Safety Precautions for Administering Influenza Vaccine to Pharmacy Staff: 2020 Update

The 2019 Coronavirus Disease (COVID-19) pandemic has brought many changes to the daily lives of people around the world. Security is the driving force behind most of these changes, which have been made to reduce the spread of COVID-19. People are practicing social distancing, schools have switched to online learning, and businesses are finding new ways to operate to keep their communities safe. Pharmacies have made changes such as delivering drugs to customers, requiring staff to wear masks, and stepping up cleaning and sanitation procedures.1 During this pandemic, patients can better understand the changes in pharmacy, given the reasoning behind them.

Vaccines were a hot topic during this time. As people wait for the development of a COVID-19 vaccine, they may also consider the need for other vaccinations. Due to this increased awareness, there could be a substantial increase in demand for the influenza (influenza) vaccine this coming season.2 The administration of vaccines puts pharmacists in close contact with their patients. Safety becomes an even more important goal in such an intimate setting, and pharmacists must plan for the flu shot season. The implementation of appropriate controls and protection and the use of appropriate personal protective equipment (PPE) should be part of every pharmacist’s plan to ensure their safety, that of their staff and of patients.1 This article provides an overview of changes pharmacists might consider implementing in their pharmacies.


Controls are methods that can be used to help protect healthcare professionals from a specific hazard or hazard. The figure3 shows the hierarchy of controls that can be used. The most effective controls are at the widest part of the inverted pyramid, and the least effective controls are at the top. In our discussion, COVID-19 is the danger, and we’ll discuss the hierarchy of controls in that context.

  • Elimination and substitution are not applicable with respect to COVID-19, as exposure to asymptomatic carriers in public spaces cannot be eliminated or avoided.3
  • Engineering controls, or the use of physical barriers to reduce exposure, are the most effective control strategies for COVID-19. The presence of plastic windows at the pharmacy counter is an example of good technical control. Pharmacists should consider other controls that can be used in waiting rooms or vaccination areas to help protect pharmacists and patients.1.3
  • Administrative checks are things done by staff intentionally for protection. Examples include cleaning, keeping a distance between people, and ensuring that plastic barriers are spoken instead of being spoken around or over them.1.3
  • The PPE is located at the bottom of the pyramid, which may come as a surprise. PPE is very important, but it must be used correctly; thus, it is less reliable as a control compared to other strategies which do not depend so much on proper use. Personnel should always wear PPE, avoid contamination and ensure the correct fit for the highest level of effectiveness.3


Putting protections in place and implementing best practices before influenza vaccination season can help pharmacy staff be as prepared as possible. It’s unclear when the country will be in regards to social distancing when the season arrives. Embrace the status quo and adjust as needed. Protection strategies include minimizing personal contact, ensuring that all staff receive training, and maintaining appropriate staffing levels.4 The table shows the areas where changes need to be made to reduce contacts and the strategies for implementing them.1.4

Maintain appropriate staffing levels and ensure that all staff are trained in security procedures.4 Check with your state’s pharmacy board to see if technicians can be trained to administer vaccines. During the busier months, it can be useful to hire a new staff member or train an employee from another part of the store to help. Make sure all pharmacy staff are on the same page with workflow and safety procedures. Be firm with the policies and apply them in all situations.


Pharmacies across the country are now using more PPE than ever before. Wearing masks and gloves has become standard practice for most employees. Now is the time to think about what types of PPE to use during vaccinations and to ensure that there is an adequate supply of PPE available.

  • All vaccinators should wear a mask when administering vaccines; however, this may not provide sufficient protection. Full face shields or removable goggles could also be considered.3.5
  • Prescription glasses are open on the sides and therefore may not provide sufficient protection for the eyes. If eye protection is to be worn, it should be in the form of wrap-around goggles.5
  • Gloves should be worn throughout the preparation and administration process and should be changed after each patient.6

Pharmacists should start ordering additional PPE now. As masks and gloves are scarce in some areas, it’s not too early to start preparing. The CDC has a burn rate calculator that can be used to estimate the amount of PPE needed.3.7 Ask district directors or clinical staff what their plan is and urge them to stay on top of the demand in order to properly stock the pharmacy when needed. A decision needs to be made as to whether patients will need to wear a mask when receiving a vaccine. If they are required to do so, pharmacies should consider whether they will be able to obtain enough masks to supply them to patients who arrive at the pharmacy without one.

To maximize protection, PPE must be used correctly. All personnel should be trained in the correct donning and doffing of masks and other equipment. Appropriate gaskets should be maintained on masks and goggles.7.8 Masks should fully cover the mouth and nose, extending below the chin.8 Gloves should fit snugly and cover the cuff of the sleeves.8 Protective measures against contamination should be strengthened to avoid wasting valuable PPE. Any PPE suspected of having been contaminated should be disposed of or disinfected properly.5.9


The 2020-2021 flu season could be one for the ages. Concerns about COVID-19 and heightened awareness of the need to get vaccinated could push demand for influenza vaccines to record levels. Pharmacists should develop a plan to manage the crowds and high demand. Patients and staff are extremely concerned about safety, which will only add to the challenges. Safety must be the top priority for vaccine administrators so that they can stay healthy and virus-free, especially during this time of great need. Most importantly, every pharmacist should make sure that they take care of their own safety. Waiting or expecting someone else to do it may not lead to the desired result.


1. Advice for pharmacies. CDC. Updated June 28, 2020. Accessed June 29, 2020.

2. Humer C, Steenhuysen J. Fears of second wave of coronavirus prompt flare-up in US pharmacies, drugmakers. Reuters. May 26, 2020. Accessed June 29, 2020. – drugmakers-idUSKBN2321F0

3. Hierarchy of controls. CDC. Updated January 13, 2015. Accessed June 10, 2020.

4. Interim Guidance for Businesses and Employers Responding to Coronavirus Disease 2019 (COVID-19), May 2020. CDC. Updated May 6, 2020. Accessed June 29, 2020.

5. Strategies for optimizing the offer of eye protection. CDC. Updated June 28, 2020. Accessed June 29, 2020.

6. Precautions based on transmission. CDC. Updated January 7, 2016. Accessed June 29, 2020.

7. Personal protective equipment (PPE) burn rate calculator. CDC. Updated April 7, 2020. Accessed June 29, 2020.

8. Use personal protective equipment. CDC. Updated June 11, 2020. Accessed June 29, 2020.

9. Strategies for optimizing the supply of disposable medical gloves. CDC. Updated April 30, 2020. Accessed June 29, 2020.

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Susan W. Lloyd