Two birds with one shot: Flu vaccination terror drill

Going beyond the tabletop in a real-time exercise

In the event of a natural or intentional infectious disease outbreak, rapidly delivering any available vaccine or prophylaxis to health care workers could be critical to a hospital's chances of keeping its doors open to treat incoming infectious patients. While that may be a stated goal in disaster response plans, an infection control professional decided to take it a step further by setting up a drill to mass immunize 70% of patient care staff in six days.

"The issue was for us was preparedness," said Stephanie Holley, RN, an ICP at the University of Iowa Hospital and Clinics in Iowa City. "Would we be ready and able to mass vaccinate our susceptible health care workers and do it efficiently and rapidly? We thought it would go beyond our typical table top where we would sit around discussing hypothetical situations, and how we might implement those."

While one of the stated goals was to measure the hospital's ability to respond to a bioemergency, Holley killed two birds with one shot by tying the plan to seasonal flu immunization. "My fellow ICPs can attest that we are often challenged to be very resourceful," Holley recently said in Tampa at the annual conference of the Association for Professionals in Infection Control and Epidemiology. "When we are asked to take on a huge project that takes a lot of our time, energy, and resources, we want to get the most bang for our buck. Well, the bang here was maybe we could increase our [influenza] vaccination rates as well."

The hospital's disaster emergency group designed a drill to achieve mass immunization without disrupting patient care. "When we first pitched this idea to hospital leadership, they were not real keen [on it] and were very concerned that we might disrupt normal operating procedures," she said.

However, planners were sufficiently convincing and the drill was approved. The scenario of an influenza pandemic required staff to respond to actual events and to implement decisions in real time, Holley explained. The proposed plan focused on the following components: communication, education and promotion, dispensing strategies, and real-time data collection. Dispensing strategies included using the employee health clinic, a peer vaccination program, and mobile vaccination teams.

"For the peer vaccination program we used nurse champions at the unit level to coordinate vaccine delivery," she said. "We have some groups of nurses in the institution at the unit level who had been designated for champions for other projects so they were a great group to tie in to for this project."

Though the drill was set in real time, there was considerable planning and education beforehand that could not have happened in an actual emergency.

"We did a lot of marketing and promotion," she said. "When you say a drill that lends the idea that you just kind of do it. But there was a lot of preparation put into it and we did collaborate with a lot of areas such as our department of nursing to look at resources. We told them it was a drill and we were testing our preparedness and we wanted to see if we could vaccinate them in case of emergency."

Info collection a problem

Overall, 54% of direct patient caregivers were immunized during the drill. Groups with the highest compliance were physicians 58%, residents and fellows 65%, and nurses 58%, Holley reported. During the drill, peer vaccinators delivered 82% of vaccine, while the employee health clinic administered 12% and mobile vaccination teams gave the remaining 6%. Forty-one percent of the vaccine given during the campaign was given in the first two days of the drill, but planners kept offering vaccine after the six-day mark and achieved a 66% rate in two weeks, she said. "We learned that the peer vaccination strategy was very effective," Holley said. "In fact, we never imagined we would be implementing this type of strategy again, but we did within a couple of months [due to mumps outbreaks in Iowa]."

The drill also demonstrated critical weaknesses such as in the area of information collection. "We couldn't use [our] information systems very well to collect and analyze necessary data in real time," she said.

Holley cited the need to improve information management systems to rapidly identify staff who have direct patient contact so they can be quickly prioritized to receive vaccine or prophylaxis. "We need to develop systems that allow us to collect real-time data so we can track those vaccinated and not vaccinated," she added. "We feel that this is a drill format that others might consider to both increase their vaccination rates and to test preparedness. In addition — and this is really the silver lining — this drill demonstrated the importance of influenza vaccination to our hospital leadership and it is now an institutional priority for 2006."