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Mary Jean Ricci MSN, RNBC: “[Infection preventionists] really need to think about how we’re getting people from the assessment area to the vaccination area to the evaluation area in a unidirectional flow so that we don’t have the spread of the virus at the time of inoculation.”
Make sure you have enough doses and that you have the proper storage containers for those doses. Those are just two of the elements to a vaccination drive for coronavirus disease 2019 (COVID-19) that infection preventionists need to keep an eye on, says Mary Jean Ricci MSN, RNBC. Ricci is a member of Infection Control Today®’s Editorial Advisory Board and the director of clinical education at Drexel University College of Nursing and Health Professions. Ricci asks “are you using your nursing students? Are you using your pharmacy students that are affiliated with your hospital?” Infection preventionists need to work out the practicalities of any COVID-19 vaccination effort that they may be overseeing either in the hospital or out in the community. “Really ask the right questions,” Ricci tells ICT®. “If you’re given 1000 doses, does that mean I’m giving 1000 total doses—doses one and two? Or does it mean I’m given 1000 doses, and I can only inoculate 500 people? You need to really make sure you ask the right questions, make sure you have the vaccine available.” The answer to these types of questions—the kind of questions someone in the trenches might ask—could very well determine how long it takes us to reach the post-COVID side of history.
Infection Control Today®: So COVID-19 vaccination efforts in hospitals. How is this different than any other vaccination effort? For the flu for instance? Or, as you mentioned in our email exchange, the COVID-19 vaccination effort in hospitals is going to have to be approached in some creative ways. Can you give us ideas of sort of creative ways? Right, one
Mary Jean Ricci MSN, RNBC: One of our biggest things is that the COVID vaccine requires sub-zero temperatures, especially some of the brands where it’s like a negative 94. What we need to do is think about how we can coordinate actually having the exact number of people that need to be vaccinated, so that we’re not wasting dose. One of the big things that we have to do is think about what kind of registration system we’re using to get the vaccine out to the 1A workers because that’s who’s being vaccinated first. Those in the hospital and things like that. We have to make sure that we’re able to give people a registration system where not only do we schedule them for their first dose, but at the same time schedule them for their second dose, because it really should be given roughly 28 days [apart] The CDC [Centers for Disease Control and Prevention] did come out last week, and basically said, we had a little bit of wiggle room with the timeframe. But you really need to have a great registration system. You really need to know, because the vaccine is so scarce, how many doses you need at any given time. And I think when you’re asking me how you have to be creative, you have to keep a unidirectional flow, because we have to still maintain social distancing, everybody needs to wear their mask. We really need to think about how we’re getting people from the assessment area to the vaccination area to the evaluation area in a unidirectional flow so that we don’t have the spread of the virus at the time of inoculation.
ICT®: I said in the introduction that infection preventionists are usually very involved with vaccination efforts in hospitals. Is that a fair assumption? Just the way you answered that last question, I assume that it is.
Ricci: Yes. And not only are we on vaccinations in vaccine clinics, in ancillary sites or a stadium type of site. Once we’re able to give it to the general public—the vaccine—we’re going to have to be very creative, in terms of how many people do we need? How many people can we process? Because if you’re only doing one person every 10 minutes, we really will be very slow at answering the call of getting the vaccine in people’s arms. You really have to have a process in which you can do two, three people every five, six minutes.
ICT®: Will that be harder to do because of social distancing?
Ricci: No, actually. I’m in one city, Philadelphia. Where I’m from, there’s a group that has been able to vaccinate 1A workers at a rate of about 1200 per day. If you’re really creative with your sign-in system, if you have a sufficient number of volunteers to help, or employees to help you get the vaccine into the arms of people who need it, you should be able to do it. The one big thing is when I said about being creative, are you using your nursing students? Are you using your pharmacy students that are affiliated with your hospital? I would ask people to really think about how many people do they need and how many additional hands can they ask for. Volunteers in terms of students and things like that. And also, use your non-clinical staff. For example, secretaries in various departments and within hospitals: Can they come and help with things that they’re able to do like the registration process and things like that?
ICT®: So, 1200 a day. That’s very impressive. I don’t have to tell you that there’s been some hiccups with the vaccine rollout. And some issues about are there enough vaccines to go around. Eventually there will be, but right now there seems to be a bottleneck. Is there any way infection preventionists can possibly help alleviate that bottleneck?
Ricci: What I think they do is they work through the details of their vaccination clinic plan ahead of time, and then make sure that they have the vaccine in hand that is ordered. It’s got to be delivered on the day of their clinic, and make sure that they are going to have the second dose available for the people after giving the first dose. Really ask the right questions. If you’re given 1000 doses, does that mean I’m giving 1000 total doses—doses one and two? Or does it mean I’m given 1000 doses, and I can only inoculate 500 people? You need to really make sure you ask the right questions, make sure you have the vaccine available.
ICT®: Forgive me if I get this wrong, because you have an extensive CV. You’re in charge of nursing education at Drexel University Hospital, is that correct?
Ricci: Clinical education at Drexel University. Yes.
ICT®: You mentioned earlier that you get the nursing students involved in helping with the vaccination efforts. How much training will they need to be able to vaccinate people? Is that like a one-day thing: Here’s how you vaccinate somebody now go ahead and do it?
Ricci: No. What we did at Drexel prior to actually beginning classes this quarter, we actually asked our clinical students if they would want to volunteer with a group in Philadelphia. And we made sure that we only sent the invites to students who were able to A) give vaccinations, and B) be able to assess the patients receiving the vaccinations or the personnel receiving the vaccinations. We assured that. We also did other things. We ran little boot camps to make sure everybody’s technique for administering vaccines was up to speed. We also made sure that our students had done a module on PPE. They also did modules on anaphylaxis to assess the patient or the personnel that received the vaccine thus far. We made sure that they were able to assess for any adverse untoward effect after receiving the vaccine. We were able to do that. And then we did incorporate into our clinical courses a group of students that would be able, if a hospital or someone asked us for assistance, we would be able to send a group of students with an instructor. Currently under the laws in our state in Pennsylvania, students can be a part of a vaccine clinic if they’re supervised by an RN. Not necessarily an instructor. Currently while we’re in clinical, we are sending an instructor with the students.
ICT®: I know when I get the flu vaccine, you have to check off the box about whether you’re sick. Do you currently have symptoms? Is that germane to the COVID-19 vaccine?Can somebody get the COVID vaccine if they are actually positive with COVID?
Ricci: Right. So, of course, there aren’t a lot of clinical trials on that right now. Some of the physicians in the area are saying wait 30 days, 40 days, 90 days. I personally have friends who have received it 30 or 40 days after being sick with COVID and they did fine. I’m not recommending that we do that. I recommend that you ask your primary care provider based on your health condition when they recommend that you receive the vaccine.
ICT®: I’ve also read that getting the vaccine even if you are positive with COVID helps lessen the symptoms. Do you put much credence in that?
Ricci: I saw an article on it. I haven’t had time to fully evaluate all that or read up on it. Again, I would recommend discussing your individual health with your physician for a recommendation there because I think there are a lot of things that we don’t know about the vaccine. For example, right now with the strain coming out of Africa, we don’t have a lot of information as to whether or not [COVID vaccines] will or will not have an effect on that strain. But some people are saying they think based on what they’re seeing in the research, which is currently being done as we’re talking, that it may lessen the severity. So, I don’t have an answer to that question.
ICT®: Where does testing fall in all this? I mean are people tested as they line up to get the COVID-19 vaccine? Are they tested? Or are they not tested?
Ricci: They are not tested. That’s one of the things I was hoping we can talk about, because one of the biggest strategies to help eradicate this pandemic is to have a robust vaccination plan, as well as a robust testing plan. And my biggest concern as a health care provider is, are we still testing? Some of the testing sites are shutting down to become vaccination sites. Some of the health departments don’t have the manpower to test. Some of the hospitals are not able to run the number of tests. I was reading an article today that some of the labs aren’t able to get reagents. We still have a big testing problem. And the two should be hand in hand. We should be testing and vaccinating.
ICT®: I’ve read that testing is crucial also because of the number of asymptomatic carriers. Could be 50% of spread is caused by asymptomatic carriers, apparently, and that’s very unusual for a coronavirus. I guess that could be used to get more tests available. How do infection preventionists play a part in this? Or do they? Do they try to like talk to the procurement team or the occupational safety team or anybody that will get them more tests?
Ricci: I think that we need to be creative in that realm, too. I think we need to ask everyone, “Who can help us?” Are there organizations outside of hospitals that can help with testing? Can we do this—I don’t want to say simultaneously—but, you know, have—I’m just making this up as we’re speaking—a testing day twice a week at a vaccine clinic? So that we can kind of balance it. We need to really think about how we distribute our manpower between the two components to stop the spread of the disease: testing and administration of vaccine.
ICT®: You’re in Philadelphia. I’m outside of Philadelphia, born and raised in Philadelphia. I’m thinking about Los Angeles where they opened Dodger Stadium to administer COVID-19 vaccines? Have you heard of anything like that going on in Philadelphia? What do you think of the idea of opening stadiums throughout the country to try to administer this vaccine?
Ricci: I think it would be wonderful, especially if you can do it as a drive-thru that people didn’t have to get out of their car. Problem with not getting out of your car, which we’ve done with flu shots and all, is that how do you assess the patient for adverse or untoward effects after you administer it if they don’t get out of their car? But any open area would provide an appropriate place for the vaccine administration because it would help us to socially distance. And also you’re asking me have I heard [about anything like this] in the Philadelphia, Pennsylvania area. I know that they did do big vaccine clinics for 1A workers like essential workers in health care and all at the [Pennsylvania Convention Center] for the last two weekends. And it really did work well. I do believe that as the weather gets warmer, there is talk of using [Lincoln Financial Field], but I haven’t seen an official plan.
ICT®: Other than testing for COVID, which as we just talked about, may or may not preclude you from getting a vaccine, I guess it depends on the infection preventionists and the epidemiologists at a particular site to make that decision. Is there anything else physically that a person might show that you would say, “Well, maybe you shouldn’t get the vaccine?” Something like high blood pressure or any other kind of symptoms that you would say would make you step in and say, “I think maybe you should wait a week or two or three?”
Ricci: It’s my understanding that everyone who has comorbidities is in the high-risk category, whether it be heart disease, respiratory issues, high blood pressure or obesity: You should be getting the vaccine. I mean, I’m sure there are limitations in terms of other diseases, but you’d have to look at each disease specifically. The general recommendation is if you have comorbidities, you should be getting the vaccine. And when in doubt, discuss it with your primary care provider.
ICT®: We’ve been reporting here at Infection Control Today® that when the dust finally settles—knock wood—that long-term care facilities will have to rethink their infection prevention methods. And not to disparage long-term care facilities because those who run the facilities will say that they have nowhere near the financial resources that hospitals and other health systems have. But in terms of infection preventionists, many of them don’t have an infection preventionist full-time on staff. Are infection preventionists now going out from your facility to nearby long-term care facilities to facilitate vaccination efforts?
Ricci: I have not been asked to assist in any long-term care facility. We would be willing to go out and assist. Currently, we’re not permitted with students to return to long-term care facilities from a clinical standpoint where our students are actually doing clinical in the long-term care facility. Prior to COVID, I had many students in long-term care facilities. But right now, we have to wait until basically the residents are getting vaccinated. And also, as soon as more vaccine becomes available. I think there’ll be more assistance to long-term care facilities.
ICT®: We all know about the huge surge after the holidays. Now there’s talk that the surge is going down, but people are still not exactly thrilled with how little it’s going down. And people are also nervous about the variants that are cropping up. Do the variants make you nervous?
Ricci: I think it’s a virus and those of us who have been in health care for a long time know that viruses mutate. I think the speed at which the virus is mutating is something that we need to think about and have a little anxiety over. But I do believe that all of our government officials and scientists are actually looking at that right now.
ICT®: Any final words for your fellow infection preventionists who may be coordinating [COVID-19] vaccination efforts at their hospitals? Or words for those who may not be coordinating vaccination efforts at their hospitals and maybe they want to be involved?
Ricci: I would recommend that everybody go to the CDC website. There’s a wealth of information about how to conduct a vaccine clinic there. And the other thing is, be creative in how you’re going to implement it. Remember, to have the things like everybody wearing a mask, everybody having sanitizer available, gloves. Things like that. All the things that can help mitigate the spread of the disease. We can’t get careless on our mitigation strategies while trying to vaccinate.
This interview has been edited for clarity and length.