Site Care

1. Site Care

2. Site Care Education Goals • Review normal reactions after vaccination • Provide site care instructions (oral and written) • Provide contact information for concerns

3. Site Care Education Goals (2) • Provide successful vaccination “take” reading date and location information

4. Vaccination Site Reaction Day 4 Day 7 Day 14 Day 21

5. Normal, expected local reactionsUsually seen ~1 week after vaccination • Soreness at vaccination site • Intense erythema surrounding the vaccination site • Lymphadenopathy (local): 25% – 50%

6. Headache Myalgia Chills Nausea Fatigue Normal, expected systemic symptoms – usually occur ~1 week after vaccination 0.3 – 37.0%

7. Normal, expected systemic symptomsusually seen ~1 week after vaccination • Malaise • Fever •  100º F: 17% •  101º F: 7% •  102º F: 1.4%

8. Normal variant responses & symptoms • Local satellite lesions • Lymphangitis • Local edema • Viral cellulitis • Mild rashes

9. Local Satellite Lesions 1 or more additional lesions near vaccine site

10. Lymphangitis Inflammation of the lymphatic vessels characterized by red streaks or patches in the skin

11. Local edema Fluid accumulation in the vaccination area

12. Site Care Clinical Issues • Vaccinia virus may be cultured from the site of a vaccination from 2-3 days after vaccination until the scab separates • Care must be taken to prevent the spread of the virus to other parts of the body or other persons

13. Dressing • Keep covered with 2x2 gauze and tape at all times until scab separates • Semi-permeable occlusive bandage over 2x2 dressing for HCW at work • Use waterproof covering during shower

14. Dressing Changes • Wash hands with soap and water before and after every contact with the vaccination site or any materials (dressing, clothing, etc). • Change dressing every 1-2 days

15. Dressing Changes (2) • HCW may change own dressing at home • Place used dressing in zip bag and discard in trash • Vary position of tape over gauze

16. Comfort Measures • Acetaminophen and ibuprofen for pain • DO NOT scratch—may use oral antihistamines for itching • DO NOT apply anything (ointments, salves or antibiotic band-aids) to the vaccine site • DO NOT apply heat or cold to the vaccine site

17. At-work Issues • Cover dressing with semi-permeable membrane, e.g., Opsite • Wear long-sleeves over dressing • HCW do not need to be furloughed • Have dressing assessed on work days before beginning shift

18. At-home Issues • Use normal laundering (hot water) to wash clothes, towels or sheets that have touched the vaccination site • Keep family members from touching your vaccination site (keep site covered)

19. At-home Issues (2) • Wear long sleeves to bed • Wash hands first thing in the morning • Dispose of scab in zip bag and discard in trash

20. Additional Clinic Roles

21. Vaccination Assistants • May assist vaccine administrator with all aspects of pre and post vaccination activities • May set up/break down vaccination stations

22. Vaccination Assistants (2) • May assure area is available for vaccinees having reactions • May replenish vaccine station supplies • May apply bandages to vaccination site

23. Data Entry Staff • MDCH intends to provide data entry staff • Vaccination not required • Data entry discussion to follow

24. Entry/Exit Monitors • Maintain clinic flow • May answer questions related general vaccine clinic operations (entrances, exits, parking, bathroom locations etc.) • May be clerical staff or volunteers • Vaccination not needed

25. Security • Assure clinic parking is adequate, close and protected • Provide telephone numbers for police, fire, utilities, facility owner/manager

26. Security (2) • Assure facility is secure, well lighted and functional • Vaccination not indicated

27. Supply Issues

28. Supplies Provided by MDCH • 4X4 Tegederms • $50.00 per vaccinee for other supplies • Copies of CDC vaccination packets (as requested in January by each region) • Color brochures for each vaccinee to be handed out during site care instruction

29. Supplies Provided by MDCH • Vaccination card for vaccinee • Vaccine Information Statements • Consent forms

30. Additional Clinic Supplies • Detailed supply checklist provided in Handout #4

31. Section V: Data Issues

32. Data System • MCIR • Modifications: age restrictions, assessment, adverse event tracking, cost, time to develop, and daily extract to CDC of the data • May be available for Stage 2

33. Data System • Pre-Event Vaccination System (PVS) • Written by CDC • Web-based application • Digital certificates used for security

34. Smallpox Vaccination Form—Data Flow • Matches clinic flow • Printed in triplicate • Top sheet used for data entry and sent to MDCH • Second sheet sent to clinic responsible for reading the “Take” response • Third sheet given to the vaccinee

35. Greeter & Smallpox Vaccination Form • Greeter gives form to vaccinee • Vaccinee completes • Patient Information • Vaccination History

36. Nurse Screener & the Form • The nurse screener completes • Referring Organization • Current Vaccination Questions • Disposition once the patient signs the form giving consent to be vaccinated • Record the PVN on each copy of the form

37. Vaccinator/Vaccination Assistant & the Form • After vaccination, nurse vaccinator or vaccination assistant will • Document the date of administration and sign the form • Fill in the vaccine, diluent and batch information

38. Vaccinator/Vaccination Assistant & the Form (2) • After vaccination, nurse vaccinator or vaccination assistant will • Complete the vaccine record card for vaccinees to have for their records

39. Site Care Educator & the Form • Site care educator will record the date and location where the “take” response should be read

40. Data Entry Staff • The completed form is then given to the data entry staff for entry into the PVS

41. “Take” Response Readers • The “take” response should be recorded in the appropriate section at the bottom of the form • The form will be sent to MDCH for data entry

42. “Take” Response Readers (2) • The “take” response should also be recorded on the vaccinee’s vaccine record card • An additional form will be developed for use at sites where the “take” response will be read in case the original form is not available

43. Data Reminders • Use of the PVN is key to tracking the individual and linking any follow-up activity back to the same individual • MDCH plans to supply staff for data entry at clinics depending on the number of clinics occurring simultaneously

44. Data Reminders (2) • CDC expects us to account for every dose of vaccine administered and have a “take” reading done on every person receiving the vaccine

45. Section VI: Evaluating Vaccine “Take”

46. Evaluating Vaccination Site for “Take” • Major response • Equivocal response • No response

47. Major “Take” Response

48. Major “Take” Response (2) • Need to see one of the following 6-10 days after vaccination: • Clear-cut pustule OR • Area of definite induration or congestion around a central lesion, e.g., an ulcer or a scab

49. Equivocal Response • Any other reaction • May result from • A person being sufficiently immune to suppress viral replication • Sub-potent vaccine or improper technique

50. Equivocal Reaction (2) • May result from (cont.) • Hypersensitivity reaction to components of the vaccine • Do not confuse with reaction to tape