smallpox vaccination clinic operations michigan department of community health january 3, 2002
TRANSCRIPT
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Smallpox Vaccination Clinic Operations
Michigan Department of
Community Health
January 3, 2002
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Goal
The goal of this training is to assist you in planning and implementing a smallpox vaccination clinic for the first health care workers and public health staff who will be vaccinated to prepare for a smallpox event.
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Objectives
• Describe– Communication issues– Vaccine logistics– Clinic operations– Data issues
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Objectives (2)
• Describe– Evaluation of vaccine “takes”– Reporting adverse events– Role of MDCH
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Overview
• Pre-event smallpox planning
• To protect– Health care workers (health care response
teams--HCRT)– Public health response teams (PHRT)
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Health Care Response Teams
• Based on October ACIP Recs
• Health care workers most likely to care for or interact with a person with smallpox in the hospital setting
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Pubic Health Response Teams
• Medical team leaders
• Public health nurses
• Epidemiologists
• Disease investigators
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Communication Issues
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Communication with…
• Vaccinated staff
• Non-vaccinated staff– Public health employees – Hospital employees
• Assistance with messages available from MDCH if needed
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Audiences include…
• Medical staff & administration– ER– Consults (dermatology, ophthalmology,
infectious disease, et al.)
• Nursing staff & administration
• Medical assistants
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Audiences include… (2)
• Non-medical floor staff
• Ancillary staff
• Volunteers
• Clergy
• Housekeeping
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Key Points for Messages
• Description of stage 1 vaccination– Who is being vaccinated– Why they’re being vaccinated
• Screening for vaccination
• Information about the vaccine
• Vaccination process
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Key Points for Messages (2)
• Roles for those not vaccinated
• Vaccination plans for facility
• Identify a point of contact for questions
• Keep staff informed as pre-event planning continues
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How to get the message out
• Hospital newsletter
• Staff meetings
• Morning report
• Grand Rounds
• Individual or small group meetings
• In-house e-mail
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Messengers
• CEO
• Chief of staff
• Continuing education staff
• Occupational health staff
• Infection control staff
• Vaccine site facility manager
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Vaccine Logistics
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Dryvax®Dried Smallpox
Vaccine Kit
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The Vaccine Kit
• The smallpox vaccine “kit” contains– 1 vial (100 doses) of vaccine– Diluent for vaccine reconstitution– Vented needle for reconstitution– 100 bifurcated needles
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The Vaccine Kit (2)
• Package insert
• Reconstitution instruction card
• Stability holder for vaccine vial (comes with the kit, not in the kit)
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Vaccine Logistics—Storage
• Vaccine kits will be stored at one location in each region (2°-8° C)
• Regional storage facilities must store the vaccine in a secure location that assures limited access to the vaccine
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Vaccine Logistics—Storage
• Vaccine kits will be transported to each vaccination clinic and returned to the storage location after each vaccination clinic
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Transporting Vaccine
• Will be transported to and from clinics in provided containers using cold packs as we do with other vaccines
• Does not need to be kept cold during use at clinics
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Transporting Vaccine (2)
• Each time the vaccine is transported from the regional storage location to a clinic and back, the vaccine must be packed in the provided container with a Dixon temperature-monitoring device turned on continuously while the vaccine is in transit
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Clinic Operations
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Clinic Operations
• Clinic Staffing
• Scheduling vaccinees (30-35/hour)
• Supplies
• Coordination with hospital site facility coordinator
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Coordination with Hospital
• Vaccination clinic manager works with hospital site facility coordinator to– Identify suitable clinic location– Schedule HCRT members– Determine dates and location(s) for "take"
evaluation
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Clinic Site Considerations
• Considerations include– Adequate size– Separate doors for entrance and exit– Access to telephone– Access to telephone line for computer Internet
access
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• Large, open, well lighted and well ventilated space
• At least 2 large doors for access and egress
Clinic Layout and Flow
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Vaccination Clinic Staffing
• Each vaccination team will require approximately 21 staff
• Handout #1 provides details regarding # of each type of staff, vaccination requirements, etc.
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Hospital Site Facility Manager
• Works with regional vaccination coordinator to – Identify appropriate location within facility– Schedule clinics at facility– Schedule employees for vaccination
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Hospital Site Facility Manager (2)
• Makes all facility arrangements for clinics– Parking for clinic staff– Tables, chairs, cot, screen for clinic, etc.
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Hospital Site Facility Manager (3)
• Arranges for– Signs for clinic and clinic stations– Telephone access for clinic staff– Restroom access for clinic staff– Food or break area for clinic staff– Internet access for data enterers
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Vaccination Clinic Manager
• Works with regional vaccination coordinator to– Identify clinic staff for each clinic
– Coordinate supplies for each clinic location
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Vaccination Clinic Manager (2)
• Works with regional vaccination coordinator to– Provide on-site management for
vaccination clinic
– Make clinic staffing assignments
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Clinic Greeter
• Verifies appointment when vaccinees arrive
• Directs vaccinees to Nurse Screener
• Answers questions related general vaccine clinic operations (entrances, exits, parking, bathroom locations, etc.)
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Clinic Greeter (2)
• May be clerical staff or volunteer
• Vaccination not needed
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Nurse Screener Considerations
• Take the necessary time
• Locate screeners to maximize privacy
• Review pre-screening packet
• Obtain signed consent
• Answer all questions
• Have written resources available
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Nurse Screener Considerations (2)
• Must have quick access to medical consultant (may be “Hospital Assigned Physician”)– On site or– Pager
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The Vaccination Process
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Nurse Vaccinator
• Terminology– Vaccinia– Variola– Dryvax– Multiple-puncture vaccination– Bifurcated needle
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Handling and Storage of Vaccine
• Refrigerator temperature-36°-46° F
(2°-8° C)
• Do NOT freeze
• Stable vaccine– O.K. to leave on table for duration of clinic
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Handling and Storage of Vaccine (2)
• Return vaccine to a refrigerator or provided transportation container during clinic breaks lasting longer than 15 minutes
• Re-pack appropriately for return to regional storage location
• Assure security of vaccine
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Vaccinator Preparation
• Must be vaccinated
• Review with vaccinee– Contraindications– Allergies– Other vaccinations in last month– Paperwork
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Vaccinator Preparation (2)
• Review with vaccinee, cont– Voluntary nature of vaccinee
• Identify non-dominant arm
• Table set up– Chux– Specific place for paperwork
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Supplies
• Vaccine
• Vaccine holder
• Needles
• Gloves
• Gauze
• Tape
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Vaccine Preparation
• Wear gloves
• The vaccine kit– Vaccine– Diluent
• 0.25 ml already in syringe
• If cold, warm in palm
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Vaccine Reconstitution
• See Handout #2
• Allow vial to stand for 3-5 minutes after reconstitution—do not shake
• Record date of reconstitution and batch # on vial
• Vaccine may be used for 60 days following reconstitution
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Vaccine Vial
• Care of stopper– Keep in clean zip bag or urine specimen cup
with lid– If stopper becomes contaminated or lost, cover
vial opening with clean tape
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Vaccine Vial (2)
• 100-dose vial
• May get only 85-90 doses/vial
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Vaccine Spills
• Use tuberculocidal solution– Lysol– Bleach solution, 1 part bleach to 10 parts water
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Skin Preparation
• None needed
• Under no circumstances should alcohol or acetone be used
• Site– In deltoid area– Not over tattoo or prior scar
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Bifurcated Needle
Never re-introduce used needle into vaccine vial
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Vaccine Administration Video
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Key Points
• See handout #3, Smallpox Vaccine Administration Job Aid– Point of bifurcated needle is sterile– Do NOT hold needle like a dart– DO hold needle so it is parallel to floor– Pull skin taut
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Key Points (2)
• Rest wrist on vaccinee’s arm
• Make 15 rapid insertions in 5 mm site
• Dispose of needle in sharps container
• Cover vaccination site
• Record vaccination information and sign smallpox clinic form
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Caution Vaccinee
• Site will need special care for 3 weeks
• Keep site dry
• Do NOT scratch
• In-depth information will be provided by site care educator
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Getting ready for the next vaccinee
• Remove gloves and discard properly
• Disinfect hands
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Handling Waste Material
• Treat as biohazardous material
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Anaphylactic Reaction/Syncope
• Know the difference
• Be prepared for emergencies
• Syncope--wheelchair/cot available
• Anaphylaxis– Life-threatening emergency– Epinephrine/syringes available– Know protocol for your agency
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Finally, remember…
• Smallpox vaccine is a LIVE vaccine
• Be careful with it
• NO skin preparation
• Only vaccinate persons who have been properly screened and educated