Vaccine

Technique For Administering the Vaccine

[For further information refer to CDC’s “Vaccine – Guidelines and Recommendations” at http://www.bt.cdc.gov/agent/smallpox/vaccination/guidelines.asp]

Vaccination is normally performed using a bifurcated needle. A sterile needle is inserted into an ampoule of reconstituted vaccine and, on withdrawal, a droplet of vaccine sufficient for vaccination is held by capillarity between the 2 tines. The needle is held at right angles to the skin; the wrist of the vaccinator rests against the arm. Fifteen perpendicular strokes of the needle are rapidly made in an area of about 5 mm in diameter. The strokes should be sufficiently vigorous so that a trace of blood appears at the vaccination site after 15 to 30 seconds. After vaccination, excess vaccine should be wiped from the site with gauze that should be discarded in a hazardous waste receptacle. The site should be covered with a loose, non-occlusive bandage to deter the individual from touching the site and perhaps transferring virus to other parts of the body. (9:8)

A successful vaccination for those with partial immunity may manifest a gradient of responses. These range from what appears to be a primary take (as described herein) to an accelerated reaction in which there may be little more than a papule surrounded by erythema that reaches a peak between 3 and 7 days. A response that reaches a peak in erythema within 48 hours represents a hypersensitivity reaction and does not signify that growth of the vaccinia virus has occurred. Persons exhibiting such a reaction should be revaccinated. (9:8-9)

Only the diluent supplied with the vaccine should be used for reconstitution. Vaccine reconstituted with any other diluent should be discarded. Reconstituted, vaccine should be kept at refrigerator temperature, 2-8¾C. (22:V6:42) Once reconstituted, the vaccine may be used for 30 days if kept at the recommended storage temperature.

Vaccination Steps from CDCs “Smallpox: Disease, Prevention and Intervention” (22:V1:25-33) are listed below.

  1. First, remove the bifurcated needle from its package. The needle is sterile, so be careful not to touch the bifurcated, pointed end.
  2. Dip the bifurcated point of needle into the vaccine solution – so that the needle is perpendicular to the floor. The needle will pick up a drop of the vaccine in the space between the two prongs. Inspect the needle tip after dipping to assure that vaccine is present between the prongs. DO NOT shake the needle after it has been dipped into the vaccine vial. If no vaccine is between the prongs of the needle, and the needle has not touched the skin of the vaccinee (i.e., it is still sterile), it may be dipped again.
  3. Do NOT re-dip the needle into the vaccine solution once it has touched the person’s skin. A single dip into the vaccine will prevent contamination of the vaccine vial.
  4. Pull the skin on the arm taut, rest you wrist on the arm, and prick the skin the recommended number of times. This should be done rapidly, perpendicular to the skin, within an area 5 millimeters in diameter. The intention is to break the skin and introduce the vaccine into the skin. The wrist of the vaccinator should be resting on the arm while pricking the skin.
  5. Prior to administration of smallpox vaccine, please refer to the package insert for number of bifurcated needle punctures to administer. (22:V6:50)
  6. Administering the strokes rapidly, within about 3 seconds, also helps induce enough pressure by the needle to produce this small amount of bleeding and assure that the vaccine was administered appropriately. This method allows the live vaccinia virus to penetrate the superficial layers of the skin so that viral multiplication can occur and produce immunity.
  7. A trace of blood should be present after 10-20 seconds.
  8. Bifucated needles should never be re-used. Dispose of used needles immediately into sharps container.
  9. Cover the vaccination site to prevent dissemination of the virus. The site should be covered by a gauze pad then tape applied over the gauze. For hospital personnel, the gauze should in turn be covered by a semi-permeable occlusive dressings. Semi-permeable dressing alone should not be used because it causes skin maceration and may increase the risk of secondary bacterial cellulitis.

Vaccinees should be instructed that thorough hand washing with soap and water or disinfecting agents should be performed after any direct contact with the site or contact with materials that have come into contact with the site. Care must be taken to prevent contact of the site or contact with contaminated materials from the site by any other person. Keeping the site covered provides barrier protection against inadvertent inoculation or transmission. (22:V6:56)

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