Chapter 2 Part B: Vaccine Administration,
with Dr. Brett Petersen.
The site of vaccination is the upper arm
over the deltoid muscle.
No other sites on the body have been well studied
or approved by the FDA.
Do not perform skin preparation unless the skin
at the intended site of vaccination is obviously dirty.
If skin preparation is needed, use an alcohol swab
to clean the area, and allow the skin to dry completely.
If the skin is not completely dry, inactivation
of the live vaccinia virus by the alcohol could occur.
ACAM2000 smallpox vaccine is administered
by the percutaneous route through multiple punctures
to the skin using a bifurcated needle.
ACAM2000 should not be administered
by the intramuscular, intradermal,
subcutaneous, or intravenous route.
Only the multiple puncture vaccination technique will
confer the necessary immunity.
Prior to vaccination, carefully inspect the individually
packaged bifurcated needle to ensure
that the package and seal are intact.
Do not use the bifurcated needle
if the package appears compromised, damaged,
or tampered with and dispose of it
in a biohazard sharps container.
In a smallpox emergency,
supplies of bifurcated needles may be limited.
Therefore, during an emergency the FDA authorizes the
distribution and use
of bifurcated needles currently stored
in the Strategic National Stockpile
that are either past their labeled expiration date
or that do not have an expiration date.
Do not be alarmed by any expired dates on the packaging.
All bifurcated needles provided whether
within their labeled expiration date,
past their labeled expiration date,
or without an expiration date are all usable products.
Don new gloves before each patient contact
and remove the stopper from the reconstituted vaccine vial.
Remove the bifurcated needle from its packaging.
Be careful not to touch the bifurcated, pointed end.
Submerge the bifurcated end of the needle
in the reconstituted vaccine solution.
The needle will pick up a droplet of vaccine
within the fork of the bifurcation.
Do not insert the upper part of the needle that has been
in contact with fingers into the vaccine vial,
and never re-dip the needle into the vaccine vial
if the needle has touched skin.
We will now describe how to administer ACAM2000
by the multiple puncture vaccination technique using a
bifurcated needle.
Deposit the droplet of vaccine onto the clean,
dry skin of the upper arm over the insertion
of the deltoid muscle.
Hold the needle between your thumb
and first finger perpendicular to the skin.
Rest the wrist of the hand holding the needle
against the individual's arm.
Rapidly make 15 jabs of the needle perpendicular to the skin
to puncture the skin, within a diameter of about 5 millimeters.
The jabs should be vigorous enough so that a drop
of blood appears at the vaccination site.
Discard the needle in a biohazard sharps container.
Remember, bifurcated needles are for single patient use only.
Wipe off any excess droplets of vaccine
and blood off the skin using a dry gauze pad
and discard the pad in a biohazard container.
Close the vaccine vial by reinserting the rubber stopper.
Remember, after reconstitution, the vaccine must be administered
within 8 hours if kept at room temperature.
Following vaccination, cover the vaccination site loosely
with a gauze bandage or other porous, absorbent materials
that can absorb exudates, and use medical adhesive
or paper tape to keep it in place, if needed.
This bandage provides a barrier to protect against spread
of the vaccinia virus.
Do not put salves, ointments, or creams on the vaccination site.
Immediately wash your hands with soap and water
or use an alcohol-based hand rub,
if you have had direct contact with the open vaccination site
or contaminated materials used during vaccination
administration to prevent spread of vaccinia virus.
After vaccination, vigilant hand washing
and proper vaccination site care will be important
to prevent the spread of vaccinia virus.
Recently vaccinated healthcare workers or individuals
who provide direct patient care must take additional vaccination
site precautions while at work.
The vaccination site should be covered
with an absorbent material such as gauze along
with an additional semi-permeable dressing
to provide an additional barrier.
Long-sleeved clothing to cover the entire vaccination site is
also encouraged.
Here is the multiple puncture technique again.
Instructions, such as the ACAM2000 Package Insert
and Medication Guide, are included
with each vaccine shipment.
They also outline the multiple puncture vaccination technique
used to administer ACAM2000
and contain other important information
about smallpox vaccine.
You can also find more information at:
www.cdc.gov/smallpox.