Immunization Skills
Institute
Vaccine Preventable Diseases
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Why Vaccinate?

To prevent/reduce common disease

To prevent infections that can easily emerge

To prevent/reduce infections that are common in
other parts of the world (disease is only a plane
ride away)
Risks of not vaccinating

A decision not to vaccinate is a decision to risk getting
the disease

Disease outbreaks can return in epidemic proportions,
causing serious illness and
death

Increased financial drain on economy: medical costs,
time off work
Immunization Job Aids
CDC Recommended Immunization Schedule
2014
CDC Catch Up Schedule
CDC Adult Immunization Schedule
Utah Vaccine requirements

Utah School Immunization Law requires that
children in private, public, or parochial schools
and child care facilities are appropriately
immunized for age.
School Immunization Requirements
Early Childhood Entry Requirements (As appropriate for age):
• Diptheria, Tetanus, Pertussis (DTaP)
• Measles, Mumps, Rubella (MMR)
• Haemophilus Influenza Type B (Hib)
• Hepatitis A
• Hepatitis B
• Pnemococcal
• Varicella
Kindergarten Entry
• 5 DTP/DTaP/DT
• 4 Polio
• 2 MMR
• 3 Hepatitis B
• 2 Hepatitis A
• 2 Varicella (starting July 2015)
7th Grade Entry
• 1 Tdap
• 3 Hepatitis B
• 2 Varicella
• 1 Meningococcal
Exemptions in Utah
The Utah Immunization Rule for Students (R396-100)
allows for three exemptions:

Medical

Religious

Philosophical (personal)
Before giving immunizations

Introduce yourself

Explain what you will be doing

Make sure the parent and patient
are comfortable

If parent has questions, let them
talk to the provider
Vaccine Information Statements
Vaccines For Children (VFC)
The Utah Vaccines for Children (VFC) Program provides
vaccines to participating providers for children birth
through 18 years of age who are:
•
•
•
•
•
Enrolled in Medicaid
Enrolled in the Children's Health Insurance Program (CHIP)
American Indian/Alaskan Native
Not insured
Under-insured* (insurance does not cover immunizations)
*Under-insured children may receive VFC-supplied vaccines
only at Federally Qualified Health Centers (FQHC) or
Medicare Certified Rural Health Centers RHC)
Patient Screening

Insurance/VFC Eligible

Vaccine History

Contraindications
Scope of Medical Assistants
and Immunizations

MAs work under the license of the MD,
PA, or NP

Vaccine orders must be written, never
verbal

Give only immunizations ordered by
licensed medical staff

Licensed medical staff must be in the
building when you give shots

Report mistakes immediately
Skills Checklist
Vaccine Storage

Store vaccine in a temperature stable location of
the storage unit.
 Store
vaccines in middle of refrigerator or freezer unit
away from coils, walls, floor and cold air vents.
 Never
store vaccines in door, vegetable bins, on floor of
the unit, or adjacent to cooling vents.
 Stabilize
refrigerator and freezer temperatures with
proper placement of water bottles in refrigerator;
frozen packs in freezer.
 Avoid
over-filling refrigerator and hindering air
circulation.
 Do
not store food or drink in vaccine storage units.
Refrigerator Storage
Freezer Storage
Vaccine Temperatures

Monitor vaccine storage unit temperatures.

Refrigerator temps must be maintained between
2 and 8°C (35° and 46°F).

Freezer temps must be maintained between
-50°and -15°C (-58°and +5° F).

Monitor and record storage unit temps twice daily.

Take immediate action for out of range temps.

 Contact
vaccine manufacturer to determine viability.
 Contact
VFC Program.
Use NIST Certified Calibrated Thermometers.
 Prefer
glycol, fluid-filled thermometers and data loggers.
What is wrong with this
storage unit?
Thermometers

Required


Calibrated thermometer for refrigerator and freezer.

Must have Certificate of Traceability & Calibration Testing.

NEW- Tested every 1-2 years or according to manufacturer recommendations.
Recommended

NEW- Use digital thermometer with detachable biosafe glycolencased probe that measures liquid temperature.

NEW- Accuracy +/- 1°F (0.5° C).

NEW- Continuous data monitoring device (ie: digital data logger).


Active display with min/max/current readings / placed on outside of unit door.

Alarm.

Reset button.

Memory storage of at least 4000 readings.

Does not rewrite over old data and stops recording when memory is full.

User programmable logging interval (for reading rate).
NEW- Data should be stored for downloadable review.
Continuous Data Thermometers

Continuous monitoring
provides more reliable
information on vaccine
storage temperatures.

NIST studies
demonstrated that
without a continuous
monitoring system
likelihood of
undiscovered
excursions occurring is
very high.

A probe in a thermal
buffer (i.e. glycol, glass
beads) is a more
reliable measure of
actual vaccine vial
temperatures than a
sensor that measures
air.

Totally relying on an
alarmed system is
insufficient.
Immunization Supplies
SAFETY SYRINGES
PRE-FILLED SYRINGES
AND SAFETY NEEDLES
ALCOHOL PREP PADS
SHARPS DISPOSAL
CONTAINER
BANDAGES
GLOVES
(OPTIONAL)
7 RIGHTS
FOR
MEDICATION
ADMINSITRATION
1. RIGHT
PATIENT
2. RIGHT TIME
3. RIGHT
VACCINE (AND
DILUENT)
4. RIGHT DOSAGE
5. RIGHT ROUTE,
NEEDLE AND
TECHNIQUE
6. RIGHT
INJECTION SITE
7. RIGHT
DOCUMENTATION
Vaccine Orders
Provider writes
vaccines orders
Can be part of Progress
Note or a separate page
Make sure you can read
and understand them
If you have questions,
ASK!
WASH YOUR HANDS
Before preparing vaccines
Before and after patient
contact
Safety engineered syringes &
needles
 Designed to decrease
needle sticks
 Required by OSHA
 Be familiar with the
different types
 Make sure you know how
to use the ones in your
office
 Report all needle sticks
Manufacturer-filled syringes
Needle lengths for immunizations
INTRAMUSCULAR (IM)
23-25 gauge
1 inch length (longer needle
may be necessary for larger
patients)
SUBCUTANEOUS
25 gauge
5/8 inch length
Vaccines: Which route is
right?
Intramuscular

DTaP, DT, Td, Tdap

Hep A

Hep B

Hib

HPV

Influenza (TIV)

MCV4

PCV

Pediarix

Pentacel

Kinrix

Twinrix
Subcutaneous

MMR

Varicella

MMRV

Zostavax

MPSV4
Oral

Rotavirus
Intranasal

FluMist (LAIV)
IM/SC
IPV
 PPSV23

Challenge: Vials look alike
SIMILAR COLORS
SIMILAR ANTIGENS
Check Your Vials
04/21/2014
Alex Simpson DOB: 04/01/2003
Tdap
MCV4
HPV #1
-Dr. Quinn
Expiration Dates
Expiration
Dates
Ready to Use Vaccine Vials
SINGLE-DOSE VIAL
MULTI-DOSE VIAL
Ready-to-use vaccine:
manufacturer-filled syringes
Reconstituting Vaccine
DILUENT
VACCINE
Site Maps
Comfort Measures

Involve parents and patients before, during, and after shots.
Comforting Restraint
Preparing the Injection
 IDENTIFY THE
INJECTION SITE
 CLEAN THE
INJECTION SITE
WITH ALCOHOL
 LET IT DRY
Intramuscular (IM) Injections
 1” LENGTH
 23- or 25-GAUGE
NEEDLE
 INSERT ENTIRE
NEEDLE AT 90
DEGREES
Intramuscular Shots for
Babies and Toddlers
 Vastus Lateralis for infants, babies,
and toddlers
 Use this site for children younger
than three
Intramuscular shots for
adolescents and adults
 Deltoid for anyone older than three
 The deltoid is three fingers below acromion process
Subcutaneous (SC) Injections
 5/8” LENGTH
 25-GAUGE NEEDLE
 INSERT ENTIRE
NEEDLE AT 45
DEGREES
SUBCUTANEOUS (SC) SHOTS FOR
CHILDREN AND ADULTS
 Upper leg for
children
 Upper, outer
arm for older
children and
adults
Oral Vaccines
Nasal Vaccine
Proper Disposal
After the Vaccines
Documentation
Documenting combination vaccines
Be prepared for emergencies
VAERS AND VERP
Vaccine Adverse Event
Reporting System (VAERS)
 Report side effects and
outcomes
 Give patient and provider
names
 Type of facility
 Vaccine information
 Online, fax, and mail





Vaccine Error Reporting
Program (VERP)
Report wrong
vaccine/patient/dose/etc.
Type of facility
Type of practitioner
Confidential
Online only
YOU CAN MAKE THE
DIFFERENCE!
Produced by Utah Department of Health
Immunization Program and California
Department of Public Health