1. Smallpox Vaccination Clinic Operations Michigan Department of Community Health January 3, 2002

2. 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.

3. Objectives Describe –Communication issues –Vaccine logistics –Clinic operations –Data issues

4. Objectives (2) Describe –Evaluation of vaccine takes –Reporting adverse events –Role of MDCH

5. Overview Pre-event smallpox planning To protect – Health care workers (health care response teams--HCRT) –Public health response teams (PHRT)

6. 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

7. Pubic Health Response Teams Medical team leaders Public health nurses Epidemiologists Disease investigators

8. Communication Issues

9. Communication with… Vaccinated staff Non-vaccinated staff –Public health employees –Hospital employees Assistance with messages available from MDCH if needed

10. Audiences include… Medical staff & administration –ER –Consults (dermatology, ophthalmology, infectious disease, et al.) Nursing staff & administration Medical assistants

11. Audiences include… (2) Non-medical floor staff Ancillary staff Volunteers Clergy Housekeeping

12. Key Points for Messages Description of stage 1 vaccination –Who is being vaccinated –Why theyre being vaccinated Screening for vaccination Information about the vaccine Vaccination process

13. 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

14. How to get the message out Hospital newsletter Staff meetings Morning report Grand Rounds Individual or small group meetings In-house e-mail

15. Messengers CEO Chief of staff Continuing education staff Occupational health staff Infection control staff Vaccine site facility manager

16. Vaccine Logistics

17. Dryvax® Dried Smallpox Vaccine Kit

18. 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

19. The Vaccine Kit (2) Package insert Reconstitution instruction card Stability holder for vaccine vial (comes with the kit, not in the kit)

20. Vaccine LogisticsStorage 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

21. Vaccine LogisticsStorage Vaccine kits will be transported to each vaccination clinic and returned to the storage location after each vaccination clinic

22. 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

23. 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

24. Clinic Operations

25. Clinic Staffing Scheduling vaccinees (30-35/hour) Supplies Coordination with hospital site facility coordinator

26. 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

27. Clinic Site Considerations Considerations include –Adequate size –Separate doors for entrance and exit –Access to telephone –Access to telephone line for computer Internet access

28. Large, open, well lighted and well ventilated space At least 2 large doors for access and egress Clinic Layout and Flow

29. Vaccination Clinic Staffing Each vaccination team will require approximately 21 staff Handout #1 provides details regarding # of each type of staff, vaccination requirements, etc.

30. Hospital Site Facility Manager Works with regional vaccination coordinator to –Identify appropriate location within facility –Schedule clinics at facility –Schedule employees for vaccination

31. Hospital Site Facility Manager (2) Makes all facility arrangements for clinics –Parking for clinic staff –Tables, chairs, cot, screen for clinic, etc.

32. 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

33. Vaccination Clinic Manager Works with regional vaccination coordinator to –Identify clinic staff for each clinic –Coordinate supplies for each clinic location

34. Vaccination Clinic Manager (2) Works with regional vaccination coordinator to –Provide on-site management for vaccination clinic –Make clinic staffing assignments

35. 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.)

36. Clinic Greeter (2) May be clerical staff or volunteer Vaccination not needed

37. 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

38. Nurse Screener Considerations (2) Must have quick access to medical consultant (may be Hospital Assigned Physician) –On site or –Pager

39. The Vaccination Process

40. Nurse Vaccinator Terminology –Vaccinia –Variola –Dryvax –Multiple-puncture vaccination –Bifurcated needle

41. 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

42. 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

43. Vaccinator Preparation Must be vaccinated Review with vaccinee –Contraindications –Allergies –Other vaccinations in last month –Paperwork

44. Vaccinator Preparation (2) Review with vaccinee, cont –Voluntary nature of vaccinee Identify non-dominant arm Table set up –Chux –Specific place for paperwork

45. Supplies Vaccine Vaccine holder Needles Gloves Gauze Tape

46. Vaccine Preparation Wear gloves The vaccine kit –Vaccine –Diluent 0.25 ml already in syringe If cold, warm in palm

47. Vaccine Reconstitution See Handout #2 Allow vial to stand for 3-5 minutes after reconstitutiondo not shake Record date of reconstitution and batch # on vial Vaccine may be used for 60 days following reconstitution

48. 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

49. Vaccine Vial (2) 100-dose vial May get only 85-90 doses/vial

50. Vaccine Spills Use tuberculocidal solution –Lysol –Bleach solution, 1 part bleach to 10 parts water

51. Skin Preparation None needed Under no circumstances should alcohol or acetone be used Site –In deltoid area –Not over tattoo or prior scar

52. Bifurcated Needle Never re-introduce used needle into vaccine vial

53. Vaccine Administration Video

54. 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

55. Key Points (2) Rest wrist on vaccinees 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

56. 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

57. Getting ready for the next vaccinee Remove gloves and discard properly Disinfect hands

58. Handling Waste Material Treat as biohazardous material

59. 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

60. 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