Chapter 3: How to care for the smallpox vaccination site
and prevent the spread of vaccinia virus,
with Dr. Brett Petersen.
In Chapter 3 of this training video we will provide
instructions on how to care for the smallpox vaccination site
and how to prevent the spread of vaccinia virus.
Successful smallpox vaccination produces a pustular lesion
on the skin.
Vaccinia virus can shed from an active lesion
until the scab separates from the skin,
about 2 to 4 weeks after vaccination.
During this time before the scabbing occurs,
proper infection control must be taken
to prevent accidental self-inoculation or spread
of the virus from the vaccination site to other areas
of the body and to prevent contact transmission or spread
of the virus from the vaccination site
to other persons through close, physical contact.
It is critical to educate vaccinees on how
to practice good hand hygiene, how to properly care
for their vaccination site, and how to properly handle
and dispose of contaminated material.
These practices will also reduce the chances
of secondary bacterial infection at the vaccination site.
Provide the following instructions: Vaccinees need
to consistently perform thorough hand washing with soap and water
or use of an alcohol-based hand-rub solution,
usually greater than 60 percent is sufficient,
after any direct contact with the site and after contact
with materials that have come into contact
with the vaccination site or vaccine virus.
This is one of the most important measures
to prevent transmission of vaccinia virus to another person
to another part of the body.
Vaccinees are encouraged to wear gloves, if available,
when caring for their vaccination site.
Used gloves should then be disposed
of in a sealed plastic bag with a small amount of bleach.
Vaccinees will need to keep the entire vaccination site covered
until the scab falls off on its own, which is generally
up to 4 weeks but could be longer.
This is especially important when handling infants
and young children during breastfeeding
or when participating
in intimate activities such as having sex.
Do not routinely use a non-porous bandage
that blocks air from the vaccination site.
This may cause the skin at the vaccination site to soften
and wear away or lengthen the time of healing at the site.
The vaccination site bandage must be changed every 3 days
or sooner if the bandage gets dirty or wet
until the scab falls off.
This will keep the skin at the vaccination site intact
and minimize softening.
Dispose of contaminated bandages properly in order
to prevent others from coming into direct contact with them.
Vaccinees can do this by placing used dressings
in sealed plastic bags with a small amount of bleach
to kill the virus before disposal in the trash.
Once the vaccination site scab falls off,
vaccinees should also dispose of the scab
in a sealed plastic bag with bleach.
Immediately after proper disposal, hands must be washed.
The vaccination site will itch as it heals.
Vaccinees must make a conscious effort not to scratch or touch
or pick at the scab until the scab has fallen off on its own
in about 2 to 4 weeks.
Vaccinees must avoid touching their eyes or other parts
of their body when caring for their vaccination site.
Vaccinees should also consider wearing long-sleeved clothing
in addition to their bandage to help cover the vaccination site,
particularly when sleeping, to avoid scratching the lesion
or contaminating their bedding while sleeping.
It is extremely important that others,
including household pets, do not come into contact
with the active vaccination site or contaminated materials
from the site in order to avoid accidental spread
of vaccinia virus to household members
or other close contacts and/or pets.
Do not use salves, ointments, including topical antibiotics,
or creams on the vaccination site
as these can cause an occlusive barrier that may cause the skin
at the vaccination site to soften and wear away,
which can prevent the vaccination site
from forming a scab properly.
Vaccinees should separately wash clothing, towels, bedding
or other items that may have come in direct contact
with the vaccination site using hot water
with detergent and/or bleach.
Immediately after handling contaminated laundry,
hands must be washed.
The vaccination site needs to be kept dry,
although normal bathing and activities can continue.
A waterproof bandage can be used while bathing or exercising.
The site should not be scrubbed.
After bathing or exercise,
vaccinees must remove the waterproof bandage
and then cover the vaccination site
with a porous bandage afterwards.
If the bandage soaks through, then it should be changed.
If the site gets wet, then it should be dried
with a paper towel, gauze, or a disposable cloth
that can then be disposed of in a sealed plastic bag
with a small amount of bleach before disposal in the trash.
Immediately after a bandage change or drying
of the site, hands must be washed.
Do not use cloth towels to dry the site
because they can spread the virus.