Influenza Vaccine Clinic Orientation for nurses

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Influenza Vaccine Clinic Orientationfor nurses
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Welcome

• Thank you for your assistance today.

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Nursing

• Non ADH and ADH Non-Clinical
• Attend orientation
• Non-ADH nurses
• Provide current Arkansas Nursing License
• Picture ID
• Sign Volunteer Indemnity form

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Trivalent Influenza Vaccine (TIV)

• Two preservative free vaccine products
• For 6months through 35months of age
• (pre-filled syringe with 0.25 ml)
• B. Two preparations for people 3 years of age
• Prefilled syringe with 0.50 ml
• Single dose vial
• ADH will not administer LAIV

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ADH Recommendations Children Age 6 Months-8 Years

• Children 6 months through 8 years of age who did
  not receive the recommended second dose of
  influenza vaccine in the initial year that they
  received influenza vaccine should receive 2 doses
  during the next influenza season.
• Children 6 months through 8 years of age who are
  being vaccinated two or more seasons after
  receiving an influenza vaccine for the first time
  should receive a single annual dose, regardless
  of the number of doses administered previously.

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Influenza Vaccination of Children 6 Months
through 8 Yrs of Age

• Prior Vaccination This Year
• 1 dose last year 2 doses
  
• (only dose)
• 1 dose 2 yrs ago, 1 1 dose
• dose last year
• 1 dose 2 yrs ago 1 dose
• (only dose)

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Vaccine

• Approx 2 weeks after vaccine-antibodies develop
• Common reactions
• Soreness/erythema/induration at site lasting 1-2
  days (15-20)
• Fever/chills/malaise/myalgias lasting 1-2 days
  (lt1)
• Rare immediate hypersensitivity allergic
  reactions (hives/angioedema/allergic
  asthma/systemic anaphylaxis)

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Indications

• Any person who wishes to reduce the likelihood of
  becoming ill or transmitting influenza
• Inactivated influenza vaccine can be given to
  anyone 6 months of age or older, including
  breastfeeding and pregnant women

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Recommendations

• Children and adults at risk of having
  complications from disease
• ALL children and adolescents age 6 months-18
  years
• ALL adults gt 19 years
• Travelers
• General population
• Persons who provide essential community services
• Students or other persons in institutional
  settings
• Routine annual vaccination of all children 6
  months-18 years is a new addition to the ACIP
  recommendations for the influenza season 2009-2010

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People at Increased Risk of Influenza
Complications

• Children ages 6 months through 4 years
• People gt50 years of age
• Children/adolescents (ages 6 months through 18
  years) receiving long-term aspirin therapy
• Women who will be pregnant during the flu season
• Adults/children with chronic disorders of the
  pulmonary or cardiovascular systems, including
  asthma (hypertension is not considered a
  high-risk condition)

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continued

• Adults and children who are immunosuppressed
• Adults and children who have any condition that
  can compromise respiratory function or the
  handling of respiratory secretions or that can
  increase the risk for aspiration
• Residents of nursing homes/chronic-care
  facilities

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To prevent transmission to those who are at high
risk for influenza-related complications

• Immunize the people who live with or care for
  them!

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People Who are Transmission Sources

• Healthy household contacts and caregivers of
• children ages 0-59 months
• persons gt 50 years old
• persons at high risk for severe complications
  from influenza

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continued

• Health Care Providers
• People who provide home care to persons in groups
  at high risk
• People working in health-care settings include
  physicians, nurses, and other workers in
  hospitals, long term care facilities, assisted
  living and outpatient-care settings
• Medical emergency response workers
• Students in these professions who will have
  contact with patients

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Contraindications

• People who had a severe (anaphylactic) reaction
  to chicken eggs
• People who had a severe reaction to a flu
  vaccination in the past
• Children lt6mo of age
• People who developed Guillain-Barre' syndrome
  following influenza vaccination (requires a
  consultation with patients physician).

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Clinic Flow

• Patient enters clinic/site
• Route to screening area
• Some clinics may have designated family or
  special needs area or line
• Give VIS (Vaccine Information Statement)
• Route to Data Intake area to complete Imm-Flu
  form (name/age/dob/etc)
• Route to nursing station for vaccination

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Nursing Station

• Greet patient/collect Imm-Flu form
• Screen for contraindications/precautions
• Answer all questions
• Patient sign and date Imm Flu form
• Nurse administer vaccine
• Nurse complete Imm Flu form
• Shot code
• Site/dosage/lot
• Nurse signature
• Route patient to exit

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Vaccine Administration

• Sites
• Infants vastus lateralis (anterolateral thigh)
• Young children over the age of 12
  months-anterolateral aspect of the thigh may be
  used if the deltoid is underdeveloped
• Adults and older children deltoid (upper arm)
• Dosage
• Infants 6mo through 35mo of age 0.25ml IM
• 3 years old and older 0.5ml IM
• (Vaccinator assistants (physicians and nurses)
  may prefill syringes with vaccine preparing just
  enough vaccine to meet the clinics needs on an
  ongoing basis. Discard any vaccine-filled
  syringes after the clinic closes.)

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Injection TechniqueNursing 101
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Injection TechniqueNursing 101 (1)

• Determine appropriate injection site

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Injection Technique,Continued (2)

• Prep site with alcohol wipe/cotton ball
• Using circular motion/wipe from center out/allow
  to dry

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Injection Technique,Continued (3)

• Spread skin taut between thumb and forefinger OR
  grasp tissue and bunch up muscle. (acceptable
  for pediatric and geriatric patients)
• Insert needle fully into muscle at 90 degree
  angle and inject vaccine quickly.

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Nursing 101

• Withdraw needle and apply light pressure to site
  for several seconds with dry cotton ball or gauze
• Dispose of needle in sharps container

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Standard Precautions
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Standard Precautions
Hand washing-if soap and water not available-use
alcohol-based waterless cleanser between each
patient (available at each nursing station)
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Standard Precautions,contd.
Gloves-not mandatory unless provider has open
lesion on hands. (Available at each nursing
station) If latex free gloves required-contact
nursing coordinator
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Remember

• Gloves will not protect from needle stick
  injuries

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Needle Safety

• DO NOT
• Detach used needles from syringe
• Recap used needle
• Bend or break used needle before disposing
• If needle stick injury occurs-report IMMEDIATELY
  to the nursing
• coordinator

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Clinic Site

• A nursing coordinator will be at each clinic site
  for your assistance- can answer questions as
  needed
• Locate emergency kit/first aid station at each
  clinic site.

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THANK YOUTHANK YOUTHANK YOUTHANK YOUTHANK YOU
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You are appreciated