Healthcare Personnel Immunization Toolkit - APIC

351 Pages·2012·17.88 MB·English

by  Ruth Carrico

This toolkit was reviewed by the APIC Practice Guidelines Committee.
Healthcare Personnel Immunization Toolkit
2012

Funding provided by the U. S. Department of Homeland Security, Science & Technology Directorate,
through a technology development and deployment program managed by The National Institute For
Hometown Security.
Toolkit Work Group: Ruth Carrico PhD RN FSHEA CIC; Kelly Westhusing MPH; Rebecca Ford MPH;
Timothy Wiemken PhD MPH CIC, W. Paul McKinney MD; Paula Peyrani MD; Michael Smith MD
University of Louisville
School of Public Health and Information Sciences
School of Medicine, Division of Infectious Diseases
School of Medicine, Pediatric Infectious Diseases
Healthcare Worker Immunization Toolkit
Table of Contents
Section 1 Introduction to the Toolkit
Section 2 Vaccine Storage & Handling
• CDC Vaccine Storage & Handling Guide-October 2011
• Temperature Logs
• Signage
• Frequently Reported Errors
• Transporting Refrigerated Vaccine
• Emergency Response Worksheet
• Checklist: Importance of Vaccine Administration, Storage & Handling
Section 3 Vaccine Selection and Administration
• Healthcare Personnel Vaccination Recommendations (in brief)
• Immunization of Health-Care Personnel. Recommendations of the
Advisory Committee on Immunization Practices (ACIP). November 25,
2011
• The Basics of Vaccine Administration
• Administering Vaccines to Adults: Dose, Route, Site, Needle Size, and
Preparation
• How to Administer Intramuscular and Subcutaneous Vaccine Injections to
Adults
• How to Administer Intramuscular, Intradermal and Intranasal Influenza
Vaccines
• Vaccines with Diluents
• Guide to Contraindications and Precautions to Commonly Used Vaccines
in Healthcare Personnel
Section 4 Management and Reporting of Vaccine Reactions
• Medical Management of Vaccine Reactions in Adult Patients
• Vaccine Adverse Event Reporting System (VAERS) Table of Reportable
Events Following Vaccination
• Frequently Asked Questions, Vaccine Misadventures and Glossary of
Terms
1
Section 5 Healthcare Personnel (vaccine recipient) Information
• Vaccine Information Statements and Federal Law
• Vaccine Information Statements (English)
Hepatitis B
o
Influenza, LAIV
o
Influenza, Inactivated
o
Measles, Mumps, Rubella (MMR)
o
Tdap (tetanus, diphtheria and acellular pertussis vaccine)
o
Varicella
o
Vaccines Recommended for Special Circumstances
o
 Meningococcal (MCV4 and MPSV4)]
 Typhoid
 Inactivated Polio Vaccine (IPV)
• Vaccines and Autism: What you should know
Section 6 Documentation
• Electronic Health Records and Immunization Registries
• Sample Healthcare Personnel Immunization Record
• Sample Adult Vaccine Record
• Example of a Lifetime Immunization Record
• Sample Influenza Vaccination Declination Form
Section 7 Program Evaluation and Improvement
• Sample Monitoring Report for Immunization Rates
• Checklist for Safe Vaccine Handling and Storage
• Vaccine Storage and Handling Sample Policy
• Checklist for Improving Immunization Rates Among Healthcare Personnel
• Safe Injection Practices Checklist
• Sample Improvement Strategies
Sample Standing Orders
o
Vaccine Excipient & Media Summary (vaccine ingredients)
o
• Sample Job Descriptions
• Sample Practice Assessment Tools
Skills Validation for Intramuscular Seasonal Influenza
o
Immunization Administration (adult)
Skills Validation for Intranasal Seasonal Influenza Immunization
o
Administration (adult)
2
Administration of Intradermal Seasonal Influenza Immunization
o
Administration (adult)
Skills Validation for Subcutaneous Immunization Administration
o
(adult)
Vaccines with Diluents: How to Use Them
o
Section 8 Additional Resources
3
Introduction to the Toolkit
Utilization of vaccines as a means to prevent disease transmission is a pillar of an effective
infection prevention and control program. Often, this activity is provided through a separate
and distinct employee/occupational health program within an individual healthcare facility with
the infection preventionist either providing support or consultation. In smaller facilities, the
individual may be responsible for the infection prevention and control as well as the
employee/occupational health programs. Regardless, knowledge regarding program
requirements, implementation, ongoing assessment and summative evaluation are critical as a
means of ensuring the health and safety of the healthcare workforce. Ideally, the basis for the
immunization program will be an integral part of a risk assessment process that links employee
health and infection prevention and control.
The purpose of this toolkit is to provide infection preventionists and their
employee/occupational health colleagues with a full spectrum of information, tools and
resources that will assist them with the planning, development, implementation, evaluation
and improvement of their healthcare personnel immunization program relevant in all
healthcare settings.
The term “healthcare personnel” is used throughout this toolkit instead of the term “healthcare
worker”, as healthcare personnel encompasses a broader group of workers. Healthcare
personnel refers to individuals working in healthcare settings (paid and unpaid) who have the
potential to be exposed to patients; infectious material; contaminated environmental surfaces;
equipment and supplies; as well as contaminated air. Groups of healthcare personnel may
include nurses, physicians, dentists, pharmacists, nursing assistants, therapists, technicians,
laboratorians, emergency medical services personnel, dental hygienists, dental assistants,
students and trainees, contract staff not employed by the facility, and licensed independent
practitioners, among others. Healthcare personnel also include those without direct patient
care responsibilities but with the potential for exposure to infectious agents that can be
transmitted to them during their work time. These personnel include clerical, food services,
environmental services, security, maintenance, finance and billing, and volunteers, among
others. Consequently, the information contained in this toolkit must be considered to be
relevant and applicable to all persons working in healthcare settings.
Resources critical for the immunization program have been provided via guidelines and
recommendations from the Centers for Disease Control and Prevention (CDC) through the
Advisory Committee on Immunization Practices (ACIP) and the Healthcare [formerly Hospital]
Infection Control Practices Advisory Committee (HICPAC), with these documents focusing on
which vaccines should be provided, to whom, and under what circumstances. Most recently, a
summary document was released by the ACIP entitled Immunization of Health-Care Personnel
which pulled together current immunization recommendations for healthcare personnel and
has essentially replaced the immunization guidelines provided in an ACIP/ HICPAC summary
document from 1997 1,2. However, aspects of the healthcare personnel immunization program
involve programmatic elements including safe handling of the vaccine supply, implementation
of the immunization program, management of the immunization process, and overall program
evaluation. Robust guidance for these aspects have been provided by the CDC and are included
in the Vaccine Storage and Handling Guide that was revised in October 2011 as well as the
Pink Book that provides comprehensive information regarding vaccine-preventable diseases as
well as practical factors such as vaccination schedules, administration, contraindications and
precautions, adverse reactions .3,4 Additional information can be found in the 2008 CDC Vaccine
Storage and Handling Toolkit that is currently under revision. Although the information
provided in the aforementioned Vaccine Storage and Handling Guide and the Vaccine Storage
and Handling Toolkit seem to target physician offices and clinics, they are relevant to practices
in the employee/occupational health offices in hospitals, long term care facilities, ambulatory
surgery settings, and any other facility that provides services to patients. Tools and resources
to assist the employee/occupational health nurse and the infection preventionist are abundant
and need only be gathered together and promoted. To that end, this document, the Healthcare
Personnel Immunization Toolkit, has been compiled to provide assistance to the
employee/occupational health and infection preventionists as they work to promote and
improve healthcare personnel immunization through effective and evidence-based programs.
Practical items, including sample policies and procedures, have been added to facilitate
implementation of the recommendations and resources.
At present, the infection prevention and employee/occupational health fields lack clearly
articulated competencies to guide professional development and practice with respect to
healthcare personnel immunization programs outside those proposed for hospital-based
healthcare personnel in 2008.5 The Toolkit therefore, addresses areas of specific practice
expertise (instead of competencies) that are important for a safe, comprehensive and dynamic
approach to immunization for healthcare personnel, recognizing the likelihood of healthcare
personnel experiencing varying job roles and changes in physical status. These practice areas
include: 1) vaccine storage and handling; 2) employee/occupational health provider roles; 3)
vaccine selection; 4) vaccine administration; 5) management of vaccine reactions; 6) education
of healthcare personnel receiving immunization; 7) documentation; 8) program evaluation; 9)
performance improvement; and 10) practice expertise assessment for the
employee/occupational health professional. In support of the practice areas, tools and
resources for the immunization program including checklists, frequently asked questions,
assessments, and sample policies are included.
Care should also be taken to review the package inserts of all vaccines to ensure the most up-
to-date information regarding administration, indications, and contraindications. Frequent
visits to the CDC and Immunization Action Coalition websites are important to ensure that
printed materials provided to vaccine recipients (e.g., VIS) are the most current.
References:
1. CDC. Immunization of Health-Care Personnel: recommendations of the Advisory
Committee on Immunization Practices (ACIP). MMWR November 25, 2011; 60(No. RR-
07); 1-45
2. CDC. Immunization of health-care workers: recommendations of the Advisory
Committee on Immunization Practices (ACIP) and the Hospital Infection Control
Practices Advisory Committee (HICPAC). MMWR 1997;46(No. RR-18).
3. CDC. Vaccine Storage and Handling Guide 2011. Available at
www.cdc.gov/vaccines/recs/storage/default.htm . Accessed November 25, 2011.
4. CDC. Epidemiology and Prevention of Vaccine-Preventable Diseases. The Pink Book 12th
Edition (April 2011). Available at
http://www.cdc.gov/vaccines/pubs/pinkbook/index.html Accessed November 25,
2011.
5. Carrico R, Rebmann T, English JF, Mackey J, Cronin, SN. Infection Prevention and Control
Competencies for Hospital-Based Healthcare Personnel. American Journal of Infection
Control. 2008 Dec; 36(10):691-701.
Section 2 Vaccine Storage and Handling
This section addresses the basics of vaccine storage and handling. A general overview of the
document and its web location, if available, are provided. The section includes the following:
• A major component of this section is the CDC Vaccine Storage & Handling Guide that was
revised in October 2011. This document provides an overview of best practices that are
relevant to the employee/occupational health office where vaccines are received, stored
and maintained. In addition, this document includes specific information for the full range
of vaccines that should be included in the healthcare personnel immunization program. The
Guide addresses vaccines that are not part of healthcare personnel immunization programs,
but that information may be helpful in addressing related questions.
http://www.cdc.gov/vaccines/recs/storage/guide/default.htm

• Temperature logs for the refrigerator and freezer and a troubleshooting record to note
refrigeration incidents and action taken.
Celsius http://www.immunize.org/catg.d/p3039a.pdf
Fahrenheit http://www.immunize.org/catg.d/p3039.pdf
• Vaccine storage signage. http://www.immunize.org/catg.d/p2090.pdf
http://www.immunize.org/catg.d/p2091.pdf

• Frequently reported errors in vaccine storage and handling with explanations regarding
those errors. http://www.immunize.org/catg.d/p3036.pdf

• Pictures and tips for use when transporting vaccine or when short-term storage is needed.
http://www.eziz.org/assets/docs/IMM-983.pdf

• A worksheet for use when a power failure or other event occurs that results in exposure of
the vaccine to temperatures outside the expected range.
http://www.immunize.org/catg.d/p3051.pdf

• A final component of this section is a checklist that can be used in any setting to ensure
appropriate vaccine handling and management. The checklist is a summary of information
that can be used to monitor the effectiveness of the program as well as provide a basis for
training of personnel responsible for the program.
More detailed information is available at the CDC website www.cdc.gov and in the Pink Book.