Seasonal Influenza Peer Vaccination Programme 2018 Immunisation Process
Overview of Continuous Professional Education on Immunisations for Registered Nurses and Midwives 1. Introduction to Seasonal Influenza Peer Vaccination Programme (SIPVP) 2. Current Issues and Communications 3. Professional and Legal Aspects of Vaccinations 4. Immunisation Process 1. Storage Handling & Transportation 2. Standard Infection Control & Prevention Precautions 3. Vaccine administration/monitoring 4. Documentation 5. Audit 5. Medicine Protocol. 6. Questions & Evaluation 2
Learning Outcomes Demonstrate practice is in accordance with the Seasonal Influenza Peer Vaccination Programme and local policies and guidelines. Manage the safe and effective administration of vaccinations. Demonstrate effective documentation and record keeping. 11/07/2018 3
Storage, Handling and Transportation All medical, nursing and administrative staff involved in handling vaccines for the SIPVP should be aware of their respective responsibilities as set out in the guidelines. National Immunisation Office Seasonal Influenza Peer Vaccination Programme 2016; Guidelines for Staff HSE https://www.hse.ie/eng/health/immunisation/hcpinfo/fluinfo/peerguidelines.pdf HSE Guidelines for maintenance of cold-chain in vaccine fridges and management of vaccine stock. National Immunisation Office Version July 2016. https://www.hse.ie/eng/health/immunisation/hcpinfo/vaccineordering/sop201 6.pdf HSE Guidelines for maintaining the vaccine cold-chain in vaccine cool boxes https://www.hse.ie/eng/health/imunisation/hcpinfo/vaccineordering/sopcoolbox es2016.pdf Relevant local policies. 11/07/2018 4
Storage, Handling and Transportation The cold chain is the system of storing and transporting vaccines within the safe temperature range of 2 C to 8 C. Any vaccine that has not been stored at a temperature of 2-8ºC as per its licensing conditions is no longer a licensed product. 11/07/2018 5
Vaccine Stability Vaccine Stability Vaccines are sensitive to heat and cold A temperature monitoring chart should be on each vaccine refrigerator door. These charts should be kept for the duration of use for storing vaccines NIO should be contacted if there is a deviation in temperature Light Sensitivity Vaccines should always be stored in their original packaging until point of use to protect them from light NIO should be contacted if there is a light exposure National Immunisation Office (NIO) Tel 01-8676108 / 087-9915452 11/07/2018 6
Ordering Vaccines Vaccines must be ordered by the Peer Vaccinator see National Immunisation Office Seasonal Influenza Peer Vaccination Programme 2016; Guidelines for Staff HSE. https://www.hse.ie/eng/health/immunisation/hcpinfo/fluinfo/peergui delines.pdf Vaccines will only be delivered as per the National Cold Chain schedule Prior to ordering the vaccine, ensure that suitable storage is available to ensure cold chain management. 11/07/2018 7
Vaccination Clinics Schedule in advance and advertise locally via multiple communication processes e.g. Broadcasts, direct email, signage, verbally at meetings/report handover etc Request promotional material from www.healthpromotion.ie See Seasonal Influenza Peer Vaccination Programme Guidelines 2016 for Appendix II - Equipment list for Clinic Appendix III - Checksheet at Clinic Location 11/07/2018 8
Clinic Requirements Require clinic room per vaccinator and waiting area immediately beside these rooms Require a desk/table and 2 chairs, with adequate space for dealing with someone who becomes unwell Waiting area must have sufficient space for HCWs to - read vaccine information - sign consent before the vaccine - wait 15 minutes as is required, in the waiting area after receiving the vaccine - small number of seats should be available for people unable to stand or to accommodate someone feeling unwell following vaccine Rooms must be accessible in the event of an emergency
Standard Infection Control Precautions (SICP) SICP are evidence based clinical work practices and measures to minimise, prevent and control the transmission of infectious agents in healthcare settings. Please refer to local and national guidelines on infection control. 11/07/2018 10
SICP for Immunisation Process Hand hygiene Safe management of sharps Safe injection practices Management of needle stick injuries Management of waste Decontamination of the environment 11/07/2018 11
SICP: Hand Hygiene Hand Hygiene can be carried out in 3 ways 1. Use an alcohol hand rub foam/gel 2. Wash with plain liquid soap 3. Wash with an antiseptic hand wash SARI (2013) Healthcare-associated infections (HCAI) are infections that are acquired on healthcare facilities or as a result of healthcare interventions and are a major problem for patient safety. Hand hygiene is one of the most effective means of preventing HCAIs. Follow local hand hygiene policies SARI (2013) 11/07/2018 12
Immunisation process, administration, monitoring Correct vaccine administration is integral to ensuring the optimal safety and effectiveness of vaccine. Vaccinators should be competent in vaccine administration. Programmes are available through CNME/CNE to facilitate further education and training in injection technique. 11/07/2018 13
Immunisation process, administration, monitoring There are many components in the Immunisation process Communication current issues Informed consent Assessment - suitability under medicine protocol Administering vaccine Post vaccination monitoring Reporting adverse events Recognition and management of anaphylaxis Immunisation documentation. Refer to supporting local/national policies in immunisations. 11/07/2018 14
Vaccine Administration Preparation Injection technique Injection site These are all important considerations as each factor can affect both the immunogenicity and the risk of local reactions at the injection site 11/07/2018 15
Preparation of Healthcare Worker Correct identity Explanation of procedure Privacy, dignity Consent has been obtained. There are no contraindications to the vaccine being given. 11/07/2018 16
Preparation of Medicine Administer all vaccinations in accordance with medicine protocols, manufacturers guidelines and NMBI medicines guidelines. Any vaccine removed from their packaging should be used at that vaccination session or discarded. 11/07/2018 17
Injection site Vaccine to be given Intramuscularly into the deltoid muscle Assess injection site by observation and palpitation. If any evidence of trauma or damage, do not use. Identify and landmark injection site. Stop and practice finding correct site! 11/07/2018 18
Position of HCW and management of pain Ensure the HCW is in relaxed position to allow the muscle to relax i.e. flex arm across chest. Discuss process and reassure Rapid needle insertion and do not aspirate (NIAC, 2013) 11/07/2018 19
Skin preparation Not required if clean skin Visibly dirty skin: wash with soap and water Avoid alcohol swabs and cotton wool balls use gauze swabs. 11/07/2018 20
Administration of Vaccine Aseptic Non-Touch Technique (ANTT) through out the procedure check local policies and guidelines. Medicine management and 5 rights (ABA, 2007) Medicines should be discarded upon expiration or any time there are concerns regarding the sterility of the medicine Swift needle entry, slow injection and swift needle withdrawal equates to less pain. 11/07/2018 21
Intramuscular Injection Technique Use prefilled unit The needle should be inserted at a 90 degree angle to the skin The skin should be stretched flat No need to aspirate (NIAC 2013) Inject slowly if possible Needle needs to be long enough to ensure vaccine is injected into muscle 11/07/2018 22
Warnings and Precautions for use: The intradermal or intravenous routes must not be used As with all injectable vaccines, medical resources must be readily available in case of a rare anaphylactic event (Management of a Patient who Develops Anaphylaxis and the Medicine Protocol for the Administration of Epinephrine (2018); 11/07/2018 23
Post procedure Dispose of sharps immediately, without recapping the needle, into the sharps container provided as in the HSE Guidelines At all times ensure that sharps containers are managed in accordance with national Guidelines and located appropriately and safely https://www.hse.ie/eng/health/immunisation/hcpinfo/guideline s/ Sharps bins should be replaced once two thirds full. Request HCW stays at the clinic for 15 minutes after procedure and request they report to vaccinator if feeling unwell. Vaccinators must remain at the clinic for 30 minutes post final vaccination 11/07/2018 24
Documentation Documentation Data should be recorded for statistical purposes at the end of each session on the Clinic Summary Document Other documentation Consent forms Medicine protocols Information leaflets Clinic Check sheets Recording on Consent Record vaccine name date and time of administration Vaccine name batch number dosage expiry date name, signature and PIN of vaccinator patients response if negative i.e. anaphylaxis See Appendices in Seasonal Influenza Peer Vaccination Programme 11/07/2018 25
Data Management Consent forms sent to Occupational Health Service for recording, statistical analysis and storage No local copies to be kept Send with Clinic Summary Document and keep copy of this document for local records See National Immunisation Office Seasonal Influenza Peer Vaccination Programme 2016; Guidelines for Staff HSE; Appendix IV
All Staff should be familiar with the following documents Immunisation Guidelines for Ireland available at https;//www.hse.ie/eng/health/immunisation/hcpinfo/guidelines www.immunisation.ie Summary of Product Characteristics (SmPCs) for Inactivated Influenza Vaccine (Influvac) https//www.hpra.ie National Immunisation Office Seasonal Influenza Peer Vaccination Programme 2016; Guidelines for Staff HSE Medicine Protocol for the administration of Inactivated Influenza Vaccine (Influvac) for nurses, midwives and healthcare workers Healthcare professionals FAQs are available at www.hse.ie/eng/health/immunisation/hcpinfo/frequentlyaskedquestions/ 11/07/2018 27
Procedure for Reporting Adverse or Suspected Reactions to Vaccines for the Seasonal Influenza Peer Vaccination Programme All adverse drug reactions or suspected adverse drug reactions following administration must be reported as soon as possible in accordance with criteria outlined by the Health Products Regulatory Authority or through use of the yellow card system HCW should be reviewed by the Occupational Health Physician for medical assessment. The OHP will advise on requirement for HPRA reporting The incident and all actions taken must be promptly recorded in the HCW documentation/notes by the nurse/midwife involved Reported incident to the relevant line manager immediately. Complete incident form and forward to Risk/Line Manager. Record vital signs. 11/07/2018 28
Resources and Equipment See Appendix II Equipment list for Clinic on Seasonal Influenza Peer Vaccination Programme Vaccines Emergency bag with resuscitation equipment, anaphylaxis kit Mobile phone access Gauze swabs & tape/plasters Sharps bins, bags for disposal of hazardous waste materials and bags for recycling. Alcohol hand gel/hand washing facilities Documentation If relevant, appropriate medically approved cool box with max/min thermometer display 11/07/2018 29
Needle Stick Injury? BLEED IT WASH IT REPORT IT Refer to local policies 11/07/2018 30
Revision & Audit The Medicine Protocol for Inactivated Influenza Vaccine will be revised annually The Seasonal Influenza Peer Vaccination Programme will be reviewed annually as vaccine manufacturer may change 11/07/2018 31
References Barron, C., Hollywood, E. (2010) Drug administration. In Clinical Skills in Children Nursing, (Coyne, I., Neill, F., Timmins, F., Eds) Oxford University Press. 147-181. Canadian Agency for Drugs and Technologies in Health (2014) Aspirating versus not aspiration prior to injection medication. Comparative Clinical Evidence Guidelines. Department of Health UK. (2013) Immunisation and Infectious Diseases (Green Book) Dougherty, L., Lister, S. (2015) the Royal Marsden Hospital Manual of Clinical Nursing Procedure. 9 th Edition, Blackwell Publishing: Oxford. Greenway, K., (2014) Rituals in nursing: intramuscular injection, Journal of Clinical Nursing 11/07/2018 32
References Immunisation Guidelines for Ireland https://www.hse.ie/eng/health/immunisation/hcpinfo/guidelines/ Our Lady s Children s Hospital, Crumlin (2017) Guidelines on Administration of Intramuscular and Subcutaneous Injections. https://www.olchc.ie/healthcare-professionals/nursing-practice- Guidelines/Intramuscular-and-sub-cutaneous-Injections-pdf Guidelines for Hand Hygiene in Irish Health Care Settings (2015) Update of 2005 Guidelines. https://www.hpsc.ie/az/microbiologyantimicrobialresistance/infectioncontrolandhai/g uidelines/file,15060,en.pdf. 11/07/2018 33
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