FLU Clinic Volunteer Orientation 2017-2018 Arkansas Department of Health

Goals and Objectives Provide protection against influenza Decrease Illness Decrease Absentees Decrease Spread of Disease Community Immunity Herd Immunity Cocoon Effect

Nursing/Volunteers Non ADH and ADH Non-Clinical Non-ADH nurses Attend orientation Non-ADH nurses Provide current Arkansas Nursing License Picture ID Sign Volunteer Indemnity form Sign HIPPA form If you are a volunteer nurse or are not currently working in the immunization program in the local heatlh unit. we ask that you take a few moments to review this presentation. Additionally, if you are not a current employee of the Division of Health, we will need a copy of your current nursing license and have you sign the indemnity or waiver form along with a HIPPA disclosure. 3 3

Indications for flu vaccine Any person who wishes to reduce the likelihood of becoming ill or transmitting influenza Inactivated influenza vaccine can be given to anyone 6 months of age or older, including breastfeeding and pregnant women

Recommendations All persons aged ≥ 6 months, unless medically contraindicated. Persons at higher risk for influenza-related complications

People at Increased Risk of Influenza Complications People with asthma People with diabetes People with heart disease and those who have had a stroke Adults 65 and older Pregnant women People who have HIV or AIDS People who have Cancer Children younger than 5, but especially children younger than 2 years old

People Who are Transmission Sources Healthy household contacts and caregivers of: Children ages 0-59 months Persons > 50 years old Persons at high risk for severe complications from influenza

Transmission Sources (cont.) Health Care Providers: People who provide home care to persons in groups at high risk People working in health-care settings include physicians, nurses, and other workers in hospitals, long term care facilities, assisted living and outpatient-care settings Medical emergency response workers Students in these professions who will have contact with patients

Immunize the people who live with or care for them! To prevent transmission to those who are at high risk for influenza-related complications: Immunize the people who live with or care for them!

Influenza Vaccine 2016-2017 The 2017-2018 Quadrivalent influenza vaccines contain the following influenza strains: A/Michigan/45/2015 (H1N1)pdm09-like virus; A/Hong Kong/4801/2014 (H3N2)-like virus; B/Brisbane/60/2008-like virus (B/Victoria lineage) B/Phuket/3073-like virus (B/Yamagata lineage)

All ADH vaccine will be in pre-filled syringes. All ADH vaccine will be preservative free and latex free.

Vaccine Reactions Approximately 2 weeks after vaccination, antibodies develop Common reactions Soreness/erythema/induration at site lasting 1-2 days (15-20%) Fever/chills/malaise/myalgia lasting 1-2 days (<1%) Rare: immediate hypersensitivity allergic reactions (hives/angioedema/allergic asthma/systemic anaphylaxis)

Age Group Dosage > 6 months FluLaval 0.5 mL IM* *Children 8 years and younger may need two doses administered at least 4 weeks apart

Children aged 6 months through 8 years who are receiving influenza vaccine for the first time or those who have not received > 2 doses before July 1, 2017, require two doses of vaccine administered ≥ 4 weeks apart.

Influenza vaccine dosing algorithm for children aged 6 months through 8 Years, ACIP , United States, 2017–18 influenza season

Contraindications and Precautions: Contraindications: Severe allergic reaction to any component of the vaccine or after previous dose of any influenza vaccine. Precautions: Moderate to severe illness with or without fever; history of Guillain-Barre syndrome within 6 weeks of receipt of influenza vaccine * *requires a consultation with patient’s physician

Side Effects/Adverse Reactions: FluLaval Local: Pain, tenderness, and redness at the injection site Systemic: Drowsiness Headache Irritability Myalgia Fatigue, arthralgia, GI symptoms, and loss of appetite have also been noted in children

Flublok: Injectable > 18 years of age 0.50ml Utilized for ADH employees with serious, anaphylactic reaction to eggs 10 doses available in each region and Central Office

Mass Flu Clinics

Clinic Site A nursing coordinator will be at each clinic site for your assistance and can answer questions as needed Locate emergency kit/first aid station at each clinic site 20 20

Clinic Flow Patient enters clinic/site Route to screening area Give current VIS (Vaccine Information Statement) Route to Data Intake area to complete Imm-Flu form Patient must sign and date Imm-Flu form Route patient to a nursing station with the Imm-Flu form for vaccination 21 21

Forms Vaccine Information Statements (VIS) Arkansas Department of Health Influenza Season--Immunization Consent form (IMM-Flu form)

Nursing Station Shot code if requested Greet patient/collect Imm-Flu form Screen for contraindications/precautions- answer all questions Administer the indicated vaccine Complete the Imm Flu form and keep form Shot code Site/dosage/lot# Nurse signature Provide documentation of vaccination, if requested Route patient to exit 23 23

Injection Technique

Vaccine Administration Sites: Infants: vastus lateralis (anterolateral thigh) Young children over the age of 12 months-anterolateral aspect of the thigh may be used if the deltoid is underdeveloped Adults and older children: deltoid (upper arm) Dosage: 6 months and older : 0.5ml IM

Injection Technique Determine the appropriate vaccine and injection site Prep site with alcohol wipe/cotton ball Using a circular motion, wipe the site with alcohol from center out and allow to dry Attach the safety glide needle to the prefilled syringe

Injection Technique (cont.) Spread skin taut between thumb and forefinger OR grasp tissue and “bunch up” muscle (acceptable for pediatric and geriatric patients). Insert needle fully into muscle at 90 degree angle and inject vaccine quickly.

Injection Technique (cont.) Apply light pressure to injection site for several seconds with dry cotton ball or gauze Dispose of syringe in sharps container

Injection Technique (cont.) USE OF VANISHPOINT SAFETY NEEDLES ADH will be using VanishPoint safety needles for injections Activate safety mechanism immediately after injection by pushing the color coded tab toward the safety chamber, allowing the needle to automatically retract into the safety chamber Activate the safety mechanism away from self and others.

Vaccine Management Influenza vaccine should be stored at 36°F-46°F (2°C-8°C) Temperatures should be documented every hour Report out of range temperatures immediately Keep storage unit container(s) closed as much as possible No more then 10 doses of vaccine should be removed from the storage unit and prepared during an off site clinic Discard any vaccine-filled syringes if the needles have been attached after the clinic closes

Standard Precautions Good handwashing is recommended but if soap and water is not available, you may use alcohol-based waterless cleanser between each patient (available at each nursing station)

Standard Precautions (cont.) Gloves are not mandatory unless the provider has open lesion on hands. (Available at each nursing station) If latex free gloves are required, contact the nursing coordinator

If a needle stick injury occurs-report it IMMEDIATELY to the nursing Needle Safety If a needle stick injury occurs-report it IMMEDIATELY to the nursing coordinator

Hotwash/Debriefing with Local Health Unit and Volunteers

THANK YOU! 36 36