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(IPC) Principles and Procedures for COVID-19 Vaccination Activities

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(IPC) Principles and Procedures for COVID-19 Vaccination Activities AIDE-MEMOIRE Infection prevention and control (IPC) principles and procedures for COVID-19 vaccination activities This document summarizes the key IPC principles information regarding IPC measures for safe to consider and the precautions for safely COVID-19 vaccine delivery. delivering COVID-19 vaccines. A clean, hygienic and well ventilated environment3,4,5,6, appropriate waste The principles and recommendations provided in management5,6,7 and adequate spaces that AND CONTROL INFECTION PREVENTION this document derive from World Health facilitate best IPC practices (e.g. physical Organization (WHO) IPC and immunization distancing) are necessary for COVID-19 standards and other guidance in the context of vaccination activities. COVID-19 and are the result of consultations and National guidance and protocols for IPC consensus with the United Nations Children’s measures including those related to COVID-19, Fund (UNICEF) and the ad hoc WHO COVID-19 should be consulted and adhered to. IPC Guidance Development Group (COVID-19 IPC 2021 15 JANUARY GDG). Preparation and planning phase This document is intended for policy makers, immunization programme managers, IPC focal Staff points at national, sub-national, and facility level, Appoint a facility IPC focal point8 for the as well as for health workers involved in COVID-19 planning, deployment and monitoring of the vaccination delivery. vaccination activities. Identify an adequate number of vaccinators to ensure there is sufficient staff and time to Key overall IPC principles for COVID-19 support correct implementation of the IPC vaccine deployment practices required to safely administer the vaccine. Standard precautions1 to be applied during Identify trained staff to deliver IPC training to any vaccination activity are also valid for those involved in vaccination activities COVID-19 vaccine delivery, considering that (including managers, logisticians, vaccinators, the population to be vaccinated consists of cleaners and health workers dedicated to individuals not presenting signs and symptoms screening) and to provide information for of infection. clients to be vaccinated. However, additional IPC precautions are Identify health workers for the supervision of necessary in the context of the COVID-19 vaccination activities and define a monitoring pandemic to reduce the risk of SARS-CoV-2 and evaluation process of IPC practices, transmission (e.g. mask use)2,3. including providing feedback to vaccinators It is critical to provide health workers with and other staff as required. specific training and the public with targeted 1 Standard precautions in health care. Aide memoire. Geneva: World Health 5 Immunization in Practice. A practical guide for health staff 2015 update. Geneva: Organization; 2007 (https://www.who.int/csr/resources/publications/ World Health Organization; 2015 (https://apps.who.int/iris/handle/10665/193412, standardprecautions/en/, accessed 5 January 2021). accessed 5 January 2021). 2 Mask use in the context of COVID-19: interim guidance, 1 December 2020. 6 Injection providers’ guide for safe injections. Geneva: World Health Organization; Geneva: World Health Organization; 2020 (https://apps.who.int/iris/ 2017 (http://158.232.12.119/infection-prevention/tools/injections/IS_providers-guide. handle/10665/337199, accessed 5 January 2021). pdf, accessed 14 January 2021). 3 Infection prevention and control during health care when coronavirus disease 7 Water, sanitation, hygiene, and waste management for SARS-CoV-2, the virus that (COVID-19)is suspected or confirmed: interim guidance, 29 June 2020. Geneva: causes COVID-19: interim guidance, 29 July 2020. Geneva: World Health World Health Organization; 2020 (https://apps.who.int/iris/handle/10665/332879, Organization& United Nations Children’s Fund (UNICEF); 2020 accessed 5 January 2021). (https://apps.who.int/iris/handle/10665/333560, accessed 5 January 2021). 4 Cleaning and disinfection of environmental surfaces in the context of COVID-19: 8 Minimum requirements for infection prevention and control programmes. Geneva: interim guidance, 15 May 2020. Geneva: World Health Organization; 2020 (https:// World Health Organization; 2019 (https://apps.who.int/iris/handle/10665/330080, apps.who.int/iris/handle/10665/332096, accessed 5 January 2021). accessed on 5 January 2021). 1 World Health Organization 2021 Guidance in these areas, the ventilation rate should Develop local IPC guidance and standard be 6 air changes per hour9 or according to operating procedures for COVID-19 national or local requirements; vaccination, outlining the following: • medically equipped post-vaccination • screening policies for COVID-19 signs and observation area for dealing with possible symptoms of staff and individuals arriving vaccine adverse reactions; for vaccination with clear exclusion criteria; • adequate number of hand hygiene • key IPC measures to be taken by anyone stations in strategic areas to support in the vaccination area or clinic (see appropriate hand hygiene for the public below); and staff (i.e., at the entrance and exit • key IPC measures for safely administering areas, in the waiting areas, and in each COVID-19 vaccines; vaccination station); • cleaning and disinfection of the • signage/posters to include reminders environment; about: • appropriate waste management also reporting COVID-19 signs and considering the increase of waste symptoms; associated with COVID-19 vaccination mask wearing; activities, including environmentally hand and respiratory hygiene; friendly treatment methodologies and physical distancing (e.g. floor markings, solutions to minimize both general and seating arrangements, tape, ropes, and medical waste at point of use, cones); segregation, disposal and collection; • adequate space for vaccine storage and • visual reminders emphasizing hand preparation (e.g. clean and hygienic hygiene, safe injection practices, safe use environment, adequate ventilation and of medical masks, respiratory hygiene, equipment to adhere to specific COVID-19 and other IPC measures; vaccine cold chain requirements); • training materials for relevant staff and • vaccination stations a least 1 metre apart educational and informational materials for (ideally with installation of physical barriers the public. between vaccination stations); • adequate cleanability of screening areas, Environmental considerations and engineering vaccination stations, waiting areas (e.g. controls at the vaccination site removal of items that cannot be readily Assess the layout of the building or area decontaminated and minimizing clutter to identified for vaccination delivery and ensure aid effective cleaning); that the following features are in place to • appropriate waste management system support appropriate IPC implementation: including safe disposal of waste (such as • clearly marked one-way foot traffic flow vials and masks) and sharps at each with clear entry and exit areas through the vaccination station. vaccination clinic; these should be separated when the vaccination area or IPC supplies clinic is located in a health care facility; Ensure continuous and sufficient availability of • adequate screening area (ideally, private the following: spaces) at the entry where people are • adequate supplies of medical masks for assessed, including questioning for signs health workers and for individuals to be and symptoms of COVID-19 and other vaccinated who may not have a mask; criteria for inclusion; • sufficient supplies of other personal • sufficient space to allow at least 1 metre protective equipment (PPE), including eye physical distance between all individuals protection, gloves and gowns, in case it is including between health workers at all required for health workers’ protection stations (at the entrance, at the screening when dealing with vaccine adverse events, stages, while waiting to be vaccinated and to prevent exposure of non-intact skin to during the observation period post- blood or body fluids or if a suspected case vaccination) and between staff; of COVID-19 is identified during the • adequate ventilation (mechanical, natural screening process; or hybrid) of all areas, including the • other supplies: screening, waiting, post-vaccination soap, clean water, Veronica Buckets (if observation, and vaccination areas; if a sinks are not available) and disposable mechanical ventilation system is operating or clean towels; 9 ANSI/ASHRAE/ASHE Addendum a to ANSI/ASHRAE/ASHE Standard 170-2017 standards-and-guidelines/standards-addenda/ansi-ashrae-ashe-standard-170- Ventilation of Health Care Facilities (https://www.ashrae.org/technical-resources/ 2017-ventilation-of-health-care-facilities, accessed on 11 January 2020). 2 alcohol-based hand rub products; Vaccinators should always perform hand thermo-scans for temperature hygiene before putting on and removing PPE screening; (e.g. mask), before preparing the vaccine and tissues; between each vaccine administration (see waste bins/waste bags; Figure 1), preferably using alcohol-based hand safety boxes, preferably puncture- and rubs, which have advantages for logistics, leak-proof; efficacy and tolerability12. cleaning and disinfection equipment Gloves are not required and, if used, do not and products; replace the need for performing hand hygiene visual reminders and signage/floor between each vaccine administration and for markers; other indications5,13. physical barriers to aid spatial Applying alcohol-based hand rubs on gloved separation. hands is strongly discouraged. If gloves
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