Training Vaccination Training for Health Care Providers

Vaccination Training
for Health Care Providers


Agenda--1
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Overview & Introductions

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Flu Disease & Flu Vaccine

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Intramuscular Injection

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“Immunization Techniques” Video

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Skills practice 1: Drawing up vaccines &
using safety syringes

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Locating IM injection landmarks

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Skills Practice 2: Locating IM injection
sites


Agenda--2
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Skills Practice 3: FluMist administration
Giving Vaccines in a Medication Center
Adverse Reactions
Skills Practice 4: Positioning &
comforting restraint
Skills Practice 5: Locating IM injection
sites on adult and child arm and leg
Skills Practice 6: Use of Triage Algorithm
Q&A and Evaluation


What is the flu?
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Highly infectious viral illness
Characterized by abrupt
onset of fever, dry cough,
muscle aches and malaise
Cough and malaise may
persist up to two weeks
Transmitted by respiratory droplets
Seasonal flu season typically
occurs late fall through spring


Flu can complicate underlying
medical conditions, causing….
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Bacterial infections
 Pneumonia
 Sinus and ear infections
in children

Increased risk of stroke, MI, and heart
failure
Increased blood sugar in diabetics
Death


How is influenza transmitted?
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Large-particle
respiratory droplets
(infected person
coughs or sneezes near
a susceptible person)
Requires close contact
(<6 feet)
Novel A H1N1 probably
spread in ways similar
to other flu viruses


Transmission of Influenza
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Other possible sources of transmission:
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Contact with contaminated surfaces

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Via droplet nuclei--also called
“airborne” transmission (particles stay
suspended in the air)

All respiratory secretions and bodily
fluids (diarrheal stool) of novel influenza
A (H1N1) cases should be considered
potentially infectious


Distribution by Age Group of Cases
Hospitalized with Pandemic H1N1
July 2009

*April 12–June 30





Health Care Workers: Protect
Yourself, Protect Your Clients
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Individuals are contagious for 1 to 4 days
before the onset of symptoms and about
5 days after the first symptom

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About 50% of infected people do not
have any symptoms but are still
contagious

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Health care workers are frequently the
source of influenza transmission in
health care settings


Influenza Vaccine


Why immunize?
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Flu is a serious illness, the
cause of 36,000 deaths each

year in the U.S.
Immunizations are first line
of defense:
70-90% effective in <65 yrs;
30-40% in frail elderly
Immunizations prevent serious
illness, hospitalization and death


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Groups at Increased Risk
for
Seasonal
Complications
Children
less thanFlu
5 years
old
Persons aged 65 years or older
People age <18 years who are on long-term aspirin
therapy (risk of Reye syndrome)

Pregnant women
Adults and children with chronic medical conditions
Adults and children who have immunosuppression
(caused by medications or by HIV)
Residents of nursing homes and other chronic-care
facilities


H1N1 vaccine—
Target groups for vaccination
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All pregnant women
People who live with or care for children
age < 6 months
Healthcare and emergency services
personnel
All people ages 6 months through 24
years
Persons ages 25 through 64 years with
chronic medical conditions

Who Should Not Be
Immunized?
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Anyone with:
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Severe (anaphylactic) allergy
to eggs, gentamycin or a previous
dose of influenza vaccine.

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Moderate to severe illness, with or
without fever

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History of *GBS within 6 weeks
after a previous flu shot.


Flu Vaccine Formulations
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Seasonal flu vaccine
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Trivalent inactivated influenza vaccine (TIV)
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Ten-dose vial
Prefilled syringe 0.25 ml and 0.5 ml

Live attenuated influenza vaccine (LAIV)

Novel H1N1 –monovalent versions of the
same formulations
Age range for vaccines and formulations
differs by manufacturer


Flu Vaccine Strains
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Seasonal flu vaccine components usually
change every year
 2009-10 vaccine has: A/Brisbane
(H1N1), A/Brisbane (H3N2), and
B/Brisbane

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Novel H1N1 vaccine (A/California)
licensed as “change of strain”—would
have been in seasonal flu vaccine if
outbreak had started earlier in the spring


Flu Vaccine Dosage
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TIV and Novel H1N1
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LAIV (seasonal and novel H1N1)
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0.5 ml--Children 3 years through adult
0.25 ml--Infants/toddlers age 6-35 months
0.2 ml (intranasal)

Two doses of vaccine 4 weeks apart are
needed the first year they get it for:
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children under age 9 years for seasonal flu

children under age 10 years for novel H1N1


Thimerosal Free Influenza
Vaccine--1
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Thimerosal is a preservative containing
ethyl mercury used in vaccines since 1930’s
No conclusive scientific evidence of harm
from exposure to thimerosal
 Studies of risk were of methyl mercury
In 1999, USPHS recommended eliminating
thimerosal in vaccines for infants, as a
precaution and to retain trust in vaccine
supply


Thimerosal Free Influenza
Vaccine--2
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Influenza vaccine in multi-dose vial
contains 25mcg/dose
Manufacturers make a limited amount of
thimerosal-free (<1mcg /dose) flu vaccine
Benefits of flu vaccine outweigh any
theoretical risk from thimerosal
Washington law requires that children <3
years and pregnant women be given
thimerosal-free vaccine, as of 7/1/2007


Thimerosal Free Influenza
Vaccine--3
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Emergency suspension of thimerosal law
for H1N1 vaccine only, as of 9/24/09
Can give thimerosal-containing vaccine
to children <3 years and pregnant
women, BUT must give notice of the
suspension to:
 Everyone < 18 years
 Pregnant and breastfeeding women


10 minute break

Break out Health Educators


Use the correct needle length
for IM injections
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1” minimum needle recommended
1½” to 2” needle for larger arm
Longer needles:
 Hurt less
 Cause fewer local reactions1
 Assures proper route and a valid
dose of vaccine

Diggle L, Deeks J. BMJ 2000;321(7266):93133.