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    • #2652
      Sharon
      Member

      Reflection question: The COVID-19 pandemic has caused health care professionals to critically examine evidence of current best practices. There has been discussion about ‘pooling’ residual COVID-19 vaccine from several vials to obtain a full dose. Does this meet current best practice? Explain why or why not?

    • #3246
      Dale
      Member

      Although some provincial health units such as BC advise that the residual vaccine from up to three
      vials may be withdrawn into the same syringe to constitute a full dose provided the vials are
      from the same manufacturer and the same lot number. Manufacturer’s such as Pfizer-BioNTech have advised the Centre for Disease Control and Prevention (CDC) in the USA that they should NOT combine remaining vaccine from multiple vials to obtain a full dose.

      Since best practice recommends the use of single dose vials or if using multi use vials preference is to limit to single patient use I believe best practice would be to discard the vial and contents, if the amount of vaccine remaining in the vial cannot provide a full dose.

      • #3638
        Tanya
        Member

        In reference to Dale’s post, I completely agree with his point of discarding residual COVID-19 vaccine. As “pooling” is not in best practice, I believe the cons outweigh the pros.

      • #3695
        Dale
        Member

        I agree with Jean. Pooling from several vials to obtain a full dose does not meet best practice guidelines.

    • #3273
      Melissa
      Member

      Ontario Public Health has advised that nurses can withdraw residual vaccine from up to three vials into the same syringe to make a full dose.

      Most COVID-19 vaccines are in multi-use vials (Pfizer you can get up to 6 doses with at times still leaving residual vaccine in the vial). I believe that as long as you are following protocol and making sure that if you are pooling residual vaccine from three vials to make a full dose you need to make sure that all of the lot numbers, expiry dates of vaccine and that the vaccine was thawed at the same time and match all of your checks. If when pooling an extra dose if it is not a full dose from the three vials used initially then you must discard all the vials and contents.

      I know with Pfizer you must destroy the label on each vial before discarding it. I know within our public health in my area we discard the vials after destroying the label into a sharps container.

      • #3462
        Cynthia
        Member

        Melissa,

        You post was a great to read and help with my post as well. I look forward to reading more of your post as well. I really had to think about the guidelines and standards as well.

      • #3678
        Jean
        Member

        Hi Tanya,

        I agree with you that “pooling” can increase the risk of contamination and can start a secondary thread of complications; however, when there are shortages of the vaccines and in order to save lives careful consideration of “pooling” may be considered but not without exploring all safety protocols. With combining different lot numbers , I think , this is where you accurate documentation comes in.
        Thank you.

        Jean

    • #3321
      Shannon Ruth
      Member

      I believe this does not meet with best practice guidelines. Best practice recommends the use of single dose vials or if using multi use vials limit to single patient use. I agree with Dale . I would discard the vial/contents if unable to make a full dose.

    • #3409
      Amanda
      Member

      I do not believe that this would be best practice. Using multiple vials to extract the residual vaccine increases the risk of contamination. Best practice would be a single dose vial used a single time or a multi-dose vial used for the prescribed doses and then discarded.

      I did read from both the BC CDC and the Ontario MOH that it is safe to combine the residual vaccine from 3 separate vials provided that they have the same lot number and manufacturer. It is necessary that these vials have all been handled with strict aseptic practice. I also read direction from the European Medicines Agency that stated partial doses were to be discarded and not combined as it’s not best practice.
      While I understand the rationale for wanting to pool residual doses to provide more vaccinations during a shortage, I do see how this could be more likely to lead to contamination of the product. Best practice would certainly be to use the vial as directed and discard ard the residual.

    • #3444
      Jordanna
      Member

      The “pooling” of the residual vaccine from multi-dose vials does not follow the best practice guidelines that we were taught in nursing classes. I understand the reasoning behind this during the Covid 19 pandemic but do not believe it would be a best practice. There are conflicting recommendations and ultimately we should be following the manufacturers direction.

    • #3445
      Judy
      Member

      Pooling of excess vaccine does not meet best practice guidelines . Because I believe it is not safe due to possible increase contamination risks.

    • #3461
      Cynthia
      Member

      I agree that the best practice is to have single dose vaccine is more sterile and better in many ways however in some countries they do not have the resources to do this. They have to use multiple vials. With that being said they can make it as sterile as possible. Use a needle just to withdrawal the vaccine then dispose then use new needle to do the injection. Clean the vial with alcohol swab each time it is used to get vaccine out of vile. If the country can afford to use single dose then do so. You have to think of your settings what can the facility afford to do in the safest way and follow the practice guideline/standards so that the nurse, patient and facility are safe.

      • #3608
        Makenzie
        Member

        Cynthia, I agree with you on this. Cost is a big contributing factor when it comes to single or multi dose vials. Ensuring you are making the use of a multi dose vial as sterile as possible will help decrease some risks of using it.

    • #3467
      Lois
      Member

      Moderna was sent to our First Nation clinics.
      This came in multi-dose vials. Started with 10 doses and now receiving 15 dose vials
      A knew syringe was used to take each dose. They received protocol that they could take left over vaccine from multiple vials but never had to followed this guideline
      Of interest there was no expiry date on vial but when you went to Covax to enter info there was a expiry date in system of vials received
      Name of product, lot# and expiry date was entered in each clients file. Best practice.
      Vials wiped with alcohol swab before withdrawal of vaccine.

    • #3475
      Alice
      Member

      It does not meet the best practices guidelines to pool excess vaccine and increases risk of product contamination.

    • #3546
      Leslie
      Member

      This doesn’t meet best practice guidelines.

    • #3603
      Brittany
      Member

      Pooling excess vaccines does not meet the current best practice guidelines. However, I know many of us when we first started vaccinating for COVID were torn. From my own experience we were given two different recommendations, follow best practice or follow our public health guidelines by combining partial doses to make a full dose as long as they had the same lot and expiry. (Due to vaccine shortages at the time).

    • #3604
      Prince
      Member

      Pooling of excess vaccines is not best practice because of the risk of contamination. However, I believe Public Health made that recommendation because they were under pressure to find solution or mitigate the devasting impact that COVID-19 virus was having on the population.

    • #3609
      Makenzie
      Member

      This isn’t best practice, as multi dose vials should be used on one client, due to the risk of contamination. That being said there is precautions that can be taken and with shortage and wanting to make sure everyone has access to the vaccine I can understand why pooling would be an option. However it would need to be as sterile as possible when doing so.

    • #3637
      Tanya
      Member

      In a critical time such as now with the COVID-19 pandemic, I can understand why “pooling” residual COVID-19 vaccine from several vials in order to obtain a full dose may be in discussion by several health care professionals, especially when the demand is high and the population outnumbers the supply on hand. However, this practice is unethical and is not in line with current best practice. “Pooling” can only increase, exponentially, the risk of contamination, combining different lot numbers, as well as going beyond use dates. While it may seem like a waste to some individuals, contamination alone can start a secondary thread of complications.

      • #3651
        Stephanie
        Member

        I like how you laid out very clear points about the risks of pooling of vials such as contamination, different combinations of lot numbers and going beyond use dates or expiration dates. It is true it might appear as a waste to some people when supply of the vaccine may be limited and even low in many parts of the world fighting Covid but one must go back to the significance of contamination risk and as you pointed out, contamination has a very real threat to a whole thread of new complications. Very good points!

    • #3650
      Stephanie
      Member

      As stated in the medication video it is preferred and recommended as best practice to obtain medications that are injected and vaccines from a single vial for the patient as oppose to use of multidose vials as the chances of blood-borne pathogens and risk of bacteria increases. With critical vaccines like the Covid vaccine, there is possibility of such risks. There could also be the potential for errors with the type of vaccine and the dose may be inaccurate if you are pooling from multiple vials. This could put patient safety at risk. One vial should be designated for one single does per patient and not the mixing of multiple vials to make a full dose just for the sake of not wasting residual vaccine remaining in the vial.
      Accuracy and safety must be the priority. There may be a perspective of trying to save cost with vaccines such as the Covid vaccine during this pandemic however are higher risks from unsafe practices really worth it in the end?

    • #3664
      Melony
      Member

      ‘Pooling’ residual COVID-19 vaccine from several vials to obtain a full dose, does not meet the current best practice guidelines. Although during this pandemic I can see why this idea was entertained by some health units the potential for risk out weighs the benefits in my opinion.
      Although there was a time when the vaccine was limited the efforts to obtain residual vaccine to make one single dose causes such a risk the efforts are not worth it. I don’t feel going against best practice guidelines was going to make any great impact on the overall vaccine campaign.

    • #3666
      Adella
      Member

      Reflective Questions – Please select one to comment on, in addition to the initial discussion question.

      1. You are caring for a client on an outbreak unit, the client requires a nebulizing treatment, what type of PPE should you don when administering the treatment? Does your work place have a policy and procedure in place?

      2. Can you administer both the COVID-19 vaccine and the seasonal influenza vaccine at the same time? If so, what considerations should be in place when administering?
      https://www.canada.ca/en/public-health/services/immunization/national-advisory-committee-on-immunization-naci/recommendations-use-covid-19-vaccines/summary-updates-september-28-2021.html

      • #3687
        Heather
        Member

        Can you administer both the COVID-19 vaccine and the seasonal influenza vaccine at the same time? If so, what considerations should be in place when administering?

        Yes, you can give them at the same time.
        Considerations are:
        -do not give both doses in the same arm
        -give them on the same day as appose to days apart
        -advise the patient of the side effects

        • #3691
          Leslie
          Member

          While the latest data suggests that we can administer the COVID and Flu vaccines at the same time with the considerations that you’ve outlined; personally I would want to wait a couple of weeks in between. Consider how you might react to one vaccine and double it? No thanks.

          • #3767
            Stephanie
            Member

            I see your point about considering adverse effects or reactions with both vaccines. A time period apart is a good suggestion. Perhaps other considerations also may be age and medical history, other chronic conditions or previous reactions to vaccines. Considering this pandemic though, both are very essential to provide the best protection possible as flu season upon us and the pandemic still has its grip.

        • #3823
          Melissa
          Member

          It has been advised that we can give multiple vaccines the same day now but they must be 1 inch apart if given in the same arm. I agree with Leslie that I personally would want to wait at least 2 weeks between vaccines so that you know which vaccine is giving you side effects if you should have any. I know that right now the clinic where I work we are trying to catch up the grade 7 school immunizations so at times we are giving 2 immunizations in one arm and then 1 immunization in the other arm. I know that my arm is sore after any IM injection so I couldn’t imagine how these children’s arms feel with having multiple injections the same day.

      • #4317
        Dale
        Member

        Can you administer both the COVID-19 vaccine and the seasonal influenza vaccine at the same time? If so, what considerations should be in place when administering?

        According to NACI, COVID-19 vaccines can now be given at the same time as the seasonal influenza vaccine, as long as it is in a different injection site. Studies are still underway so this recommendation may change and it is still recommended as “best practice” that the vaccines be given several days apart.

        Therefore, I feel that with the potential risk of increased temporary side effects, we should follow best practice and wait a few days between the vaccines.

    • #3673
      Jieun
      Member

      Drug pooling means combining/ withdrawing the volume from multiple vials to obtain a dose. This practice would increase the potential risk of contamination, aseptic technique, and transmission of both bacterial and blood-borne virus.
      According to CDC and Public Health Ontario, the residual vaccine in vial should be discarded if there’s not enough to get a full dose and also should not combine volume of vaccine from multiple vials to obtain a dose.
      FDA has advised that “…any further product remaining that does not constitute a full dose should not be pooled from multiple vials to create one.”
      We all should follow the practice standard and guidelines to provide safety. I strongly believe that pooling residual COVID-19 vaccine would be not a best practice as it against the infection prevention and control measures.

      Reference

      US Food and Drug Administration (FDA). Pfizer-BioNTech COVID-19 vaccine frequently asked questions. January 28, 2021.

    • #3674
      Anna Marie
      Member

      Excellent points made given the ethical dilemmas due to COVID-19 vaccine shortages . But to answer the question posed, “does pooling’ residual COVID-19 vaccine from several vials to obtain a full dose meet current best practice?” I am going to have say NO, as aware, single dose vials are recommended and pooling of medications increases many risks – such as contamination etc. Additionally, if different batches are accidently used, it would make things difficult for tracing.

    • #3675
      Anna Marie
      Member

      If caring for a client on an outbreak unit, and the client requires a nebulizing treatment, the following
      PPE for airborne, droplet and contact precautions are required when administering the treatment:
      -N95 respirator (fit-tested, seal checked)
      -Isolation gown
      -Gloves
      -Eye protection
      Negative pressure room if available

      Working in the community, we don’t have the option of a negative pressure room. Our policies include wearing the above PPE, recommend treatments be completed in a private room like the patients bedroom, where others are not generally walking in and out of – keeping the number of people in the room during the procedure to a minimum and keeping the door closed and opening a window if possible.

      • #3692
        Leslie
        Member

        I would also consider contacting the doctor to see if the treatment could be changed (i.e nebulized v.s. aerosol ventolin)

    • #3677
      Jean
      Member

      “pooling” residual COVID-19 vaccines from several vials to obtain a full dose does not meet best practice guidelines, risk the safety of an individual and creates dilemma. However, during this time of pandemic and shortages of vaccine and inorder to save lives perhaps “pooling” should be considered but without exploring thoroughly with the following:

      a) ensuring all safety protocols are followed
      b) following manufacturer’s recommendation
      c) discussing with multi-disciplinary teams
      d) referring to CNO medication standard, practices and decision tree making.

    • #3690
      Cheryl
      Member

      You are caring for a client on an outbreak unit, the client requires a nebulizing treatment, what type of PPE should you don when administering the treatment? Does your work place have a policy and procedure in place?

      Reply:
      PPE required would be a fitted N95 mask ( fitted within 2 years or with significant facial changes such as weight loss or gain) and seal checked with every application
      Gown secured with both ties at the back ensuring full coverage
      Appropriate sized gloves which would cover the cuffs of the gown and face shield or google without side vents
      Limiting number of people in the room

      Yes our agency has these protocols in places gone other than the nurse present in the room is also required to wear a face mask

    • #3707
      Brittany
      Member

      Q: Can you administer both the COVID-19 vaccine and the seasonal influenza vaccine at the same time? If so, what considerations should be in place when administering?

      A: Yes, you can administer both COVID-19 Vaccine and seasonal influenza vaccine at the same time.
      It was previously recommended that COVID-19 vaccines not to be given until after 4 weeks after other vaccines 28 days before and 14 days after other vaccines. It has been recently changed that waiting the 4 weeks is no longer necessary for any vaccines including…live, non-live, adjuvanted or unadjuvanted vaccines.

    • #3763
      Jordanna
      Member

      Can you administer both the COVID-19 vaccine and the seasonal influenza vaccine at the same time? If so, what considerations should be in place when administering?

      NACI has recently, September 28, 2021, changed their directive regarding administration guidelines allowing for the Covid-19 vaccine to be given with other non Covid-19 vaccines.
      Their statement:
      “Covid-19 vaccines may be given at the same time before or after other vaccines, including live, non-live, adjuvanted, or unadjuvanted vaccines”

      As with all vaccines
      – informed consent
      – benefit versus risk
      – health status
      – appropriate site/route/dose
      – monitoring after injection

    • #3764
      Adella
      Member

      Great responses everyone. Continue to reflect on each others posts.

    • #3765
      Stephanie
      Member

      You are caring for a client on an outbreak unit, the client requires a nebulizing treatment, what type of PPE should you don when administering the treatment? Does your work place have a policy and procedure in place?

      In response to the additional question in our emails from the facilitator the PPE required for a patient with a nebulizing treatment would include gown, gloves, a shield and use of a N95 mask which includes performing the seal check and ensuring there are no cracks or malfunction with the mask before putting on. The elastic bands on the mask are also very important when putting on and taking off after. The mask should be fit tested appropriately to the nurse and is required to be fitted every 2 years or sooner if there is any change in face symmetry. Ideally the room is a neg pressure room if feasible in the workplace. In my work setting of rehab and transitional care we don’t have dedicated negative pressure rooms and would have to ensure the patient is in a private room however this is not a treatment I typically see on the unit.

    • #3766
      Stephanie
      Member

      It also depends on the hospital’s policy and collaboration with the director, unit educator, nurse practitioner or other supervisors. Of course the doctor order would have a bearing too and may have to be adjusted accordingly.

    • #3794
      Lois
      Member

      Q: Can you administer both the COVID-19 vaccine and the seasonal influenza vaccine at the same time? If so, what considerations should be in place when administering?

      We are fortunate that a high % of our communities have already received their 2nd injection of Covid – 19 vaccine, and our elders have received their 3rd.
      Covid-19 vaccines may be given at the same time from directive September 28, 2021. Little or no evidence of harmful effects if given together.
      The client should be counseled to the benefits and potential risks. If given together how could it be clarified which needle they reacted to, that would be a question I would have if offered both needles on the same day.

    • #3798
      Tracy
      Member

      Pooling residual covid 19 vaccine from several vials to obtain a full dose, does not meet best practice guidelines. The video states vaccines from a single dose vial for patient is the best practice. Multi dose vial increase risk of contamination of blood borne pathogens and bacteria. Safety should be top priority

    • #3774
      Joanna
      Member

      The COVID-19 pandemic has caused health care professionals to critically examine evidence of current best practices.

      The phrase “critically examine” is key to understanding and answering the question of whether pooling residual COVID-19 vaccine from several vials to obtain a full dose represents current best practice.

      Pooling of residual COVID-19 vaccine from several vials to obtain a full dose, as an interim measure, meets current best practice in the context of the urgency and risk to public health and the availability of vaccine manufactured in multi dose vials.

      The use of single dose vials in the administration of vaccines, prior to the COVID-19 pandemic, was held as best practice with the least risk of transmission of blood-borne pathogens and bacterial contamination.

      “Single-dose vials are ALWAYS preferred.” Reference https://www.publichealthontario.ca/-/media/documents/b/2013/bp-clinical-office-practice.pdf?la=en

      Consistent and strict adherence to aseptic technique is required for the safe administration of vaccine from multi dose vials.

      “Any error in following protocols for the correct use of multidose vials can result in the transmission of both bacterial and blood-borne viral pathogens.” In fact, “outbreaks associated with the use of multidose vials in both the outpatient and inpatient settings are frequent and continue to occur in Ontario.”
      Public Health Ontario, Infection Prevention and Control for Clinical Office Practice, Published: June 2013,1st revision: April 2015.

      “As an interim measure during this time of limited COVID-19 vaccine, an additional dose of COVID-19 vaccine may be extracted from up to 3 vials of the same vaccine using aseptic technique. Although this is not routine practice for multi-dose vials of vaccines for other diseases, there are benefits to extracting additional doses given the high COVID-19 case counts leading to significant morbidity and mortality in Ontario. Every effort should be made to withdraw the entire residual volume from one vial, before entering the next vial. The antigenicity and, therefore, efficacy of the vaccine is not affected by accessing multiple vials to obtain an additional dose.”

      See “Appendix E: Additional Dose(s) from Vaccine Vials” pg. 41,42, https://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/docs/vaccine/vaccine_storage_handling_pfizer_moderna.pdf#page42

    • #3737
      Joanna
      Member

      The COVID-19 pandemic has caused health care professionals to critically examine evidence of current best practices.

      The phrase “critically examine” is key to understanding and answering the question of whether pooling residual COVID-19 vaccine from several vials to obtain a full dose represents current best practice.

      Pooling of residual COVID-19 vaccine from several vials to obtain a full dose, as an interim measure, meets current best practice in the context of the urgency and risk to public health and the availability of vaccine manufactured in multi dose vials.

      The use of single dose vials in the administration of vaccines, prior to the COVID-19 pandemic, was held as best practice with the least risk of transmission of blood-borne pathogens and bacterial contamination.

      “Single-dose vials are ALWAYS preferred.” Reference https://www.publichealthontario.ca/-/media/documents/b/2013/bp-clinical-office-practice.pdf?la=en

      Consistent and strict adherence to aseptic technique is required for the safe administration of vaccine from multi dose vials.

      “Any error in following protocols for the correct use of multidose vials can result in the transmission of both bacterial and blood-borne viral pathogens.” In fact, “outbreaks associated with the use of multidose vials in both the outpatient and inpatient settings are frequent and continue to occur in Ontario.”
      Public Health Ontario, Infection Prevention and Control for Clinical Office Practice, Published: June 2013,1st revision: April 2015.

      “As an interim measure during this time of limited COVID-19 vaccine, an additional dose of COVID-19 vaccine may be extracted from up to 3 vials of the same vaccine using aseptic technique. Although this is not routine practice for multi-dose vials of vaccines for other diseases, there are benefits to extracting additional doses given the high COVID-19 case counts leading to significant morbidity and mortality in Ontario. Every effort should be made to withdraw the entire residual volume from one vial, before entering the next vial. The antigenicity and, therefore, efficacy of the vaccine is not affected by accessing multiple vials to obtain an additional dose.”

      See “Appendix E: Additional Dose(s) from Vaccine Vials” pg. 41,42, https://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/docs/vaccine/vaccine_storage_handling_pfizer_moderna.pdf#page42

    • #3825
      Joanna
      Member

      You are caring for a client on an outbreak unit, the client requires a nebulizing treatment, what type of PPE should you don when administering the treatment? Does your work place have a policy and procedure

      This question is dependent on what type of outbreak the unit has.

      Airborne, droplet and contact precautions are required during the administration of nebulizing treatment for a client on a respiratory outbreak unit.

      Nebulizing treatments are considered aerosol generating. Droplets can be generated by nebulized therapies. I would wear a fit tested N95 mask as well as a facial shield to protect my eyes as a portal of entry, gown, glove and hand hygiene as contact precautions.

      I have not had any residents on nebulizing therapy in the retirement home that I currently work at. But we do have many residents who are treated with puffers. We do not currently have a policy for the administration of nebulizing treatments.

    • #3840
      Judy
      Member

      Q: Can you administer both COVID-19 vaccine and seasonal influenza vaccine at the same time? If so what consideration should be in place when administering?

      Based on NACI updated recommendation that Covid 19 vaccine and influenza vaccines can be administered at the same time. Although it is already recommended I would say not at the same rime. I agree with Leslie’s point of view that I would wait for at least 2 weeks interval between 2 vaccines to monitor side effects of these vaccines.

    • #3841
      Shannon Ruth
      Member

      f caring for a client on an outbreak unit, and the client requires a nebulizing treatment, the following
      PPE for airborne, droplet and contact precautions are required when administering the treatment : N95 respirator (fit-tested, seal checked), gown, gloves, eye protection, limit number of people who enter the room, see about changing treatment from nebulization. We do have a policy in place in our home at this time.

    • #3845
      Maria Mercedes
      Member

      Pooling resaidualCovid-19 vaccine from several vials to obtain a full dose might not meet current best practice. Definitely, it is strongly recommended the use of single dose vials to promote safe, effective and ethical medication administration. More over, I believe it could be more appropriated in terms of infection control, information, and accuracy using prefilled syringes where the manufactures’ directions are stated in every single individual dose that has been already prepared in an aseptic environment. It will prevent wasting medication, potential errors, and safe administration of Covid 19 vaccines.

    • #3846
      Heather
      Member

      Pooling residual COVID -19 vaccines from several vials to obtain a full dose does not meet the current best practice. We are not to use the same needle to draw up from multiple bottles to make one dose , this can cause cross-contamination. However, we are able under the current pandemic to draw from 3 vials to make one dose. Certain rules must apply, see attachment.

      Found on : https://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/docs/vaccine/vaccine_storage_handling_pfizer_moderna.pdf
      pag 41

      Attachments:
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    • #3852
      Barbara
      Member

      From everything that we have learned in nursing school, on the job training and previous best practice through CNO standards, pooling the injectable is most certainly not best practice and should not occur. There are a few new standards that seem to contradict previous education and I believe that they are more government suggestion, to save money, rather than CNO suggestion. As most people have answered, it is agreed that every time a needle enters the glass container, there is an increase of microbials and therefore perhaps rendering the injectable with possible decreased efficacy and increased cross contamination and therefore, increased infection rate at injection site.

      • #4404
        Tanya
        Member

        In regards to Barbara’s post, I certainly agree with both of your points. It can be very contradicting when in school we are taught one way and outside of school we are told another way. I believe that what we were taught in school has scientifically proven data, whereas, the government sometimes make decisions based on convenience as opposed to making informed choices when information is given from leaders/experts in the healthcare field.

    • #3858
      Tanya
      Member

      In regards to the question: Can you administer both COVID-19 vaccine and seasonal influenza vaccine at the same time? If so what consideration should be in place when administering?

      According to some research analysts that have looked into administering, simultaneously, the COVID-19 vaccine with the seasonal influenza vaccine, there is not enough evidence to say that by doing this will lead to detrimental outcomes. In fact, there are some medical groups that are in favor of this. Having said that, it should be remembered that this pandemic is still new and there is not enough research to outweigh the pros and the cons. In my opinion, I believe that both vaccines are very important to have, and so I feel the following consideration should be in place:
      Once flu shots become available in October of 2021, it should be administered in one arm, for example, and then some time (perhaps a month or two) should be allotted before the COVID vaccine is administered in the other arm. If the COVID vaccine was given to an individual first, then again, some time should pass before the administration of the flu vaccine. I personally do not think it is safe to do them simultaneously even at different sites. What if an individual has an adverse reaction to one of the vaccines? How will it be determined which vaccine is at cause?
      On another note, speaking in regards to the COVID vaccine itself, I noticed a trend in my workplace (a retirement home), where residents developed blood clots and soon after, passed away. This could be a coincidence or possibly an interaction involving the combination of the vaccine with specific chronic illnesses; however, more research is needed.

    • #3856
      Maria Mercedes
      Member

      Question 2:
      Can you administer both COVID-19 vaccine and seasonal influenza vaccine at the same time? If so what consideration should be in place when administering?

      The Public Health Agency of Canada (PHAC) has released an updated statement from the National Advisory Committee on Immunization (NACI) on September 28, 2021. On this statement it is confirmed that exists scientific evidence to administer Covid-19 vaccines at the same time as any other vaccines, including live, non-live, adjuvanted or unadjuvanted vaccines

      https://www.canada.ca/en/public-health/services/immunization/national-advisory-committee-on-immunization-naci/recommendations-use-covid-19-vaccines/summary-updates-september-28-2021.html

      According to the CDC, administering different types of vaccines at the same time has been shown to be safe.

      https://www.cdc.gov/vaccinesafety/concerns/multiple-vaccines-immunity.html#:~:text=Getting%20multiple%20vaccines%20at%20the,cause%20any%20chronic%20health%20problems.

      When a person is receiving multiple injections at the same time, we should consider the pain that this individual could experience at the insertion sites. In addition, it is important to administer each vaccine on different limbs. This intervention will allow us to assess for potential local reactions that these preparations could cause. Informed consent must be given prior administration.

    • #3857
      Maria Mercedes
      Member

      Question 2:
      Can you administer both COVID-19 vaccine and seasonal influenza vaccine at the same time? If so what consideration should be in place when administering?
      The Public Health Agency of Canada (PHAC) has released an updated statement from the National Advisory Committee on Immunization (NACI) on September 28, 2021. On this statement it is confirmed that exists scientific evidence to administer Covid-19 vaccines at the same time as any other vaccines, including live, non-live, adjuvanted or unadjuvanted vaccines
      https://www.canada.ca/en/public-health/services/immunization/national-advisory-committee-on-immunization-naci/recommendations-use-covid-19-vaccines/summary-updates-september-28-2021.html
      According to the CDC, administering different types of vaccines at the same time has been shown to be safe.
      https://www.cdc.gov/vaccinesafety/concerns/multiple-vaccines-immunity.html#:~:text=Getting%20multiple%20vaccines%20at%20the,cause%20any%20chronic%20health%20problems.
      When a person is receiving multiple injections at the same time, we should consider the pain that this individual could experience at the insertion sites. In addition, it is important to administer each vaccine on different limbs. This intervention will allow us to assess for potential local reactions that these preparations could cause. Informed consent must be given prior administration.

    • #3870
      Alice
      Member

      Related to the question..Can you administer both the COVID-19 vaccine and the seasonal influenza vaccine at the same time? If so, what considerations should be in place when administering?
      As of September 28, 2021 NASI now recommends that “covid 19 vaccines may be give at same time as,or any time before or after, other vaccines, including live,non-live adjuvanted or unadjuvanted vaccine”
      Considerations are
      Patients history and any other health contraindications.
      Informed patient and their consent to have vaccine with risks and benefits
      Nurse to wash hands and wear gloves and use proper technique if using single use or multi use vials when getting vaccine ready to give patients. Check date opened on multi dose vials and their expiry date.
      Cleanse injection site.
      Have patient wait after vaccine given as per public health guidelines
      Chart vaccine given.

    • #3911
      Jared
      Member

      In an ideal world, you would never pool doses from multiple vials. Given the unprecedented impact of COVID-19 and the rush to vaccinate the population, best practice was “put on the back burner” to put it bluntly.

      I have heard stories from pharmacy colleagues in the community about pooling doses to ensure everyone was able to obtain a covid vaccine. Obviously, blood-borne pathogen precautions were taken (only using blunt needles to draw the vaccines, no used syringes or needles were used on vials, etc…), but it still irks me to see best practice be tossed aside to gain maybe a handful of extra doses…

    • #3920
      Margo
      Member

      It isn’t best practice to pool vials together. The risk for contamination and making mistakes during the draw up of medication increases.
      Can you administer both the COVID-19 vaccine and the seasonal influenza vaccine at the same time? If so, what considerations should be in place when administering?
      As per NACI both vaccine can be given together. “There is no need to seperate the vaccines”. I would presume the same factors would be taken into consideration when given any vaccine, whether the person is allergic to any ingredients, their reaction to previously getting either vaccine etc. Looking at whether the benefits out weigh the cost.

    • #3954
      Michelle
      Member

      very great discussion point on the pooling of vaccines. I wasn’t working at the time that there was short supply of vaccines though I can understand why some of you were torn. I believe that best practice is to follow the guidelines by uses multi-vials as with the Covid vaccine by withdrawing from 1 vial per syringe and only with a sterile needle. Withdrawing from multiple vials will introduce increase risk of contamination as you need to change the needle from vial to vial. If needed to do so in crisis situation there should be very clear and clean protocols in place and followed up by documentation.

    • #3955
      Michelle
      Member

      As per Sept 28, 2021 the PHAC released a statement from the NACI with new recommendation on the timing of giving the Covid vaccine. These are based on current scientific evidence and NACI’s experts opinions. This is great news as this means the public can now receive the flu and covid vaccine at the same time which will lead to more people being vaccinated and therefore protected from these viruses or at least getting less sick. Always following best practice while given the vaccines. This also minimizes the delays in given the routine immunizations as many 7 grade students are withholding there vaccines for HPV, Meningococcal and Hep B due to the previous precautions.

    • #3722
      Joanna
      Member

      The ‘pooling’ of residual COVID-19 vaccine from several vials to obtain a full dose, as a interim measure, meets current best practice in the context of the urgency and risk to public health and the constraints of availability of vaccine manufactured in multi dose vials.

      The COVID-19 pandemic has caused health care professionals to critically examine evidence of current best practices.

      The phrase “critically examine” is key to understanding and answering the question of whether ‘pooling’ residual COVID-19 vaccine from several vials to obtain a full dose represents current best practice.

      The use of single dose vials in the administration of vaccines, prior to the COVID-19 pandemic, was held as best practice with the least risk of transmission of blood-borne pathogens and bacterial contamination.

      “Single-dose vials are ALWAYS preferred.” Reference https://www.publichealthontario.ca/-/media/documents/b/2013/bp-clinical-office-practice.pdf?la=en

      Consistent and strict adherence to aseptic technique is required for the safe administration of vaccine from multi dose vials.

      “Any error in following protocols for the correct use of multidose vials can result in the transmission of both bacterial and blood-borne viral pathogens.” In fact, “outbreaks associated with the use of multidose vials in both the outpatient and inpatient settings are frequent and continue to occur in Ontario.”
      Public Health Ontario, Infection Prevention and Control for Clinical Office Practice, Published: June 2013,1st revision: April 2015.

      “As an interim measure during this time of limited COVID-19 vaccine, an additional dose of COVID-19 vaccine may be extracted from up to 3 vials of the same vaccine using aseptic technique. Although this is not routine practice for multi-dose vials of vaccines for other diseases, there are benefits to extracting additional doses given the high COVID-19 case counts leading to significant morbidity and mortality in Ontario. Every effort should be made to withdraw the entire residual volume from one vial, before entering the next vial. The antigenicity and, therefore, efficacy of the vaccine is not affected by accessing multiple vials to obtain an additional dose.”

      See “Appendix E: Additional Dose(s) from Vaccine Vials” pg. 41,42, https://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/docs/vaccine/vaccine_storage_handling_pfizer_moderna.pdf#page42

    • #4140
      Yaxing
      Member

      I do not think it meets the best practice guideline. However, with the shortage of the COVID-19 vaccine, I think health care provider can pooling residual COVID-19 vaccine from several vials to obtain a full dose as long as they followed safety guideline and provided proper documentation.

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