Mass Vaccination Protocol for the Administration of ...

DocuSign Envelope ID: 7E6AF20A-DB80-46A8-AA1A-C4B7A5D7D79A

Hospital Command Center

Mass Vaccination Protocol for the Administration of Influenza Vaccine

Location (includes Employee Health and all hospital and inpatient, outpatient, and community mass vaccination sites, mobile units and subacute facilities of the hospital, unless otherwise indicated)

Enterprise Wide

X

O'Connor Hospital

Santa Clara Valley Medical Center

St. Louise Regional Hospital

Who May Perform This Procedure

RN

X

MUC

LVN

X

HSR

HSA

Techs

MA

MDs, APPs, Residents

X

Other (specify): Pharmacists,

pharmacy residents, pharmacy interns, pharmacy technicians, RPh,

X

Dentists, nursing students

Who May Order This Procedure

RN

X

MUC

LVN

X

HSR

HSA

Techs

MA

MDs, APPs, Residents

X

Other (specify) Pharmacists, pharmacy interns, RPh, dentists

X

REFERENCES

1. Key Facts About Seasonal Flu Vaccine. Centers for Disease Control and Prevention (CDC). . Accessed August 03, 2021.

2. CDC. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR; August 27, 2021;70(5);1-28. Accessed August 30, 2021.

3. Influenza. National Institute of Health (NIH). . Accessed August 03, 2021.

Revised 08/30/2021

DocuSign Envelope ID: 7E6AF20A-DB80-46A8-AA1A-C4B7A5D7D79A

Mass Vaccination Protocol for the Administration of Influenza Vaccine

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REFERENCES (continued)

4. CDC. Vaccination Guidance During a Pandemic. Accessed August 09, 2021.

5. CDC. Symptoms of Coronavirus. Accessed August 09, 2021.

6. General Best Practice Guidelines for Immunization: Best Practices Guidance of the Advisory Committee on Immunization Practices (ACIP). Timing and Spacing of Immunobiologics. . Accessed August 09, 2021.

7. CDC. Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Authorized in the United States. . Accessed August 30, 2021.

8. CDC. During the Clinic Activities. Accessed August 10, 2021.

9. Immunization Action Coalition. Administering Vaccines to Adults: Dose, Route, Site, and Needle Size. Available at: . Accessed August 10, 2021.

10. Immunization Action Coalition. Medical Management of Vaccine Reactions in Adult Patients. Available at: . Accessed August 10, 2021.

11. Immunization Action Coalition. Medical Management of Vaccine Reactions in Children and Teen Patients. Available at: . Accessed August 10, 2021.

12. General Best Practice Guidelines for Immunization: Best Practices Guidance of the Advisory Committee on Immunization Practices (ACIP). Preventing and Managing Adverse Reactions. . Accessed August 10, 2021.

13. Simons, F Estelle R et al. "World allergy organization guidelines for the assessment and management of anaphylaxis." The World Allergy Organization journal vol. 4,2 (2011): 13-37. doi:10.1097/WOX.0b013e318211496c. Accessed August 10, 2021.

14. Section 4052.8. Initiation and Administration of Vaccines; Requirements. The Pharmacy Law (Business and Professions Code 4000 et seq.). Accessed August 05, 2021.

15. Section 2725. Legislative Intent: Practice of Nursing Defined. California Nursing Practice Act. Accessed August 05, 2021.

16. ? 100146. Scope of Practice of Paramedic. California Code of Regulations. Accessed August 05, 2021.

17. CDC. Vaccine Storage and Handling Toolkit. Accessed August 05, 2021

Revised 08/30/2021

DocuSign Envelope ID: 7E6AF20A-DB80-46A8-AA1A-C4B7A5D7D79A

Mass Vaccination Protocol for the Administration of Influenza Vaccine

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PURPOSE BACKGROUND

To reduce morbidity and mortality from influenza by vaccinating patients who meet the criteria established by the Centers for Disease Control & Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP).

Influenza is a contagious respiratory illness caused by influenza viruses that are spread through the transmission of respiratory droplets. Although seasonal influenza viruses are detectable year-round, activity in the U.S. typically increases in October and peaks between December and February. Symptoms of influenza, which can occur anywhere from 1 to 4 days after infection, may include fever, chills, sore throat, cough, runny or stuffy nose, muscle aches, headaches, and fatigue. Although most people can recover in a matter of a couple of days to under two weeks, some patients may develop more severe complications such as pneumonia which can be life-threatening. Certain patients, including children younger than five years old, pregnant women and those up to two weeks postpartum, adults 65 years or older, residents of nursing home or other long-term care facilities, and patients with certain chronic disease states such as asthma, heart disease, or diabetes may be at increased risk of developing more serious complications of influenza. Various tests may be used to detect influenza including rapid influenza diagnostic tests and rapid molecular assays, which can generally be performed in clinics and provide results in under 20 minutes.1 Reports from the National Institute of Health (NIH) and the Centers for Disease Control (CDC) showed that 5% to 20% of the U.S. population gets the flu. This number equates to 200,000 hospitalizations and 36,000 deaths from the flu annually.2,3 Since influenza and COVID-19 share many symptoms, preventing influenza through vaccination means fewer people will seek medical care for possible COVID-19 and influenza and avoid burdening the already overwhelmed hospitals and healthcare systems.

Because influenza viruses are always changing and immune response to the vaccinations decline over time, patients should be advised to receive the vaccine annually. Each seasonal vaccine is formulated to protect against the influenza viruses predicted by researchers to be most common in the upcoming season. Types of vaccines may include inactivated influenza vaccine (IIV), live attenuated influenza vaccine (LAIV), or recombinant influenza vaccine (RIV). Formulations may also be trivalent, protecting against three influenza viruses (influenza A (H1N1) and influenza A (H3N2), and one influenza B), or quadrivalent which provides additional protection against another influenza B virus. In general, the CDC does not recommend the use of one influenza vaccine over another.1

LEVEL

Licensed pharmacists, pharmacy residents, intern pharmacists, public health nurses (PHNs), registered nurses (RNs), licensed vocational nurses (LVNs), nursing students, paramedics, and paramedic students who have satisfactorily completed training and demonstrated competence in the administration of Influenza vaccine, with knowledge of all indications, precautions, contraindications, possible side effects and appropriate treatment of such reactions will be permitted to, screen, and administer immunization to clients requiring influenza vaccine.

Revised 08/30/2021

DocuSign Envelope ID: 7E6AF20A-DB80-46A8-AA1A-C4B7A5D7D79A

Mass Vaccination Protocol for the Administration of Influenza Vaccine

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ORDERING AND AUTHORIZING PROVIDER(S)

This is a "per protocol, no co-sign required" procedure. If using PrepMod, no order is required. If using HealthLink, enter order for Influenza vaccine into the EHR or on paper form as a "per protocol, no co-sign required" using Phuong Nguyen, M.D. as the ordering and authorizing provider for hospital and clinic sites, or Sarah Rudman, M.D., as the ordering and authorizing provider for mass community vaccination sites.

SUPPLIES

INCLUSION CRITERIA EXCLUSION CRITERIA REASON FOR DEFERRAL/ PRECAUTION:4-5

3 mL syringe with 21-gauge needle or narrower (for drawing and administering vaccine)

Alcohol wipes Pen Band-Aid Hospital approved germicidal disinfectant PPE: Gloves, surgical mask, eye protection (face shield/goggles)

The following emergency supplies must be immediately available to the clinical team assessing and managing anaphylaxis:

Epinephrine prefilled syringe or autoinjector (at least THREE doses at each vaccination site at all times)

H1 antihistamine (e.g., diphenhydramine) Blood pressure cuff Stethoscope Timing device to assess pulse

If feasible, including at sites (not mandatory): Oxygen Bronchodilator, e.g., albuterol H2 antihistamine, e.g., famotidine, cimetidine Intravenous fluids Intubation kit Adult-sized pocket mask with one-way valve (a/k/a cardiopulmonary resuscitation mask)

1. 3 years of age and older 2. No previous history of influenza vaccination for the current influenza season

1. Serious systemic or anaphylactic reaction to a prior dose of the influenza vaccine or to any of its components.

2. History of Guillain Barre Syndrome within 6 weeks of a previous influenza vaccination.

3. Patients who reported to experience onset of hives and/or anaphylaxis after ingesting eggs.

1. Routine vaccination should be deferred for persons with suspected or confirmed COVID-19, regardless of symptoms, until criteria have been met for them to discontinue isolation and until the person is no longer acutely ill. While mild illness is not a contraindication to vaccination, vaccination visits for these individuals should be postponed to avoid exposing healthcare personnel and other patients to COVID-19.

Revised 08/30/2021

DocuSign Envelope ID: 7E6AF20A-DB80-46A8-AA1A-C4B7A5D7D79A

Mass Vaccination Protocol for the Administration of Influenza Vaccine

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2. Reasons for deferral include: a. Diagnosed with COVID-19 or a positive COVID-19 test within the last 10 days b. Close contact (less than 6 feet for 15 minutes or more, or live in the same household) with someone who has been in isolation for COVID-19 or had a positive COVID-19 test within the last 14 days. Refer patient to a COVID testing site. c. Patients with the following symptoms can also be referred to a COVID testing site: i. Fever or chills ii. Cough iii. New loss of taste or smell iv. Shortness of breath or difficulty breathing v. New or unexplained in the last 3 days: Fatigue Muscle or body aches Headache Sore throat Congestion or runny nose Nausea, vomiting or diarrhea d. Seek emergency medical care immediately if a patient shows any of these symptoms: i. Trouble breathing ii. Persistent pain or pressure in the chest iii. New confusion iv. Inability to wake or stay awake v. Pale, gray, or blue-colored skin, lips, or nail beds

COADMINISTRATION WITH OTHER VACCINES:6-7

1. Inactivated influenza vaccines and recombinant influenza vaccines may be administered concomitantly or sequentially with other inactivated vaccines or with live vaccines.

2. Live attenuated (LAIV4) vaccine may be administered at the same time with another live or inactivated vaccine. a. However, if the two live vaccines are NOT given on the same day, the immunizer should wait at least 4 weeks before administering the second live vaccine. This does not apply to oral live vaccines such as cholera and oral typhoid which have no interactions with injectable live vaccines.

3. Influenza vaccine may be administered with COVID-19 vaccines without regard to timing.

4. Injectable vaccines that are given concomitantly should be administered at separate anatomical sites or at least 1 inch apart.

Revised 08/30/2021

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