ATAGI statement on considerations for establishing drive-through Covid vaccination clinic sites

Department of Health

ATAGI statement

The requirements for COVID-19 vaccination sites generally remain unchanged for drive-through COVID-19 vaccination clinics.

Careful and comprehensive planning is strongly recommended to establish a drive-through vaccination clinic, including:

Identifying a suitable site with sufficient space to meet site requirements (ideally identified in consultation with local government)
Planning traffic flow, ideally in consultation with logistics experts
Implementing clear processes for clinic flow, particularly identifying patients at higher risk for reactions immediately post-vaccination
Ensuring all requirements for post-vaccination precautions and observations regarding safety are met in principle and are implemented
Ensuring sufficient IT equipment and support
Planning for contingencies and incidents.

Co-location of drive-through COVID-19 vaccination clinics with COVID-19 testing sites is not preferred due to the risk of exposing staff at vaccination clinics to COVID-19. Where co-location is being considered as separate sites are not feasible, special precautions and additional infection control measures are required.

General principles for drive-through COVID-19 vaccination clinics

The requirements for COVID-19 vaccination sites generally remain unchanged for drive-through COVID-19 vaccination clinics and are considered feasible to implement. The requirements for vaccinating sites are listed in the Appendix and have been slightly modified to account for logistical differences between ambulatory and drive-through vaccination clinics.

Careful and comprehensive planning is strongly recommended to establish a drive-through vaccination clinic. The challenges unique to drive-through clinics, compared with ambulatory clinics, are largely logistical, particularly traffic flow. The set-up and traffic flow of the clinic must be carefully planned, with advice sought from local government and other relevant sectors on the suitability of vaccination sites and clinic arrangements.

Careful consideration should be given to ensuring requirements for post-vaccination safety precautions and observation can be met. Clinic processes and flow, particularly identifying patients who are higher risk for reactions immediately post-vaccination and methods for monitoring patients, must be clearly detailed and communicated to all staff. Prior to commencing mass vaccination, sites should consider conducting pilot testing, as this may help to determine throughput time per patient and identify and rectify bottlenecks in clinic flow and any other potential issues that may arise.

Below are some considerations for setting up a drive-through vaccination clinic. These are not absolute requirements, but considerations to help ensure that clinics are set up to be effective and efficient, and to mitigate safety issues.

Considerations for selecting a suitable site for drive-through vaccination clinics

Drive-through vaccination site selection will be restricted by the space requirements. Health authorities should ensure there is sufficient space available for line up, registration, vaccination and observation post-vaccination. Where possible, a separate area for consultation with an immunisation provider (for patients who wish to have a longer discussion prior to vaccination) may be considered to avoid congestion in traffic flow within the clinic.

Health authorities are strongly recommended to consult with local government and others with experience in arranging and managing complex logistical events. Ensuring proper traffic flow while ensuring the safety of staff and patients is imperative for running a drive-through vaccination clinic successfully. Site selection should consider traffic flow within the clinic as well as entrances to and exits from the site. Consultation with local government can help to identify a suitable site, e.g., ensuring that a vaccination site is not established in an area where traffic build up may affect traffic in surrounding areas or where extensive roadworks are planned.

Sites should be selected to ensure that the vaccinating area is protected from the weather elements, with staff provided with adequate shelter and heating and/or cooling.

Drive-through vaccination sites that are not located within or adjacent to a health facility are likely to experience more logistical challenges and require more space, due to the requirements regarding storage and preparation of vaccine doses. Ensuring proper cold chain management will be important, particularly if drive-through clinics are to be used in warmer weather. Ultra-cold temperature storage is not needed at drive-through vaccination clinics.

The transportation of pre-prepared syringes to drive-through vaccination sites is generally not recommended. Sites must have sufficient space to prepare vaccine doses on-site. There may be exceptions on rare occasions; in these cases, the principles detailed in the guidance on multi-dose vial use must be adhered to.

Experience from previous drive-through mass vaccination clinics has found that additional information technology equipment and support is required. Ideally, sites would have a wireless network that allows electronic data entry and suitable IT support available.

Co-location with COVID-19 testing sites

It is preferable not to co-locate drive-through vaccination clinics with COVID-19 testing or respiratory infection clinic (RIC) sites, wherever possible. This is predominantly due to infection control risks, e.g., the increased risk of infection to staff in vaccination clinics, given the potential for patients to inadvertently drive into the vaccination clinic instead of the COVID-19 testing clinic. In addition, different levels of PPE are required in vaccination and testing clinics.

In some settings where an additional site for drive-through vaccination is not feasible, very clear directions to the different entities will be required. Consideration may also be given to utilising the testing site as a vaccination clinic on different days, although the risk of patients seeking COVID-19 testing driving into a vaccination clinic is still present. There would need to be clear signage and guidance to minimise the risk of a patient driving into the wrong clinic. Additional infection control measures to minimise the risk of staff at vaccination clinics being exposed to COVID-19 should also be considered, such as additional PPE requirements for staff in first contact with patients.

Considerations for ensuring safety in drive-through vaccination clinics

All requirements for post-vaccination precautions and observation should be met in principle and implementation in a drive-through vaccination setting. There are three concerns regarding safety unique to this context:

Post-vaccination observation and safety events

Clinics must ensure there is sufficient space for patients to be observed as per clinical recommendations. Clear protocols and communication must be implemented for identifying patients who experience an adverse event, with abundant signage to inform patients what action, if any, they need to take (e.g. use their horn to get staff's attention).

Processes for identifying patients at risk of post-vaccination events who require a longer observation period must be in place. Sites should consider the feasibility of having a separate area for patients who are identified as high risk for syncope post-vaccination, so that they may go directly to that area and park prior to receiving vaccination. This is to reduce the risk of syncope while driving from the spot where vaccine is administered to the observation space. Patients with certain medical histories (e.g. serious allergic reactions, past reaction to a vaccine, syncope post-vaccination) may be advised at the time of booking their appointment to bring an accompanying person with them as an additional precaution.

Shoulder injury related to vaccine administration (SIRVA)

SIRVA is a rare event, and the risk is not considered to be higher in a drive-through clinic setting as long as there is clear access to the deltoid muscle. In most instances, vaccination through the car window is acceptable. In some cases, where there is a large vehicle, patients may need to step out of the car to receive the vaccine. A separate space with seating should be considered for these patients but is not required.

Staff safety

Logistics planning should account for staff safety, given staff will be moving around to run the clinic in an area with vehicles. Planning should account for ways to reduce needlestick injuries, such as having sharps bins on wheels available. Steps should also be taken to minimise staff's exposure to vehicle exhaust fumes (e.g. asking patients to turn off their engines when stationary).

Additional considerations for planning drive-through vaccination clinics

Administration of different COVID-19 vaccines

Clinics may choose to administer different brands of COVID-19 vaccines at the same drive-through vaccination clinic. This would allow families with people of different ages (and therefore eligible for different vaccines) to be vaccinated at the same time. However, the ability to do this should be assessed on a case-by-case basis, given the increased risk of administering the wrong vaccine brand to a patient. Planning should include consideration of measures to mitigate this risk.

Incident management and contingency planning

Preparing for establishing a drive-through clinic requires contingency and incident management planning. Some scenarios include technological issues or 'downtime', car accidents, staff absences (particularly in the winter season), and workplace injuries. This is especially important for larger and new clinics with staff that have limited experience running drive-through vaccination clinics.

Appointments

While not required, it is recommended that attendance at drive-through clinics for COVID-19 vaccination be by appointment only, due to the potentially large demand. Clinics may still accept patients without an appointment, if capacity allows.

Additional resources needed for drive-through mass vaccination clinics

The following are not absolute requirements but are considerations to enhance the efficiency of a drive-through vaccination clinic.

Additional staff/volunteers for various tasks such as directing patients and documentation. Additional personnel may include a logistics/flow manager (particularly for large clinics), volunteers to manage flow, traffic control personnel (line attendants, flaggers) and IT support.
IT equipment and support - e.g. laptops/tablets, wireless internet, tech support
Clear signage to direct flow
Information resources for patients
Markers or coloured cards to flag patients who require longer waiting times
Tents (depending on clinic location and set up)
Sharps containers on wheels (to reduce sharps-related injuries to staff)
Portable fridges, eskies or other appropriate container(s) to store and move vaccine doses within the clinic

Resources for planning drive-through vaccination site

The following resources may assist in planning and setting up a drive-through COVID-19 vaccination clinic. Additional, unpublished resources are available from WA and VIC (Monash) where drive-through vaccination clinics were set up in 2020.

Checklist for COVID-19 vaccination sites

Workforce requirements

Adequate well-trained staff are allocated for clinics (the required number will depend on the anticipated size of the clinic or patient volume, with provisions for emergency scenarios), including:
- Vaccinators to prepare and administer vaccines
- Authorised immunisation provider (e.g. medical officer or fully trained immunisation registered nurse/nurse practitioner to assess patients and authorise other appropriately trained clinical staff (vaccinator) to administer the vaccine)
- Concierge or team leader (to direct clinic flow)
- Clerical staff
- First aid staff, additional to vaccinating staff as per jurisdictional requirements
- Security staff (if required)
There are sufficient medical officers or fully trained immunisation providers with authority to vaccinate, especially if supervising vaccinators who have not completed a specific training course in immunisation
All immunisation providers have received adequate specific training, including regarding the use of multi-dose vials (documentation of training required)
Have access to and have a clear understanding of the clinical guidelines for administering COVID-19 vaccines from multi-dose vials.

Set up of the physical environment

Have adequate space for patients waiting to be vaccinated that is not congested, observes physical distancing requirements, and is sheltered from weather elements
Have a private space for consultation with patients and vaccinator (including obtaining informed consent, answering patient questions and assessment of any conditions that may preclude vaccination or require further assessment) - recommended, but not required, for drive through clinics
Have a dedicated, clean, well-lit space for administration of the vaccine to patients, including a desk and chairs for vaccinator(s)
Have space for patients to wait and be observed post-vaccination, separate from the area for administering the vaccine
Have safe, risk free and directed access in clinical areas to allow movement of staff between areas while minimising the risk of workplace incidents (e.g. moving doses from preparation area to patient administration area, accessing refrigerators or cool boxes, etc.) - in drive-through setting, traffic flow should be carefully planned
Have a dedicated clean and well-lit area, separate from areas that provide other clinical services at the same time, where vaccines from multi-dose vials may be drawn up, labelled, and prepared for administration
Adequate handwashing facilities for staff, and antimicrobial hand sanitisers available
Have antimicrobial /disinfectant wipes to clean stations between patients
Have visual reminders and cues in place to reduce the risk of errors
Have a process in place to safely dispose of unused vaccines, in accordance with TGA and other regulatory requirements
Have adequate sharps disposal bins, appropriate for the volume of patients, and securely placed and spaced to mitigate the risk of needlestick injuries.

Cold chain management

Have adequate number and capacity of refrigerators to store vaccines for the vaccine to be used
Able to monitor the temperatures of the refrigerator(s) and freezer(s) where vaccines are stored, including appropriate equipment and systems to monitor temperatures according to national vaccine storage guidelines
Have an appropriate policy and protocol in place to respond to temperature breaches, including relocating vials to another refrigerator/freezer and responding at times where clinic may not have any staff present
Have appropriate refrigerators and opaque containers to store vaccine syringes that have been prepared for administration under appropriate temperature conditions and protected from light from the time they are prepared till the time they are administered.

Immunisation record keeping and reporting to the Australian Immunisation Register (AIR)

Have a clear procedure for identifying individual vaccine recipients, checking to confirm any record of previous receipt of any COVID-19 vaccine doses (including date and brand product received), and recording immunisation encounters (electronic records are preferable)
Have a process of labelling syringes when they are drawn up from multi-dose vials, including date and time of preparation and of expiry
Have access to AIR via Provider Digital Access (PRODA)
Have a process to manage vaccination data and report immunisation records to AIR
Have a process to record vaccines used and those discarded, including reasons for discarding
Have a process of obtaining informed consent.

Management of the clinic

Standardised screening process to exclude patients who display symptoms of COVID-19 disease, and refer for appropriate assessment for COVID-19 or other conditions (as per guidance provided in the ATAGI Guiding Principles for Maintaining Immunisation Services During the COVID-19 Pandemic
Standardised screening process for contraindications, receipt of previous doses of COVID-19 vaccines and/or receipt of other vaccines (observing any interval requirements)
Clear record of patients vaccinated (to inform ordering of vaccines)
Clear assignment of duties and responsibilities of all staff and clear plan of workflow, particularly regarding drawing up from a multi-dose vial and administering individual vaccine doses drawn from a particular vial for each clinic session
Knowledgeable about procedures and able to report adverse event following immunisation to the appropriate health authorities
Incident management in place, with staff knowledgeable about procedures and able to report any clinical incident (e.g. injury in workplace) to the appropriate health authorities
Has process in place to manage injuries to workforce (e.g. needlestick injury)
Process in place to prevent and manage violence or aggression in the workplace.

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