast-track barriers to problem-solving.
IPs have been operating in large vaccine settings for years, in preparation for influenza in particular, but also with potential biological hazards (anthrax, smallpox) and other events such as measles and pertussis. These skills and insights make IPs and their public health colleagues the subject matter experts on how a major vaccine is emerging. For example, some hospital systems would take the opportunity to turn a staff ‘s annual flu vaccine into a drill and treat it as if it were a major vaccination event in collaboration with emergency management colleagues. These events would teach valuable lessons in how best to reach all employees, including several vaccine administration areas and how best to handle data collection required to monitor large-scale vaccination efforts.
Mass vaccine
Infectious prevention must be a partner in the large-scale planning that is currently taking place in most states and local health care facilities. These efforts are largely driven by public health at state or regional levels, but local hospitals also need to plan when vaccines will be rolled out in future cycles for local administration. Not only to help with vaccine storage logistics, administration, documentation, and data collection and reporting, but also to focus on the safety of vaccine clinicians ’staff and recipients. Staff use of personal protective equipment (PPE), workflow to ensure social pace and population reduction, and clinic site cleaning and disinfection practices are all logical concerns that should be addressed at the planning stage to minimize exposures. or avoid pollution concerns.
Another cause for concern is cold storage and transportation of the vaccine. Dedicated freezers and transport companies that can safely move from distribution sites to clinics are essential to maintaining that cold chain delivery system. Specialized transport companies with experience in this type of system will be in high demand and IP can help evaluate the processes of these third-party vendors to ensure that they are able to accept the required level of transport. and maintenance of vaccine storage parameters.
Data collection for the major clinics is likely to be centralized through health departments, but details of detection, identification of vaccinated staff, and communication with the facilities need to be addressed. local health care. Each state is likely to have to determine how best to communicate vaccine administration, but it will also be up to each employee to report their vaccine status back to the health care facility.
Local vaccine design
Hospital vaccination programs have historically been a collaborative effort between disease prevention and employee health programs. As COVID-19 vaccination efforts continue, consideration will need to be given to how this will be managed in the context of hospital-based immunization programs. How is the COVID-19 vaccine handled at each facility? Will it be compulsory? Will it be given annually? Will it be a condition of employment? These are all issues that need to be addressed. Some things are unknown at this stage, including the need for annual boosters, essential storage requirements, and data reporting.
Infection prevention is also a key partner with employee health programs to promote vaccination uptake and educate about how the vaccine works and the potential side effects. Now that these new vaccines have been approved for distribution, it will be important for IPs to learn about the studies completed so far to understand these key points to help educate employees. A review of the articles published during the trials, as well as the recommendations from the federal IPs programs will help inform the vaccines. Also, key information that may address IP is side effects, efficacy, and recommendations from priority risk groups (such as health care workers, the elderly, critical workers, etc.). IPs can help address these issues through gathering and education opportunities, published newsletters and new staff guidance.
It will take a lot of effort to plan for the logistics of how vaccines are distributed locally. Some of the things to consider when workers receive their dose and when to work the next shift are. Since almost all health care facilities screen for the symptoms of COVID-19, the perceptions of a vaccine may meet some of these criteria, such as low-grade fever or malaise. It will be important to plan for this as an organization, to consider this with screening or a plan for staff to have 24-48 hours after their dose before their next shift. The calculation must also take into account that the vaccines are given in 2 doses.
Planning for this process should already begin. With many healthcare facilities operating under a hospital incident control system, vaccine administration can be brought under that structure and the board would already have key departments to assist with coordination.
Data reporting for COVID-19 vaccines is likely to be widespread. Many employee health programs may not have the reporting capabilities to handle the level of data collection and retrieval required for the first wave of vaccinations. Employee health programs often do not have electronic systems that integrate with other reporting programs or link to state health departments, so much of the work will be manual. Infectious prevention requires advocacy for better data systems for employee health detection, which will be not only beneficial in the COVID-19 vaccination process but, going forward, for all other employee health activities .
One thing IPs need to remember: Vaccination is not the end of this pandemic. Most likely, the level of vaccine required to provide adequate population immunity to control transmission is around 80 %.1 It will take years to achieve that level of vaccination, if at all. Therefore, basic infection control measures need to be monitored in some ways to that extent. This is part of the IP tool.
After working with vaccine preventable diseases for decades, IPs understand that vaccination is not the only way to prevent the spread of disease.
Behavior change, engineering controls, such as changing traffic patterns and increasing ventilation air exchanges, and other operational processes are critical in a multi-focused prevention plan. Universal shelter in health care facilities and hope at the community level will continue for some time, until population protection is adequate or community distribution is low.
REBECCA LEACH, RN, BSN, MPH, CIC, has been an infectious protector since 2010, with a background in nursing and epilepsy. Leach, a member of the Infection Control Today® Editorial Advisory Board, currently works at a health care system in Phoenix, Arizona, which includes 5 hospitals and more than 100 outpatient treatment centers.
Information
1. Bartsch SM, MPH, O’Shea KJ, Ferguson MC, et al. Effectiveness of vaccination required for COVID-19 coronavirus vaccine to prevent or stop infection as the only intervention. Am J Prev Med. 2020; 59 (4): 493–503. doi: https://doi.org/10.1016/j.ajic.2020.10.018