Covid Vaccination - GNM ANM.pptx

CoVID Vaccination GNM ANM

1. COVID Vaccination FOR GNM & ANM

2. Prevention: What to do? HAND HYGIENE RESPIRATORY HYGIENE PHYSICAL DISTANCING

3. Facility for hand washing/ sanitization at entrance Seating arrangement to ensure physical distancing of 2 gaj / 6 feet Only one person to enter vaccination room at a time Communication materials on COVID appropriate behaviour (hand hygiene, use of mask and physical distancing) to be displayed Waiting Area

4. Vaccination Room Only one beneficiary to enter vaccination room at a time to ensure privacy Logistics to be made available 2 vaccine carriers with 4 conditioned ice packs each Adequate COVID-19 vaccine vials in one of the vaccine carriers Adequate numbers of AD syringes Hand sanitizer and masks Vaccine vial opener Hub cutter Partition Screen AEFI/Anaphylaxis kit Red and yellow bags, blue puncture proof container, bag for municipal waste

5. Observation Room Will require more space as beneficiaries will wait for 30 minutes after vaccination Seating arrangement to ensure physical distancing of 6 feet Communication materials on COVID appropriate behavior to be displayed Drinking water and toilet facility should be available

6. Reach allocated session site before time Inform supervisor/ Medical Officer incharge if you are sick Wear a mask at all times Composition of team 4 Vaccination Officers with defined roles 1 Vaccinator Officer Guidance for Vaccination Teams

7. Role of Vaccination Officer - 1 May belong to police/home guard/NCC/others Will be stationed at the entry gate Will identify the beneficiary based on available list and message received by beneficiary Ask beneficiary to wash or sanitize hands before entry Advise beneficiaries to follow COVID appropriate behaviour Wear mask/ face cover Maintain physical distance from each other Be aware of cultural sensitivities like purdah/hijab Take need based support from female teammates

8. Role of Vaccination Officer - 2 Will be available inside the vaccination room Cross check the name of the beneficiary in the Co-WIN application Will verify the identity of the beneficiary through Aadhaar Card Other Govt photo ID Service ID/ Proof of employment of healthcare worker

9. Role of Vaccinator Officer Ensure privacy of beneficiary Allow only one beneficiary at a time in the vaccination room Use a partition screen Ensure a female attendant if a male vaccinator is vaccinating a female beneficiary Ensure safe injection practices Reporting vaccination in Co-WIN app Manage injection waste as per guideline Provide key messages to beneficiary Detail of the COVID vaccine given Contact the nearest ANM/ ASHA/ Medical officers for any support post vaccination You will receive the date and venue for second dose through SMS Follow COVID appropriate behavior even after vaccination Ask beneficiaries to wait for 30 minutes in observation room Manage and report AEFIs, if any. Transfer to designated AEFI Management Centre if required

10. Giving a safe injection Wash hands with soap and water before and after the session Cover any small cuts on your skin Avoid giving injections at the injection site where there is local skin lesion, cut or dermatitis Always use AD syringes for COVID-19 vaccination Use a new sterile packed AD syringe for each injection for each beneficiary Discard AD syringes that have damaged packaging, or have passed the manufacturer expiry date Do not pre-fill syringes Sanitize your hands before vaccinating each beneficiary

11. Waste Management at session Cut the hub of the syringe after giving the injection Store broken vials in the blue puncture proof container Segregate and store the plastic portion of the cut syringes in the red bag Cotton swabs soiled with blood will go in the yellow bag All other non-infectious wastes will be collected as municipal waste in a separate bag Immunization waste to be collected by designated person for safe disposal at the end of the day

12. Role of Vaccination Officer - 3 Will be available in observation room at all times Ensure that the beneficiaries maintains physical distancing of 2 gaj from each other Ensure that each beneficiary is under observation for 30 minutes Inform vaccinator in case any beneficiary has adverse event Support vaccinator to manage the AEFI and inform the Medical Officer

13. Role of Vaccination Officer - 4 Ensure COVID Vaccine IEC are displayed at the site Ensure beneficiaries are mobilized in staggered way to avoid overcrowding at the session site Ensure one influencer to be present at the venue to support the activity Inform the beneficiaries that they will be informed the day and time of subsequent dose/ vaccination Provide the contact details of ANM/ASHA/ Medical officer to beneficiary for any support post vaccination, if required

14. Specifications of COVID Vaccine Liquid vaccine Route – probably IM, can also be SC or ID Dosage per beneficiary – probably 0.5 ml/0.1 ml Multi dose vial Temperature sensitivity - Heat stable/ heat sensitive/ freeze sensitive Cold chain space volume per dose - 4.6 ml No VVM, expiry date on the vial Open Vial Policy not applicable Shake test may be applicable/ not applicable

15. Vaccine Management Clear segregation of COVID-19 vaccines and logistics from RI vaccines & logistics to avoid program error Preferable to store COVID-19 vaccines in separate CCE, if available, at CCPs If separate equipment not available, ensure clear demarcation of vaccine storage in same CCE Dedicated and segregated dry storage space for COVID-19 syringes and other logistics In case COVID-19 vaccine is freeze dried and requires diluent for reconstitution, diluents should be segregated from other RI vaccines and diluents Non – interchangeability of COVID-19 vaccines Only one type of vaccine should be planned across sessions in a day Every beneficiary must receive the 2nd dose of same vaccine

16. Steps to ensure safe disposal of immunization waste At the session site Step 3: Store the broken vaccine vials in a separate blue container, used cotton swab in the yellow bag Step 4: Plastic wrapper, cap of the syringe and any other packaging material should be segregated as general waste Step 5: The used and unused vaccine vials should be returned to the CCP as per existing AEFI guidelines for proper disposal.  

17. Steps to ensure safe disposal of immunization waste Step 6: Send the Red bag, Yellow bag, Blue bag/container and the hub cutter to CCP for disinfection and disposal or handing over to Common Biomedical Waste Treatment Facility (CBWTF). At the CCP, Disinfect the content of the yellow bag by soaking in 1% freshly prepared sodium hypochlorite solution or through autoclaving or microwaving or hydroclaving and then handover to Common Biomedical Waste Treatment Facility (CBWTF)   Send the collected materials of the blue container, red bag and hub cutter directly to the CBWTF without any onsite treatment   If the CBWTF doesn’t exist, follow Step 7 & 8 At the Cold Chain Point (CCP)

18. Steps to ensure safe disposal of immunization waste Step 7: Treat the collected material of the Red bag, Yellow bag, Blue container and the hub cutter in an autoclave. If unable to impart autoclaving, boil the waste in water for at least 10 minutes or provide chemical treatment using 1% freshly prepared sodium hypochlorite for 30 minutes At the CCP Step 8: Dispose the disinfected waste as follows: Dispose the needles in a safety pit/tank. In case of the hospitals located in remote in rural or isolated places, dispose the same in captive deep burial pits [HUB CUTTER WASTE] Send the empty glass vials (intact/ broken) for recycling [BLUE CONTAINER WASTE] Incineration or deep burial of the used cotton swab (if any)- [YELLOW BAG WASTE] Plastic part of the cut syringes should be sent to registered or authorized recyclers or to waste to energy plants or plastics to diesel or fuel oil or for road making [RED BAG WASTE]  

19. Steps to ensure safe disposal of immunization waste At the CCP Step 9: Wash the hub cutters properly with 1% freshly prepared sodium hypochlorite before reuse. Step 10: Maintain a proper record of generation, treatment and disposal of waste at the cold chain points Weigh rather than count to avoid occupational and safety hazards.

20. Minor AEFI Severe AEFI Serious AEFI Common, self limiting reactions Examples: pain, swelling at injection site, fever, irritability, malaise etc . Can be disabling and rarely life threatening Do not lead to long-term problems Examples: include non-hospitalized cases of anaphylaxis that has recovered, high fever (>102-degree F), etc. Death Inpatient hospitalization Persistent or significant disability Cluster Significant parental/community concern For purpose of reporting, AEFIs can be minor, severe and serious. TYPES OF aefi FOR REPORTING

21. Reporting AEFI All adverse events (minor, severe and serious) following COVID-19 vaccination can be reported in Co-WIN by The vaccinator through vaccinator’s module The DIO through district login in Co-WIN Only basic information is entered into Co-WIN, automatically transferred to SAFE-VAC Immediately inform severe and serious AEFI cases telephonically by vaccinator to supervisor/medical officer/DIO Case details of minor, severe and serious AEFIs to be entered in AEFI registers also

22. Four anxiety-related reactions 4 Immunization anxiety-related reaction FAINTING VOMITING Convulsions HYPERVENTILATION

23. Anaphylaxis An acute and potentially life-threatening systemic allergic reaction Usually, but not always, mediated by an immunologic mechanism Caused by the sudden release of biologically active mediators from mast cells and basophils Leading to symptoms involving the skin, respiratory tract, cardiovascular and GI systems.

24. Vasovagal vs. Anaphylaxis Vasovagal pallor diaphoresis bradycardia or NSR Anaphylaxis tachycardia flushing urticaria / pruritis / bronchospasm

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26. Initial management of Anaphylaxis Suspected anaphylaxis: Early onset and rapid progression of symptoms At least one sign/symptom related to at least two of the following three systems Respiratory Cardiovascular Dermatological/mucosal Figure 2: Anaphylaxis Kit

27. Initial management of Anaphylaxis Adrenaline is the drug of choice to treat anaphylaxis Ensure adequate stock of adrenaline for supplying to sessions Age (in years) Needle for intramuscular injection Age specific dose of adrenaline (1:1000) in ml (tuberculin) or units (insulin) Adults    1 inch 24G or 25G 0.5 ml / 20 units 12-18 0.3 ml / 12 units 6-12 1 inch long of 24G or 25G 0.2 ml / 8 units 1-6 0.1 ml / 4 units 0-1 0.05 ml / 2 units