Immunization Skills Institute

Vaccine Preventable Diseases

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Why Vaccinate?

 To prevent/reduce common disease  To prevent infections that can easily emerge  To prevent/reduce infections that are common in other parts of the world (disease is only a plane ride away )

Risks of not vaccinating  A decision not to vaccinate is a decision to risk getting the disease  Disease outbreaks can return in epidemic proportions, causing serious illness and death  Increased financial drain on economy: medical costs, time off work

Immunization Job Aids

CDC Recommended Immunization Schedule 2014

CDC Catch Up Schedule

CDC Adult Immunization Schedule

Utah Vaccine requirements  Utah School Immunization Law requires that children in private, public, or parochial schools and child care facilities are appropriately immunized for age.

School Immunization Requirements • • • • • • • Early Childhood Entry Requirements (As appropriate for age): Diptheria, Tetanus, Pertussis (DTaP) Measles, Mumps, Rubella (MMR) Haemophilus Influenza Type B (Hib) Hepatitis A Hepatitis B Pnemococcal Varicella • • • • • • Kindergarten Entry 5 DTP/DTaP/DT 4 Polio 2 MMR 3 Hepatitis B 2 Hepatitis A 2 Varicella (starting July 2015) • • • • 7 th Grade Entry 1 Tdap 3 Hepatitis B 2 Varicella 1 Meningococcal

Exemptions in Utah The Utah Immunization Rule for Students (R396-100) allows for three exemptions:    Medical Religious Philosophical (personal)

Before giving immunizations     Introduce yourself Explain what you will be doing Make sure the parent and patient are comfortable If parent has questions, let them talk to the provider

Vaccine Information Statements

Vaccines For Children (VFC) The Utah Vaccines for Children (VFC) Program provides vaccines to participating providers for children birth through 18 years of age who are: • • • • • Enrolled in Medicaid Enrolled in the Children's Health Insurance Program (CHIP) American Indian/Alaskan Native Not insured Under-insured* (insurance does not cover immunizations) *Under-insured children may receive VFC-supplied vaccines only at Federally Qualified Health Centers (FQHC) or Medicare Certified Rural Health Centers RHC)

Patient Screening

 Insurance/VFC Eligible  Vaccine History  Contraindications

Scope of Medical Assistants and Immunizations      MAs work under the license of the MD, PA, or NP Vaccine orders must be written, never verbal Give only immunizations ordered by licensed medical staff Licensed medical staff must be in the building when you give shots Report mistakes immediately

Skills Checklist

Vaccine Storage

 Store vaccine in a temperature stable location of the storage unit.

 Store vaccines in middle of refrigerator or freezer unit away from coils, walls, floor and cold air vents.

 Never store vaccines in door, vegetable bins, on floor of the unit, or adjacent to cooling vents.

 Stabilize refrigerator and freezer temperatures with proper placement of water bottles in refrigerator; frozen packs in freezer.

 Avoid over-filling refrigerator and hindering air circulation.

 Do not store food or drink in vaccine storage units.

Refrigerator Storage

Freezer Storage

Vaccine Temperatures

 Monitor vaccine storage unit temperatures.

 Refrigerator temps must be maintained between 2 and 8°C (35° and 46°F).

 Freezer temps must be maintained between -50°and -15°C (-58°and +5° F).

 Monitor and record storage unit temps twice daily.

 Take immediate action for out of range temps.

 Contact vaccine manufacturer to determine viability.

 Contact VFC Program.

 Use NIST Certified Calibrated Thermometers.

 Prefer glycol, fluid-filled thermometers and data loggers.

What is wrong with this storage unit?

Thermometers

  Required  Calibrated thermometer for refrigerator and freezer.

 Must have Certificate of Traceability & Calibration Testing.

 NEW Tested every 1-2 years or according to manufacturer recommendations.

Recommended    NEW Use digital thermometer with detachable biosafe glycol encased probe that measures liquid temperature.

NEW Accuracy +/- 1°F (0.5° C).

NEW Continuous data monitoring device (ie: digital data logger).

      Active display with min/max/current readings / placed on outside of unit door.

Alarm.

Reset button.

Memory storage of at least 4000 readings.

Does not rewrite over old data and stops recording when memory is full.

 User programmable logging interval (for reading rate).

NEW Data should be stored for downloadable review.

Continuous Data Thermometers    Continuous monitoring provides more reliable information on vaccine storage temperatures.

 NIST studies demonstrated that without a continuous monitoring system likelihood of undiscovered excursions occurring is very high.

A probe in a thermal buffer (i.e. glycol, glass beads) is a more reliable measure of actual vaccine vial temperatures than a sensor that measures air.

Totally relying on an alarmed system is insufficient.

Immunization Supplies

SAFETY SYRINGES ALCOHOL PREP PADS BANDAGES PRE-FILLED SYRINGES AND SAFETY NEEDLES SHARPS DISPOSAL CONTAINER GLOVES (OPTIONAL)

7 RIGHTS FOR MEDICATION ADMINSITRATION 1. RIGHT PATIENT 2. RIGHT TIME 3. RIGHT VACCINE (AND DILUENT) 5. RIGHT ROUTE, NEEDLE AND TECHNIQUE 4. RIGHT DOSAGE 6. RIGHT INJECTION SITE 7. RIGHT DOCUMENTATION

Vaccine Orders 

Provider writes vaccines orders

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Can be part of Progress Note or a separate page

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Make sure you can read and understand them

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If you have questions, ASK!

WASH YOUR HANDS 

Before preparing vaccines

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Before and after patient contact

Safety engineered syringes & needles  Designed to decrease needle sticks  Required by OSHA  Be familiar with the different types  Make sure you know how to use the ones in your office  Report all needle sticks

Manufacturer-filled syringes

Needle lengths for immunizations

INTRAMUSCULAR (IM) 23-25 gauge 1 inch length (longer needle may be necessary for larger patients) SUBCUTANEOUS 25 gauge 5/8 inch length

Vaccines: Which route is right?

Intramuscular             DTaP, DT, Td, Tdap Hep A Hep B Hib HPV Influenza (TIV) MCV4 PCV Pediarix Pentacel Kinrix Twinrix Subcutaneous      MMR Varicella MMRV Zostavax MPSV4 Oral  Rotavirus Intranasal  FluMist (LAIV) IM/SC   IPV PPSV23

Challenge: Vials look alike

SIMILAR COLORS SIMILAR ANTIGENS

Check Your Vials 04/21/2014 Alex Simpson DOB: 04/01/2003 Tdap MCV4 HPV #1 -Dr. Quinn

Expiration Dates

Expiration Dates

Ready to Use Vaccine Vials

SINGLE-DOSE VIAL MULTI-DOSE VIAL

Ready-to-use vaccine: manufacturer-filled syringes

Reconstituting Vaccine DILUENT VACCINE

Site Maps

Comfort Measures  Involve parents and patients before, during, and after shots.

Comforting Restraint

Preparing the Injection 

IDENTIFY THE INJECTION SITE

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CLEAN THE INJECTION SITE WITH ALCOHOL

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LET IT DRY

Intramuscular (IM) Injections 

1” LENGTH

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23- or 25-GAUGE NEEDLE

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INSERT ENTIRE NEEDLE AT 90 DEGREES

Intramuscular Shots for Babies and Toddlers  

Vastus Lateralis for infants, babies, and toddlers Use this site for children younger than three

Intramuscular shots for adolescents and adults 

Deltoid for anyone older than three

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The deltoid is three fingers below acromion process

Subcutaneous (SC) Injections 

5/8” LENGTH

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25-GAUGE NEEDLE

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INSERT ENTIRE NEEDLE AT 45 DEGREES

SUBCUTANEOUS (SC) SHOTS FOR CHILDREN AND ADULTS

 Upper leg for children  Upper, outer arm for older children and adults

Oral Vaccines

Nasal Vaccine

Proper Disposal

After the Vaccines

Documentation

Documenting combination vaccines

Be prepared for emergencies

VAERS AND VERP

Vaccine Adverse Event Reporting System (VAERS)

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Report side effects and outcomes Give patient and provider names Type of facility Vaccine information Online, fax, and mail

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Vaccine Error Reporting Program (VERP) Report wrong vaccine/patient/dose/etc. Type of facility Type of practitioner Confidential Online only

YOU CAN MAKE THE DIFFERENCE!

Produced by Utah Department of Health Immunization Program and California Department of Public Health