Perioperative Vaccination: A Novel Approach to Boosting COVID-19 Vaccine Compliance

Nearly two years into the pandemic, low vaccination rates persist in the United States. Massachusetts General Hospital certified registered nurse anesthetist Celeste Day, MS, CRNA, wants to be part of the solution to this urgent problem.

Celeste is working to increase COVID-19 vaccine administration to patients undergoing surgery at Mass General. Last year, she was part of a team that developed a protocol for perioperative (i.e., the period before, during and after surgery) vaccination.

During a one-month period last fall, Celeste and her colleagues encountered eight unvaccinated patients during regular anesthesia practice. After briefly educating unvaccinated patients on the vaccines, clinicians asked about their willingness to be vaccinated. Four of the eight patients were on board.

“We saw that not every unvaccinated patient is opposed to getting vaccinated,” she says. “One patient had recently lost a friend to COVID and wanted the vaccine. Another was developmentally delayed, and their caretaker simply hadn’t thought of it. One patient was afraid of needles, so we arranged for administration to take place while they were under general anesthesia.”

Celeste and Edward Bittner, MD, PhD, associate director of the Mass General Surgical Intensive Care Unit, co-authored a letter summarizing the program that was published in February’s Anesthesia Patient Safety Foundation newsletter. They are now leading efforts to set up a process at Mass General to screen surgical patients preoperatively and then offer and administer a vaccine perioperatively. Celeste hopes eventually to replicate the program systemwide for COVID-19 and other vaccines.

As she acknowledges, many questions remain about perioperative vaccination. For instance, are there differences in vaccination efficacy based on the type of surgical procedure? When during the perioperative period is the best time to administer a vaccine?

Celeste and Dr. Bittner plan to examine questions like these in greater depth. They have applied for a multi-center grant along with anesthesiologist Steven B. Greenberg, MD, of the University of Chicago and NorthShore University Health Systems to study the administration of first-vaccine doses to unvaccinated patients presenting for surgical procedures. It would be a four-year study.

“Our aim is to identify optimal timing of enrollment, optimal timing of the vaccine dose, compliance with second-dose administration and any side effects with the end benefit of improved patient morbidity and mortality,” Celeste says.

She is optimistic about the potential impact of the perioperative vaccination program across Mass General Brigham and beyond.

“There’s so much misinformation out there,” she says. “If we can teach our patients that these vaccines are lifesaving and that hundreds of millions of people have been safely vaccinated, more of them will consider following suit.”