As reports circulated that up to 500,000 health care workers may receive the smallpox vaccination this fall, proactive ED managers were busy formulating plans for this scenario.
"There is nothing easy about any of this," says Peggy Piering, RN, director of emergency services and critical care for Northern Westchester Hospital in Mount Kisco, NY. "We try to address issues as we learn of them and make decisions accordingly, using local and state agencies as our advisors, while also deciding what is best for our patients, community in general, and staff."
Most EDs are awaiting the final word before making definite plans for how this will be handled. "Since there are no final recommendations concerning smallpox vaccinations, we as an organization have not had a formal planning team to formulate a process around vaccinating our employees," says Ruth Henderson, RN, ED nurse manager at Rochester, NH-based Frisbie Memorial Hospital.
[For the June 20, 2002, draft supplemental recommendations of the Advisory Committee on Immunization Practices for the Centers for Disease Control and Prevention (CDC), go to www.cdc.gov/nip/smallpox/supp_recs.htm. For updated information on smallpox vaccination plans, go to the CDC’s National Immunization Program’s home page on smallpox at www.cdc.gov/nip/smallpox/default.htm.]
However, Henderson notes that the facility’s employee health and infection control nurses will be expected to take the lead in any vaccination program that is recommended for health care workers. She also expects that several community based walk-in clinics affiliated with the hospital would be involved in the plan for any mass vaccination.
Meanwhile, ED staff are understandably eager to learn whether the vaccine will be given or not, and how an actual outbreak would be handled. ED nurses specifically have expressed concerns about whether they will be vaccinated in advance of a documented exposure and about availability of the vaccine if an outbreak does occur, reports Barbara Coyne, MBA, RN, director of emergency and trauma services at Lutheran General Hospital in Park Ridge, IL.
Coyne says that although her facility has a plan in place if the need for mass vaccination for smallpox should occur, it would be a challenge. She says the facility plans to work with the local health department to distribute the vaccine. "ED personnel are on the front line and would benefit from the vaccination should a smallpox exposure be confirmed," she stresses. If the plan is to vaccinate health care workers without a confirmed case of smallpox, then Coyne says she will provide staff with information regarding side effects, contraindications, and current recommendations.
Piering says her facility does not have a formal or comprehensive plan for vaccination of ED staff. However, as a preliminary step, employees born before 1972 have been identified. "We can assume that the vaccine was probably given to them. The list is easily generated from the hospital database and is kept confidential in employee health," she says.
The next step would to be to ask individuals on this list if they in fact received the vaccine, although Piering acknowledges this is still no guarantee of protection. "That is as far as we took it at this point," she says. If the decision is made to vaccinate ED staff, the plan is to use the list to assess risks for individual staff members. "At this point, this level of detail is only in the discussion phase," Piering says.
Of the 800 employees at the facility, 60 have been trained as first responders and will be donning personal protective equipment in the event of a smallpox outbreak, including ED staff, respiratory therapists, intensivists, security personnel, and some ICU staff, Piering says. "They would need to be vaccinated first, and then we might have to consider further vaccination for other staff," she says.
Sources
For more information about how ED managers are planning for smallpox vaccination, contact:
• Barbara Coyne, MBA, RN, Director of Emergency and Trauma Services, Lutheran General Hospital, 1775 Dempster St., Park Ridge Il 60068. Telephone: (847) 723-5161. E-mail: [email protected].
• Ruth Henderson, RN, Emergency Department, Frisbie Memorial Hospital, 11 Whitehall Road, Rochester, NH 03867. Telephone: (603) 335-8133. E-mail: [email protected].
• Peggy Piering, RN, CEN, Director, Emergency Services and Critical Care, Northern Westchester Hospital Center, 400 E. Main St., Mount Kisco NY 10549. Telephone: (914) 666-1567. Fax: (914) 666-1931. E-mail: [email protected].
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