Organization of inoculum and vaccination

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

The equipment of each inoculum should include:

• instructions on the use of used vaccines and other recommendations;
• refrigerator, intended only for storing vaccines with 2 thermometers and cold cells;
• vaccines can not be stored for a long time, their number should correspond to the number of vaccinations planned to date;
• location of vaccines and cold cells;
• a cabinet for tools and medicines;
• Bixes with sterile material, scissors, tweezers, kidney-shaped trays;
• a changing table and / or a medical couch;
• labeled tables for preparing preparations for use (at least 3);
• a locker for storing documentation;
• container with disinfectant solution;
• ammonia, ethyl alcohol, a mixture of ether with alcohol or acetone;
• tonometers, thermometers, disposable syringes, electric pump.

To combat shock in the office should be the following means:

• adrenaline solutions 0.1%, mezatonone 1%, or norepinephrine 0.2%;
• prednisolone, dexamethasone or hydrocortisone in ampoules;
• solutions: 1% Tavegil, 2% Suprastin, 2.4% euphillin, 0.9% sodium chloride; cardiac glycosides (strophanthin, korglikon);
• packing of the metered-dose aerosol of the 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 to the vaccine, check the label on the vial or ampoule:

• whether the chosen vaccine is appropriate for the appointment of a doctor;
• whether the chosen solvent corresponds to this vaccine;
• the expiry date of the vaccine and / or solvent has expired;
• there are no visible signs of damage to the vial or ampoule;
  
• whether there are visible signs of contamination of the contents of the vial or ampoule (the presence of suspicious floating particles, discoloration, turbidity, etc.), whether the appearance of the vaccine (before and after recovery) corresponds to the description given in the instruction;
• for anatoxins, hepatitis B vaccine and other sorbed vaccines and solvents - are there any visible signs that they have been frozen.

If, for any of the above, the quality of the vaccine or solvent is questionable - this drug can not be used.

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

• taking each dose of the vaccine from the vial is carried out in accordance with the rules of asepsis;
• vaccines are stored at a temperature of 2 to 8 °;
• Restored vaccines are used immediately and are not subject to storage.

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

• o All sterility rules are observed, incl. Treatment of the cork with alcohol before each dose;
• o vaccines are stored under appropriate conditions at a temperature of 0-8 °
• The opened bottles, which were taken from the medical-prophylactic institution, are destroyed at the end of the working day.

At the end of the working day, destroy the opened bottles with BCG vaccines, HCV, against yellow fever. The vial of the vaccine is immediately destroyed if:

• sterilization rules were violated or
• there is a suspicion of contamination of the opened vial.

It is not allowed to mix vaccines and solvents from incomplete open vials. The solvent for reconstitution of freeze dried vaccines should have a temperature in the range of 2 to 8 °, which is ensured by storing the solvent together with the vaccine in the refrigerator of the vaccination cabinet. To restore the vaccine, a separate sterile syringe with a sterile needle is used in each vial. Repeated use of the syringe and needle already used to mix the solvent and vaccine is not allowed. Pre-vaccination in syringes and the subsequent storage of vaccine in syringes are not permitted in advance.

The toolkit used for vaccination (syringes, needles, scarifiers) should be disposable and be rendered unusable in the presence of the vaccinated or his parent. Preferably use self-destruct (self-locking) syringes.

Self-destructive (self-blocking) syringes - Russia uses syringes and BD companies - Becton Dickinson: BD SoloShot ™ LX (for the introduction of BCG) and BD SoloShot IX (for other vaccines administered at a dose of 0.5 and 1.0 ml). BD SoloShot syringes were created in cooperation with WHO, they exclude reuse, so that the use practically eliminates the risk of spreading from the patient to the patient "blood" pathogens (hepatitis B, C, HIV, etc.). Unlike usual, the piston of a CP-syringe can be withdrawn only once, after which it is blocked. The transverse marking of the cylinder allows for accurate dose setting, CP syringes have a fixed volume, they do not have dead space, which improves the accuracy of the vaccine dosage, reducing the risk of complications and saving the vaccine. After injection, the CP-syringe is discarded without disassembling and washing by hand, which reduces the risk of infection of the health worker and the costs of his labor.

The technique of injecting a CP syringe is common, however, health workers need to practice using at least two SR syringes during the training before starting to use them independently.

Rules for the use of CP-syringes:

• Use a new needle and a new syringe for each injection,
• Open the package (having convinced of its integrity), remove the cap from the needle, without touching the cannula, and discard it in the waste container.
• Do not pull the piston back until you are ready to fill the syringe with the vaccine, otherwise the syringe will be disabled.
• Puncture the rubber cap of the vial with a needle, gently pull the piston back, filling the CP-syringe just above the 0.5 ml mark - to release excess air.
• Remove the syringe from the vial, do not put the cap on the needle (risk of needle sticking!).
• To move the air bubbles into the cannula while holding the syringe with the needle up, tap the syringe body, without touching the cannula and needle.
• Slightly pull the piston so that the air in the needle contacts the air bubbles inside the syringe, then gently press the piston, releasing the remaining air.
• Stop when you reach the 0.5 ml mark.
• If there is air left in the syringe (or there are less than 0.5 vaccines left in the syringe), destroy the syringe and repeat the procedure. Can not be vaccinated with an incomplete dose of the vaccine.
• Enter the vaccine.
• Do not wear the cap, do not detach or manually break the needle
• Place the syringe with the needle (or, first, separate the needle with the needle cutter) in a safe container for disinfection.
• The needles are disinfected with an impenetrable container, where they enter automatically when cut off from the syringe.

Treatment of the place of administration of the vaccine is usually performed with 70% alcohol, unless otherwise indicated (for example, by ether when Mantoux is given or BCG vaccine and acetone or a mixture of alcohol and ether are added with the scarification method of immunization with live vaccines - in the latter case, the diluted vaccine is applied on the skin after complete evaporation of the disinfecting liquid).

When carrying out the vaccination, the prescribed dose (volume) of the vaccine should be strictly observed. In sorbed preparations and BCG, a change in the dose may result in poor mixing, so the requirement to "shake thoroughly before consumption" must be treated very conscientiously.

Vaccination is performed in the supine or sitting position to avoid falling with fainting, which occasionally occurs during the procedure in adolescents and adults.

Observation of the vaccinated is carried out within the first 30 minutes after vaccination directly by the doctor (paramedic), when it is theoretically possible the development of immediate reactions of the anaphylactic type. Parents of the child are informed about possible reactions and symptoms that require a doctor. Then the vaccinated sister should be observed by the visiting doctor the first 3 days after the administration of inactivated and on days 5-6 and 10-11 after the introduction of live vaccines. Unusual reactions and complications are subject to careful analysis.

Information about the vaccination is entered in the registration forms (N 112, 63 and 26), inoculation journals and the Certificate of preventive vaccinations, indicating the number of the series, the expiration date, the manufacturer, the date of introduction, the nature of the reaction. When carrying out the vaccination, the private practitioner should give a detailed certificate or enter information into the Certificate.

Cleaning inoculation cabinet is carried out 2 times a day using disinfectants. Once a week, they carry out a general cleaning of the office.

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