By Gary Evans, Medical Writer

Through a wide-reaching mass flu immunization effort that doubled as an emergency drill, a healthcare system in Delaware recently vaccinated a staggering 8,035 employees in a single day.

Such an effort takes considerable planning and administrative support, but there are a multitude of positives — not the least of which is readying a large portion of your staff for flu season before the annual virus starts circulating.

ChristianaCare healthcare system in Wilmington, DE, started its “#HitMeWithYourFluShot” campaign in the 2018-2019 influenza season, mass-vaccinating 7,868 employees. They followed suit in October 2019 for the 2019-2020 season, topping the prior total in an 18-hour vaccine marathon from 3 a.m. to 9 p.m.

The one-day blitz included vaccinating on site at two hospitals, and sending mobile vaccination units to affiliated institutions in neighboring states. Overall, the outreach included 100 nearby locations in Delaware, Pennsylvania, Maryland, and New Jersey. That included the two hospitals in Wilmington and Newark, NJ. Mobile teams dropped off vaccination kits or administered vaccines so caregivers in remote sites could be vaccinated quickly and easily. These locations included primary care, specialty care, medical aid units, imaging, laboratory, rehabilitation services, and nonclinical sites.

A novel addition this year was a drive-through option, allowing workers who were not on shift to receive the vaccine without leaving their cars. Employees were encouraged to preregister for their flu shot in the weeks leading up to the drill, which improved the efficiency of the exercise. Those not vaccinated during the one-day campaign were slated for follow-up immunization.

Hospital Employee Health asked for more details about the mass immunization campaign in an interview with Marci Drees, MD, MS, FACP, DTMH, FSHEA, ChristianaCare chief infection prevention officer and hospital epidemiologist.

HEH: Why did you use this mass vaccination approach for healthcare worker flu shots?

Drees: We have had a pretty intensive flu campaign prior to the last two years, but it was spread out over three weeks. We had put into place a tracking system so that we knew who was vaccinated [in-house and affiliated sites and clinics]. We had that in place for five or six years prior to this event. There have been other hospitals that published similar plans to dual-purpose your flu campaign into a vaccination drill. We took some lessons from what we read, and put our own spin on it.

We are pretty geographically diverse, so having everyone come to one spot to get vaccinated — which is what some of the other institutions have described — was not going to be very feasible for us. We did it our own way by having several different locations plus a traveling team that went to all of our outpatient and ancillary sites across four states. They brought vaccine if there were staff that were able to vaccinate at the location. We also had a traveling vaccination team that went around to the nonclinical sites, where there was no one physically there who could administer vaccine. Most people who were vaccinated got it on campus because that is where most of our staff are on any given day. Delaware is pretty small state. We are right at the juxtaposition of the four states. It’s a complex system in terms having to get where you need to go, but it is not a huge [geographic area].

HEH: How do you set up the program for those who will be vaccinated within the hospital? Did you go around with vaccination carts?

Drees: For the two physical hospitals, we set two locations at the bigger one, and one at the smaller one. We have multiple tables, and there were very few times throughout the day that there were lines, because we had staffed up appropriately. For the outpatient sites, we had to know how many people needed vaccination so that we could drop off a package, vaccine, syringes, alcohol swabs — everything they needed to vaccinate their own staff. Or, the traveling vaccine team would come through [and immunize people]. We were able to find out ahead of time how many staff needed vaccine.

HEH: Does this one-day campaign generate a lot enthusiasm that helps with staff participation?

Drees: I think it does. We talk it up a lot. [Marketing] did a great job in terms of publicity. You have to make it fun. A radio station came in, we had therapy dogs, and tons of stuff that people could do while they were waiting. The other thing is we had a lot of nurses and pharmacists volunteer to give vaccines. We also had a lot of hospital leaders come down to help, and that was nice. It’s fun — you get to see staff you don’t see every day.

HEH: Did staff have to get out of their cars for drive-through immunization?

Drees: No; you just roll up your sleeve. We thought it might be a nice opportunity to get some of our people who were off that day. They might have their kids with them, and they don’t want to park and come in. We put it in back of the employee parking lot, and we got a lot of positive feedback. The longest wait was 25 minutes, but people were happy with that option. That was a big success for this year; that was something new.

HEH: Can you report this mass immunization effort as an emergency preparedness drill to The Joint Commission?

Drees: Yes. It helps us with that regulatory accreditation, but we really did need to understand how we would do this on very short notice. We took six months to plan our first event, and the second time it got a little bit easier. There are a lot of lessons learned. For example, nobody had a true master list of where all our staff work. Different departments had different lists. From an emergency management perspective, you need a master list. That was a great lesson learned from the first time.

We have primary care clinics with outpatient labs, outpatient radiology, and physical therapy. No one person at that physical location had a reporting system for all of those different types of clinical sites. You have to communicate four different time times for four different clinics, but they all are physically at the same place. That was a lesson learned last year. This year, we made sure there was some kind of site contact that was responsible for communicating for all of the different services at a given physical site. That really streamlined things.

It has been nice to partner with emergency management. It is a ton of work, so the fact that we have support from the very top is really essential. We never know when flu is going to hit; some years it hits earlier than others. But by the middle of October, we have two-thirds or three-quarters of this done. It is nice to have a jump start on that.

HEH: Would this kind of drill be appropriate training for the next influenza pandemic, or the kind of mass prophylaxis that would be necessary after a large exposure or bioterrorism incident?

Drees: I was here in 2009 when we had the last pandemic. I think the bigger issue then was we didn’t have vaccine. The question was how you prioritize [vaccine] to the patients, the staff, and to which staff. Who are the people at a higher risk of complications? It gets very tricky. This is slightly different, but I think we still learned things by having this drill. It doesn’t have to be a vaccine, necessarily; it could be a mass prophylaxis with antibiotics. It would be the same process, so I think it is useful for other things.

HEH: Does your healthcare system mandate seasonal flu immunization for healthcare workers?

Drees: We do not. We allow people to decline. We have what I call a “mandatory declination” process. They are required to participate in the process. We typically have less than 5% decline. That is pretty good herd immunity for flu. I know facilities that mandate vaccine have about 99% [compliance] because they fire people. This is a little more lenient, but we still get the results that we need.

HEH: Do you conduct annual education to overcome antivaccine sentiment and myths?

Drees: We always perform education. We put together web-based learning that we push out in September. For the last couple of years, we have done kind of a [basic] version for people who know they are going to be vaccinated and just wanted to know where and when. Or, they can choose a longer version that goes into the types of vaccines and any safety concerns. We probably have 200 frequently asked questions, all grouped by category, based on questions we have received. We make sure that is updated each year.

Those who do decline must give a reason. We also look at what department they are in. If there is a department that has a little lower vaccination rate, we target them for some advertising materials and try to get some of their own staff members to be models for the fliers. It really emphasizes that someone they know is supportive of the flu vaccination.

HEH: For those who decline vaccination, do you enforce mask requirements during flu season?

Drees: They must participate in the [vaccination] process, and we give them a date of Nov. 30 to complete that. We then push out to managers [whose employees] are not vaccinated and they know that they have to wear a mask. Once flu starts circulating in the community, we will put out a notice saying now is the time to start masking for anyone who is unvaccinated for any reason. We typically get another rush, at that time, down to employee health of people who want to get vaccinated. They don’t want to wear a mask, so they come down and get it, but we do have people who wear masks all winter long.