How Infection Preventionists Will Handle COVID-19 Vaccinations

The approval of the Pfizer and Moderna coronavirus disease 2019 (COVID-19) vaccines for emergency use authorization in the United States has brought much attention and focus to the vaccination process. Because of the high demand for and low initial supply of the vaccines, the government has sought to prioritize them for individuals at highest risk for complications from COVID-19, and those who hold essential service roles that are vital to a functioning economy and health care system.

By all accounts, the rollout is still a work in progress. On January 12, Alex Azar, former head of the Department of Health and Human Services, said that focusing on health care workers and long-term care facilities has led to a vaccine distribution bottleneck. Azar issued a directive saying that people aged 65 years and older and those 16 years and older with a comorbidity should be considered priorities for vaccination. That, in effect, pushed about 163 million more people—about half the population—to the front of the vaccine line.

Yearly Occurrence

But back to health care systems. What many people outside the health care realm do not realize is that vaccination logistics and planning is in the yearly wheelhouse of hospital systems. Vaccinations to combat a variety of diseases are given every day, from the first-dose hepatitis B vaccine given to a newborn, to the tetanus, diphtheria, and acellular pertussis (Tdap) booster given after one scrapes against a rusty nail, to the yearly influenza vaccination.

The role of an infection preventionist (IP) in vaccination efforts is important, both to patients and providers, regardless of whether the setting is a large hospital system or a small provider’s office. IPs can help to provide best practice recommendations on immunization, from explaining sterilization techniques, to educating health care staff on the importance of vaccination, to working with occupational health in tracking rates of vaccination.

Not all IPs can administer the vaccine directly as some lack a health care degree, but they can be subject matter experts in the logistics of large-scale vaccinations. As such, it is important they participate in multidisciplinary projects involving vaccination efforts.

Proper infection control practices in vaccine administration are critical to ensuring safety and efficacy. Vaccine vials must be disinfected with sterile alcohol prep pads prior to each withdrawal and a new, sterile needle and syringe used for each injection.

Vaccines should be drawn up in clean medication preparation areas that are not next to any dirty items, and doses should be administered as soon as they have been drawn up to avoid any potential for spoilage. For vaccines that have been prepared for administration, the date and time should be marked on the syringe to alert the administrator to when the vaccine can no longer be given.

A common misconception about vaccine administration is that gloves must be worn. Per Occupational Safety and Health Administration regulations, gloves are not required when administering vaccines unless the individual administering the vaccine has open lesions on their hands or is likely to come in contact with a patient’s body fluids.¹ If gloves are worn during vaccine administration, they must be removed between each patient and hand hygiene must be performed before donning a new pair of gloves.

If gloves are not worn, hand hygiene should be performed between each new patient administration.

Vaccine hesitancy is another area in which IPs can aid departments in helping alleviate fears and answering questions. Whether it be the influenza or the COVID-19 vaccine, the misconceptions surrounding them or fear of what may occur post vaccination are just 2 reasons that individuals may choose to not receive the vaccine.

Coordinating Efforts

IPs can help to engage health care employees and answer questions while also directing them to primary resources for further information. These include the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO). IPs can also coordinate with physicians and other subject matter experts on common areas of vaccine hesitancy among staff, and work with key stakeholders to address them.

As vaccine rollouts begin, IPs can also partner with occupational health teams to track and trend adherence with vaccination. Regarding annual influenza vaccination of health care staff, hospitals must report adherence rates to the National Healthcare Safety Network.² Often, IPs may be the only individuals who have access to this website, so it is vital they work with occupational health to obtain accurate counts of adherent and nonadherent staff. Trending health care vaccination rates by department or role type can also be valuable indicators for how to focus education efforts during the following years to increase adherence.

Although we do not yet know if the COVID-19 vaccine will be recommended yearly or whether it will offer longer immunity against severe acute respiratory syndrome coronavirus 2, health care facilities will continue to provide the influenza vaccine yearly to employees. They will also be prepared to modify their processes to help increase adherence rates, and IPs can collaborate in these efforts as well.

ANJALI BISHT, MPH, CIC, is the lead infection preventionist at an academic medical center that comprises a number of hospitals and an extensive primary care network in the Los Angeles region in California.

References

1. Occupational exposure to bloodborne pathogens; needlesticks and other sharps injuries; final rule. Occupational Safety and Health Administration (OSHA), Department of Labor. Final rule; request for comment on the Information Collection (Paperwork) Requirements. Fed Regist. 2001;66(12):5318-5325.
2. Surveillance for healthcare personnel vaccination. CDC. Updated December 2, 2020. https://www.cdc.gov/nhsn/acute-care-hospital/hcp-vaccination/index.html