Vaccination is an important aspect of prevention of several infections but at times, it may lead to complications by virtue of technical mishaps. Before recommending vaccine to anyone, practitioner must ensure the technical aspects of vaccine administration. One should ensure following points:
Right patient
Right vaccine/diluents
Right time
Right dose
Right route
Right site
Right technique
Right documentation
Right storage and handling– maintain correct temperature.
The schedule, dosing, route, and site have already been discussed previously. Here, we will focus on the technical aspect of vaccine administration.
Administration of vaccines:
Occupational health and safety issues – Utmost care should be practiced while administering vaccine so as to minimize the risk of needle stick injury and exposure to blood and body fluids. A new, sterile, disposable syringe and needle must be used for each injection. Used items must be discarded into a clearly labeled container as per biomedical waste management protocol. Vaccine providers should be aware of disposal and handling sharp containers
Equipment for vaccination – Appropriate equipment required for vaccination, such as appropriate size, gauge of needle should be used [Table 17]. Correct vaccines should be selected, maintained at correct temperature, and prepared as per requirement of the said vaccine (for example, reconstituted or prefilled vaccine). Vaccines should never be mixed in one syringe, and local anesthetic should not be mixed with a vaccine. Multidose vials should not be used. If unavoidable, extra precautions must be utilized to avoid contamination and maintain sterility
Preparation for vaccine administration – The receiver should be made comfortable and in adequate position. There is a potential of syncope after the vaccination and appropriate measures should be taken to prevent it. Hence, receiver should be adequately seated or lying. One may clean the skin using alcohol swab. Topical anesthetic may be used, if required, in children who are apprehensive, but at recommended time before the procedure
Recommended injection sites are anterolateral thigh (for infants) and the deltoid (for adults). Ventrogluteal region is an alternative site for all ages [Figure 1]
-
Vaccination injection technique – Hand washing with soap and water or alcohol-based waterless antiseptic is recommended before vaccine preparation. For multiple injections, the most painful dose should be given as last vaccine. The correct route of administration should be ensured for individual vaccine
- Intramuscular injection – use appropriate needle, position the limb, pierce the needle at 90°
- Subcutaneous injection – use appropriate needle, pierce at 45° [Figure 2]
- Intradermal injection – requires expertise and should be administered only be specialists.
Postvaccination – After vaccination, receiver should be observed for about 15 min. Vaccination-related events should be noted and informed to regulatory authorities.
Table 17.
Description of vaccine administration site and route
Figure 1.
Preferred site for vaccine injections (diagrammatic)
Figure 2.
Technique of administering vaccines
Contraindications and precautions of each vaccine should be followed at each visit.
There should be a checklist for immunization at all facility centers. The checklist should include education, protocol of administration, vaccine handling, administering immunization, and recording of procedures. The checklist should be filled at every visit for individual receiver.