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Story from the Field

Name of Health Department/Agency: District of Columbia Department of Health
State: DC
Date Added: 11/11/2009
Themes: Vaccine Planning and Administration
Issue Summary: School-based mass vaccination clinics in Washington, D.C.
Description of Issue(s): D.C. has initiated school-based mass vaccination clinics. We?re in our fifth day of them. We have a weekly schedule?we open up on two sites on Tuesdays, two sites on Thursdays, and four sites on Saturdays. So it?s a very aggressive schedule but it?s been very well taken by the community.
Actions taken to address the issue(s): We?ve had intense media interest and we?ve had to alter plans based on the media coverage and intense scrutiny by other external sources, which required alteration of our plans. Contract nurses definitely need training. That is crucial. We have the same experience that our immunization clinic personnel and most of the nurses here in the department are very familiar with the immunization program and are very facile at it but that?s not necessarily so with the contractors that you?ll encounter. We are also concerned about accommodations for pregnant women and those with medical disabilities. Depending on the size of the clinic, we?ve handled that differently. If the size of the clinic is such that the actual area where people are brought in cannot be seen by the rest of line, we?ll bring the pregnant women forward but in areas where you can see everything happening, we?ve received tremendous push back about bringing people forward into the line. So that?s one of those things, that whatever you decide to do just make sure you have your justifications for it. We also number individuals as they come into line not so that they have a priority in the line but so we can tell them when we can expect that we?ll run out of vaccine. We haven?t run out of any vaccine types yet in any of our clinics because we cut off at a time period rather than a vaccine period. We?ve been trying to overload the vaccines so that if people show up during the scheduled time period, they can get a vaccination. However, we know that this week we?ve opened up our clinics to all priority groups and we?re seeing a much heavier volume and expect that Saturday clinics this weekend will be very heavy and we may have to turn people away. From a layout perspective, because we?re in schools and our schools were built so many years ago that many of them are not ADA compliant in the areas that we are using. We?ve had to develop stroller parking areas and a process for basically doing stroller check-in and check-out and issuing kind of like coat-check forms, where we can check the strollers in and receive a number then check it back out on the way out of the clinic. That requires extra people and space in the clinic area. We also discovered that our first week was very focused on the ages 6 months through 24 years and pregnant women, that there were many other people that would show up for the clinic that we would have to turn away that were in some other priority group or not in a priority group at all. Some individuals, such as those who were caregivers of those under 6 months of age, were told they were not allowed to receive the vaccine but could come back in subsequent weeks. While they were waiting in the observation area post vaccination, if they could see who was getting the vaccine, we would often get challenges as to the ages of some of the older children who were in the 18-24 age group. LESSON LEARNED: alter your viewing area, rotate your chairs so people waiting can?t see what?s going on in the vaccination area.

Outcomes that resulted from actions taken: We definitely recommend clear messaging about the prioritization of the vaccines of the clinics that you are holding. Because we?re in an area that is surrounded by two other states and all of us are holding mass vaccination clinics but different priority groups being serviced, it can be very confusing to the public. That?s one of the reasons we?ve decided to open up to all priorities groups this week because it?s just easier than having to deal with all the hassles of focused group vaccination clinics. One of the most critical things we learned is with multi-dose vials. Since we have 16 vaccinators in the vaccine area, we have to start shutting down the issuance of the vials about an hour to go into the clinic so you have as few of the multi-dose vials open at the end. We ended up having quite a bit of wastage after the first set of clinics because we didn?t manage that well so it becomes truly a management issue. Because we are using contract nurses--although we have processes for needles sticks in a normal plan--we didn?t have really the process that we would need for the contract nurses. It took us by surprise. Since they are under the guise of our medical reserve corps, they can?t fill out that paperwork and it was a different set of papers. The frequency of clinics truly helped to keep the numbers down at every clinic.

Although it?s a massive effort on our part to put together eight clinics for six weeks straight, it?s helped to keep the numbers down and the wait time down. We have not gone over two hours for anyone so far to be waiting for the vaccine. It is a massive event so the need for volunteers has been truly incredible and we?ve had a great turnout.? We?ve put the call out for volunteers not only to the medical reserve corps people, but also to whole host of community agencies--such as the United Way and Serve DC, District of Columbia government agencies, our hospital association, and our primary care association. We would recommend that if you are going to do this on a routine basis, that you continue to reach out to other agencies outside of the ones you normally do to get these volunteers. Because we are in schools and they are not designed traditionally for task lighting, we discovered in the vaccine area you may need to bring additional lighting because gymnasiums and auditoriums don't have terrific task lighting, which becomes problematic in filling out the forms and drawing up the vaccines accurately.

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