Organization of an inoculation room and vaccinations

Vaccinations are a mass event, and even small deviations from sanitary and hygienic requirements for their implementation are fraught with the development of complications.

Each vaccination room must be equipped with:

• instructions for the use of the vaccines used and other recommendations;
• a refrigerator designed only for storing vaccines with 2 thermometers and cooling elements;
• vaccines cannot be stored for a long time; their quantity must correspond to the number of vaccinations currently planned;
• location of vaccines and cooling elements;
• cabinet for instruments and medicines;
• boxes with sterile material, scissors, tweezers, kidney-shaped trays;
• changing table and/or medical couch;
• marked tables for preparing drugs for use (at least 3);
• cabinet for storing documents;
• container with disinfectant solution;
• ammonia, ethyl alcohol, a mixture of ether and alcohol, or acetone;
• tonometer, thermometers, disposable syringes, electric suction device.

To combat shock, the following tools should be available in the office:

• solutions of adrenaline 0.1%, mesaton 1%, or norepinephrine 0.2%;
• prednisolone, dexamethasone or hydrocortisone in ampoules;
• solutions: 1% Tavegil, 2% Suprastin, 2.4% euphyllin, 0.9% sodium chloride; cardiac glycosides (strophanthin, corglycon);
• packaging of a metered-dose aerosol of beta-agonist (salbutamol, etc.)

Preparation of vaccines for administration is carried out in strict accordance with the instructions for use of the drug. Before using any vaccine or solvent for the vaccine, you should check the presence of a label on the vial or ampoule:

• whether the selected vaccine complies with the doctor's prescription;
• whether the selected solvent is suitable for the given vaccine;
• whether the vaccine and/or diluent have expired;
• are there any visible signs of damage to the bottle or ampoule;
• whether there are any visible signs of contamination of the contents of the vial or ampoule (presence of suspicious floating particles, change in colour, turbidity, etc.), whether the appearance of the vaccine (before and after reconstitution) corresponds to its description given in the instructions;
• for toxoids, hepatitis B vaccine and other adsorbed vaccines and solvents - are there any visible signs that they have been frozen.

If any of the listed signs raise doubts about the quality of the vaccine or solvent, this drug should not be used.

Opening of ampoules, dissolution of lyophilized vaccines is carried out in accordance with the instructions in strict compliance with aseptic rules. The vaccine from multi-dose vials can be used during the working day in accordance with the instructions for its use, subject to the following conditions:

• each dose of vaccine is taken from the vial in compliance with aseptic rules;
• vaccines are stored at temperatures from 2 to 8°;
• Reconstituted vaccines are used immediately and cannot be stored.

In order to save vaccines, WHO recommended rules for using opened vials of OPV, HBV, DTP, ADS, ADS-M, AS for subsequent immunization, subject to the following conditions:

• o all sterility rules are observed, including treating the stopper with alcohol before each dose is taken;
• o vaccines are stored in appropriate conditions at a temperature of 0-8°
• o opened vials that were taken from a medical institution are destroyed at the end of the working day.

At the end of the working day, open vials of BCG, ZIV, and yellow fever vaccines are destroyed. The vial with the vaccine is destroyed immediately if:

• the rules of sterility were violated or
• there is a suspicion of contamination of the opened bottle.

Mixing vaccines and solvents from incomplete open vials is not allowed. The solvent for reconstituting lyophilized vaccines must have a temperature of 2 to 8°, which is ensured by storing the solvent together with the vaccine in the refrigerator of the vaccination room. A separate sterile syringe with a sterile needle is used to reconstitute the vaccine in each vial. Reuse of a syringe and needle already used for mixing the solvent and vaccine is not allowed. Pre-filling of the vaccine into syringes and subsequent storage of the vaccine in syringes is not allowed.

The instruments used for vaccination (syringes, needles, scarifiers) must be disposable and must be rendered unusable in the presence of the person being vaccinated or his/her parent. It is preferable to use self-destructing (self-blocking) syringes.

Self-destructing (self-locking) syringes - in Russia, BD - Becton Dickinson syringes are used: BD SoloShot™ LX (for BCG administration) and BD SoloShot IX (for other vaccines administered in doses of 0.5 and 1.0 ml). BD SoloShot syringes were created in cooperation with WHO, they exclude reuse, so their use virtually eliminates the risk of spreading "blood" pathogens (hepatitis B, C, HIV, etc.) from patient to patient. Unlike conventional ones, the plunger of the SR syringe can be pulled back only once, after which it is blocked. The transverse marking of the cylinder allows for precise dose setting, SR syringes have a fixed volume, they have no dead space, which increases the accuracy of vaccine dosing, reducing the risk of complications and saving the vaccine. After the injection, the SR syringe is discarded without disassembling it or washing it manually, which reduces the risk of infection of the healthcare worker and his labor costs.

The injection technique with the SR syringe is standard, however, health workers need to practice using it during training on at least two SR syringes before they begin using them on their own.

Rules for using SR syringes:

• Use a new needle and a new syringe for each injection,
• Open the packaging (making sure it is intact), remove the cap from the needle without touching the cannula, and discard it in the waste container.
• Do not pull back the plunger until you are ready to fill the syringe with vaccine, otherwise the syringe will become damaged.
• After piercing the rubber cap of the bottle with a needle, gently pull the plunger back, filling the SR syringe just above the 0.5 ml mark - to release excess air.
• Remove the syringe from the bottle, do not put the cap on the needle (risk of needle stick!).
• To move air bubbles into the cannula, hold the syringe with the needle facing up and tap the body of the syringe without touching the cannula or needle.
• Pull back on the plunger slightly to allow the air in the needle to come into contact with the air bubbles inside the syringe, then gently press the plunger to release any remaining air.
• Stop when you reach the 0.5 ml mark.
• If there is air left in the syringe (or less than 0.5 of the vaccine remains in the syringe), destroy the syringe and repeat the procedure, as it is impossible to vaccinate with an incomplete dose of the vaccine.
• Administer the vaccine.
• Do not put the cap back on, remove or manually break the needle.
• Place the syringe with the needle (or first remove the needle with a needle cutter) in a safe container for disinfection.
• The needles are disinfected together with the puncture-proof container into which they are automatically placed when they are cut off from the syringe.

The injection site is usually treated with 70% alcohol, unless otherwise indicated (for example, with ether when performing the Mantoux test or administering the BCG vaccine, and with acetone or a mixture of alcohol and ether when using the scarification method of immunization with live vaccines - in the latter case, the diluted vaccine is applied to the skin after the disinfectant liquid has completely evaporated).

When carrying out vaccination, it is necessary to strictly adhere to the regulated dose (volume) of the vaccine. In sorbed preparations and BCG, poor mixing can change the dose, therefore, the requirement to "shake thoroughly before use" must be taken very seriously.

The vaccination is carried out in a lying or sitting position to avoid fainting, which occasionally occurs during the procedure in adolescents and adults.

Observation of vaccinated persons is carried out during the first 30 minutes after vaccination directly by a doctor (paramedic), when the development of immediate anaphylactic reactions is theoretically possible. The child's parents are informed about possible reactions and symptoms requiring a visit to the doctor. Then the vaccinated person should be observed by a visiting nurse for the first 3 days after the administration of inactivated vaccines and on the 5-6 and 10-11 day after the administration of live vaccines. Unusual reactions and complications are subject to careful analysis.

Information on the vaccination carried out is entered into the registration forms (No. 112, 63 and 26), vaccination logs and the Certificate of Preventive Vaccinations indicating the batch number, expiration date, manufacturer, date of administration, and nature of the reaction. When vaccination is carried out by a private practitioner, a detailed certificate should be issued or information entered into the Certificate.

The vaccination room is cleaned twice a day using disinfectant solutions. A general cleaning of the room is carried out once a week.

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