Smallpox Vaccination Clinic Operations

Michigan Department of

Community Health

January 3, 2002

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.

Objectives

• Describe– Communication issues– Vaccine logistics– Clinic operations– Data issues

Objectives (2)

• Describe– Evaluation of vaccine “takes”– Reporting adverse events– Role of MDCH

Overview

• Pre-event smallpox planning

• To protect– Health care workers (health care response

teams--HCRT)– Public health response teams (PHRT)

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

Pubic Health Response Teams

• Medical team leaders

• Public health nurses

• Epidemiologists

• Disease investigators

Communication Issues

Communication with…

• Vaccinated staff

• Non-vaccinated staff– Public health employees – Hospital employees

• Assistance with messages available from MDCH if needed

Audiences include…

• Medical staff & administration– ER– Consults (dermatology, ophthalmology,

infectious disease, et al.)

• Nursing staff & administration

• Medical assistants

Audiences include… (2)

• Non-medical floor staff

• Ancillary staff

• Volunteers

• Clergy

• Housekeeping

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

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

How to get the message out

• Hospital newsletter

• Staff meetings

• Morning report

• Grand Rounds

• Individual or small group meetings

• In-house e-mail

Messengers

• CEO

• Chief of staff

• Continuing education staff

• Occupational health staff

• Infection control staff

• Vaccine site facility manager

Vaccine Logistics

Dryvax®Dried Smallpox

Vaccine Kit

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

The Vaccine Kit (2)

• Package insert

• Reconstitution instruction card

• Stability holder for vaccine vial (comes with the kit, not in the kit)

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

Vaccine Logistics—Storage

• Vaccine kits will be transported to each vaccination clinic and returned to the storage location after each vaccination clinic

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

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

Clinic Operations

Clinic Operations

• Clinic Staffing

• Scheduling vaccinees (30-35/hour)

• Supplies

• Coordination with hospital site facility coordinator

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

Clinic Site Considerations

• Considerations include– Adequate size– Separate doors for entrance and exit– Access to telephone– Access to telephone line for computer Internet

access

• Large, open, well lighted and well ventilated space

• At least 2 large doors for access and egress

Clinic Layout and Flow

Vaccination Clinic Staffing

• Each vaccination team will require approximately 21 staff

• Handout #1 provides details regarding # of each type of staff, vaccination requirements, etc.

Hospital Site Facility Manager

• Works with regional vaccination coordinator to – Identify appropriate location within facility– Schedule clinics at facility– Schedule employees for vaccination

Hospital Site Facility Manager (2)

• Makes all facility arrangements for clinics– Parking for clinic staff– Tables, chairs, cot, screen for clinic, etc.

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

Vaccination Clinic Manager

• Works with regional vaccination coordinator to– Identify clinic staff for each clinic

– Coordinate supplies for each clinic location

Vaccination Clinic Manager (2)

• Works with regional vaccination coordinator to– Provide on-site management for

vaccination clinic

– Make clinic staffing assignments

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.)

Clinic Greeter (2)

• May be clerical staff or volunteer

• Vaccination not needed

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

Nurse Screener Considerations (2)

• Must have quick access to medical consultant (may be “Hospital Assigned Physician”)– On site or– Pager

The Vaccination Process

Nurse Vaccinator

• Terminology– Vaccinia– Variola– Dryvax– Multiple-puncture vaccination– Bifurcated needle

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

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

Vaccinator Preparation

• Must be vaccinated

• Review with vaccinee– Contraindications– Allergies– Other vaccinations in last month– Paperwork

Vaccinator Preparation (2)

• Review with vaccinee, cont– Voluntary nature of vaccinee

• Identify non-dominant arm

• Table set up– Chux– Specific place for paperwork

Supplies

• Vaccine

• Vaccine holder

• Needles

• Gloves

• Gauze

• Tape

Vaccine Preparation

• Wear gloves

• The vaccine kit– Vaccine– Diluent

• 0.25 ml already in syringe

• If cold, warm in palm

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

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

Vaccine Vial (2)

• 100-dose vial

• May get only 85-90 doses/vial

Vaccine Spills

• Use tuberculocidal solution– Lysol– Bleach solution, 1 part bleach to 10 parts water

Skin Preparation

• None needed

• Under no circumstances should alcohol or acetone be used

• Site– In deltoid area– Not over tattoo or prior scar

Bifurcated Needle

Never re-introduce used needle into vaccine vial

Vaccine Administration Video

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

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

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

Getting ready for the next vaccinee

• Remove gloves and discard properly

• Disinfect hands

Handling Waste Material

• Treat as biohazardous material

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

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