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Hospital prepares to launch the first COVID-19 vaccine among clinicians

Editor’s note: Find the latest COVID-19 news and guidance in Medscape’s Coronavirus Resource Center.

Initially, when a 28-year-old doctor died of receiving an experimental vaccine after the first-line news of COVID-19 in Brazil, people doubted the safety of one of the most promising coronavirus vaccine candidates. But then the story changed. Although the vaccine manufacturer cannot confirm it, the doctor seems to have entered the control group and has received a certain dose of definitive meningitis vaccine. The danger comes from exposure to the coronavirus itself.

This tragedy highlights the continuing risk of COVID-19 for healthcare workers, which the US Advisory Group has designated as part of Phase 1

A-the first person to receive any approved vaccine dose. The Centers for Disease Control and Prevention (CDC) recently reported that 6% of adults hospitalized with COVID between March and May were medical staff. The report is based on surveillance data from 13 states. The average age of the patients was 49 years. The agency has set a November 15 “preparation date” for vaccination in states (such as state health departments), even though it is unlikely that the vaccine will be approved at that time.

As hospitals scramble to prepare, their slogan is flexibility. They do not yet know how many initial doses they will get, which vaccine or within what time frame. They have a mature infrastructure that can provide flu vaccines every fall, but the framework does not match the limited supply, additional reporting requirements, two-dose treatment options, and different storage requirements.

Dr. Anna Legred Dopp

Anna Legreid Dopp, senior director of quality improvement and guidance for the American Association of Health System Pharmacists, said: “Health care organizations are constantly advancing amidst challenges. I fully believe that they have the potential to do so.” Medscape Medical News.

Medical staff will not accept vaccine authorization

Even after several months of caring for COVID patients, most clinicians are still at work and in the community vulnerable to infection. This is what Kevin Smith, an occupational medical doctor, realized when his medical system was based in Toledo, Ohio, and ProMedica provided antibody testing to all its 50,000 employees. He said that in the 6,933 tests conducted, about 2% returned positive.

Dr. Kevin Smith

However, many doctors, nurses and other medical staff are skeptical about the safety and effectiveness of the vaccine, which has been quickly approved by the U.S. Food and Drug Administration (FDA) for emergency use. According to a Medscape survey, about half of nurses (47%) and almost one-third of doctors (30%) said that they do not want to get the vaccine when the vaccine is first marketed, or are uncertain about the vaccination status.

Because the vaccination of medical staff will lay the foundation for the public to accept the vaccine, epidemiologists in the hospital are concerned about this. Dr. Marci Drees, MD, Chief Infection Prevention Officer and Hospital Epidemiologist at Christiana Care Health System in Newark, Delaware, said: “We know that healthcare workers will hesitate, just like the general public.” The Health Epidemiology Society to the CDC Immunization Practice Advisory Committee. “I think if we are not willing to vaccinate ourselves, we cannot expect anyone to be vaccinated.”

Medical staff are usually required to receive a series of vaccines, including measles, mumps, rubella (MMR) and whooping cough vaccines. Every year, according to workplace regulations, nearly half of American healthcare workers are vaccinated against influenza. But COVID-19 will be different. The FDA requires anyone who obtains a product under an emergency use authorization (EUA) to receive information about the risks and benefits, and can choose to refuse. Instead, hospitals will rely on education because the new vaccine (or multiple) they provide are at least 50% effective.

ProMedica does not require employees to be vaccinated against influenza, but employees who refuse to take the medication must obtain instructions from a doctor stating that they are already talking about the risks and benefits of the vaccine. Smith said that similar methods can be used for the COVID-19 vaccine, in which case employees may be required to learn about the vaccine before refusing to use it. He added: “I do believe some people will say they don’t want to get it.”

Like colleagues across the country, Smith is also identifying health care workers who are directly involved in the care of COVID-19 patients and are at the highest risk of exposure. He said that even among high-level personnel, those who perform the most dangerous tasks, such as respiratory therapists who provide respiratory therapy that disperses aerosols and droplets, will be marked as priority groups. He said that medical staff who spend the most time near COVID patients, such as nurses in the COVID ward, may also get the first dose.

Swirl, don’t shake the vaccine

The hospital is good at strengthening vaccination campaigns. For example, last year, Vanderbilt University Medical Center in Nashville, Tennessee vaccinated nearly 16,000 employees against influenza during a one-day “Flulalapalooza” event. The medical center even won the Guinness World Record in the first Flulapalooza competition in 2011 because it received the most vaccines in 8 hours.

Due to COVID restrictions, the 10th anniversary of the event was cancelled this year. Instead, nurses, pharmacists, and other clinicians vaccinated their colleagues against influenza. Now, under uncertain circumstances, the COVID-19 vaccination plan is moving forward.

Dr. Lori Rolando

Dr. Lori Rolando, MD of MPH, director of the Vanderbilt Occupational Health Clinic, said that instead of holding large-scale events, it is better to be more targeted and focus on the delivery mechanism. In the latest version of the US Centers for Disease Control and Prevention (CDC) vaccination plan “script”, the agency recommends vaccinating in an area that allows people to stay 6 feet apart and asking them to wait 15 minutes after being vaccinated to ensure that they Not weak, almost all vaccines have potential risks.

That is the easy part. Given the uncertainty over which vaccines will be approved and which vaccines the hospital will get, the plan becomes more complicated.

If the Pfizer/BioNTech vaccine obtains EUA certification in 2020, approximately 100,000 to 20 million doses will be available in November and 200 to 30 million doses in December. The ultra-cold container used to ship the vaccine must be replenished with dry ice within 24 hours after receiving the vaccine and every 5 days thereafter. The hospital will need a temperature probe to monitor the storage in the container. The five-dose vial can be refrigerated before administration, but only for 5 days. The product must be diluted and then must be used within 6 hours.

Initially, the number of Moderna vaccines will be reduced. It is expected that there will be about 10 million doses in November and 15 million doses by the end of December. The 10 dose vials are stored in the refrigerator. After putting them in the refrigerator to thaw, they must be used within 7 days; after taking them out of the refrigerator, they must be used within 12 hours. The pharmacist or other vaccinator must swirl-but not shake! -According to the CDC manual, the vial is prior to administration.

As more information about the vaccine becomes available, the description may change, and Smith will adapt to changing circumstances. He said: “These are all draft plans. We will continue to make changes.”

The Pfizer vaccine requires a second dose on 21 days, while the Modena vaccine targets the second dose on 28 days. In addition to using the information system to track vaccination status and any adverse effects, the hospital will also provide employees with a card showing the vaccines they received, the date of vaccination, and the date they need to be returned. (At this point, the schedule for the second dose does not seem to be flexible.)

Regardless of the vaccine used, one message remains the same: COVID prevention measures must continue to be used. This means wearing a mask, keeping your distance from society and washing your hands-medical staff who are positive for naturally acquired antibodies must also follow this practice.

Rolando said: “I don’t think anyone expects a COVID vaccine to be 100% effective in preventing COVID.” “Therefore, all other tools in our toolbox will also need to continue to be used.”

Michele Cohen Marill is a freelance journalist based in Atlanta. She has written for Wired, STAT, Health Affairs and other publications. You can contact her at michele.marill@gmail.com.

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