COVID-19 vaccination

training for health workers

Module 3:

Organizing COVID-19
vaccination sessions

© WHO/Blink Media – Giliane Soupe

 |2

At the end of this module, learners should

Learning objectives be able to:
o outline infection prevention and control
measures during COVID-19 vaccination
sessions to protect health workers, vaccine
recipients, and the community;
o describe how you prepare for vaccination
sessions according to infection prevention
and control protocols (at the health facility, for
outreach, and for a campaign); and
o outline the process of safe administration of
the COVID-19 vaccine and waste disposal.
 |3

Importance of infection 1. Protecting yourself

prevention and control

2. Protecting your patients/

clients

3. Protecting your family

and community
Photo 1: © WHO/Blink Media – Giliane Soupe
Photo 2 :© WHO/Tom Pietrasik
Photo 3: © WHO2015 Safe & Quality Health Services Package
 |4

Standard infection o Hand hygiene: use alcohol-based hand rub

or clean water and soap.
prevention and control
strategies for
vaccination sessions o Perform respiratory hygiene/cough
etiquette.

o PPE: wear a medical mask.

Aide memoire: Infection prevention and control

principles and procedures for COVID-19 o Apply safe injection practices and safe
vaccination activities disposal of waste
https://www.who.int/publications/i/item/who-2019-ncov-
vaccination-IPC-2021-1

More information on infection prevention and control: o Environmental cleaning and disinfection:
Infection Prevention and Control for COVID-19:
https://openwho.org/courses/COVID-19-IPC-EN
maintain a clean environment, especially
Hand hygiene: https://openwho.org/courses/IPC-HH-en high-touch surfaces (e.g. chairs, tables, door
Safe Injection practices: https://openwho.org/courses/IPC-IS- handles).
EN
 |5

Hand hygiene
Vaccinators should always
perform hand hygiene,
preferably using alcohol-based
hand rubs given their setting:
• before putting on and
removing PPE (e.g. mask),
• before preparing the vaccine
(especially when multi-dose
vials are used), and
• between each person/vaccine
administration.

More information:
https://www.who.int/gpsc/5may/Hand_Hygiene_Why_Ho
w_and_When_Brochure.pdf https://www.who.int/infection-prevention/tools/hand-hygiene/en/
 |6

Glove use
Gloves are NOT indicated for
intramuscular injections unless there is
skin breakdown.
• If used, they do not replace the need
for performing hand hygiene between
each vaccine administration and for
other indications.
• Applying alcohol-based hand rubs on
gloved hands is strongly discouraged.

World Health Organization. (2009). Glove use information leaflet:

https://www.who.int/gpsc/5may/Glove_Use_Information_Leaflet.pdf
 |7

Personal protective o The type of PPE used will vary based on the
equipment (PPE) health service provided, the individual risk
assessment, and additional transmission-
items – masks based precautions needed.
o For delivering COVID-19 vaccines, the
following PPE is recommended:
• medical masks – for the health worker;
and
• medical or fabric mask for the person
receiving the vaccine.
Mask use in the context of
o Ensure you are wearing a medical mask
COVID-19 throughout the entire vaccination session.
Interim guidance, 1 December 2020
https://apps.who.int/iris/handle/10665/337199
Masks – how to safely wear them
Step 1. Perform hand hygiene.
Step 4. Remove by the straps and pull
away from your face.
More information: https://youtu.be/adB8RW4I3o4
|8
Photos 2, 4,5:
© WHO/Elena Longarini,
Photos 1,3,6:
© WHO/Tom Pietrasik
Step 2. Place the loops around the ears.
Step 3. Perform hand hygiene before
Ensure the mask fits over your nose,
removing or touching the mask.
mouth and chin. Avoid touching it.
Step 5. Discard in a closed bin. Step 6. After discarding, perform
hand hygiene again.
 |9

For any vaccine delivery strategy:

Preparing for o Inform the community and target groups
the session in advance of the location and time of
vaccination.
o Set up safe vaccination sites and ensure
adequate quantities of:
• vaccines and supplies
• adequate cold-chain equipment
• appropriate injection equipment
• appropriate PPE
• safety boxes
• reporting tools.
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Setting up vaccination sites: hygienic environments and

adequate ventilation

© WHO/CO Indonesia © WHO/CO DRC © NHSEngland

Ensure adequate (mechanical, natural or combination of both) ventilation.

- For natural ventilation, open windows and doors in indoor spaces. If outdoors, pick a well-ventilated area.
- For a mechanical ventilation system, the ventilation rate should be at least 6 air changes per hour. The
recommended air exchange will depend on the setting and context. For further advice refer to national or
international heating, refrigerating and air-conditioning regulation.
https://www.ashrae.org/file%20library/technical%20resources/standards%20and%20guidelines/standards%20errata/standards/170_2017_a_20200901.pdf
 | 11

Setting up vaccination sites: physical distancing

1
m
et er
er et
1m

er 1
1 meter m
et et
1 meter 1m er

© WHO/CO Bangladesh

Adequate physical distancing: ensure at least 1 meter distance in all directions between
each person.
 | 12

Setting up vaccination sites: hand hygiene

© WHO/Saya Oka © WHO/CO Guinée Equatoriale

Make available hand-washing stations or alcohol-based hand rub dispensers.

 | 13

Setting up vaccination sites: screening and crowd control

© WHO/Ploy Phutpheng © WHO/CO Guinée Equatoriale

Screen for respiratory Limit the number of individuals to avoid crowding and
symptoms before those long waiting times.
getting vaccinated enter the
vaccination site.
 | 14

Setting up vaccination sites: flow and positioning

© WHO/CO Malawi © WHO/CO Guinée Equatoriale

Sideways positioning:
Ensure one-way flow through the vaccination site. avoid positioning yourself face-to-face
with the vaccine recipient.
 | 15

Environmental cleaning
o Ensure that cleaning and
disinfection procedures are
followed consistently and correctly
according to WHO guidance.
• Cleaning should be performed
frequently; at least twice daily
with special attention to high-
touch surfaces (e.g.
screening/triage areas). © WHO/Roxane Schneider
o Minimize clutter to aid cleaning.

Source: World Health Organization. (2020). Cleaning and disinfection of environmental surfaces in the context of COVID-19:
interim guidance, https://apps.who.int/iris/handle/10665/332096
Immunization clinic flow | 16

Adapted from Centers for Disease Control and Prevention training module:
Planning Vaccination Clinics at Satellite, Temporary, or other Off-Site Locations during the COVID-19 pandemic
 o Vaccine doses: target number x adequate | 17
wastage factor (WF)
Requirements for a o Vaccine vials: vaccine doses ÷ X (number of doses
per vial)
vaccination session o Auto disable (AD) syringes: 1 per vaccine dose
(fixed post) o Diluents (if applicable): 1 per vaccine vial
o Reconstitution syringes (if needed): 1 per vaccine
vial
o Safety boxes: total number of syringes ÷ 100
o Tally sheets (or other reporting forms, depending
on recommendation, including tracking for 2 doses)
o List with contact phone numbers (e.g. supervisor,
focal person for adverse events following
immunization (AEFI), ambulance driver)
o AEFI kit and AEFI reporting forms (specific for
COVID-19 vaccine)
o Infection prevention and control kit
o Waste bin/bag
 | 18

o Number of vaccine doses adjusted for wastage

Requirements for factor: target number x WF
outreach or o Number of AD syringes, diluents, reconstitution
campaign syringes and safety boxes adjusted for number
of required vaccine doses
vaccination session
o Microplan of the area
o A vaccine carrier in good condition with coolant
packs and foam pad
o Infection prevention and control kit
o Tally sheets (or other reporting forms,
depending on recommendation, including
tracking for 2 doses)
o List with contact phone numbers (e.g.
supervisor, local AEFI focal person, ambulance
driver), AEFI kit and AEFI reporting forms
(specific for COVID-19 vaccine)
 | 19

Recommended
o In addition to vaccination supplies, health
infection prevention
workers are advised to carry IPC kits with
and control kit for them.
outreach/campaign o This kit contains PPE that may be required
based on individual risk assessment.
o Eye protection, gown and gloves are not
routinely required, they should only be used
if the risk assessment deems it necessary.
o When used, gowns and gloves should be
discarded after single use.
 | 20

Contents of infection prevention and control kit

o This kit should at minimum contain:
1. products for hand hygiene: soap/clean water/veronica buckets (if sinks not
available)/ disposable or clean towels or alcohol-based hand rub products;
2. medical masks (bring several for replacement needs);
3. eye protection (in case there is a need);
4. gloves (in case there is a need);
5. gowns (in case there is a need); and
6. waste bins/garbage bag.

Other useful items to consider: tissues, thermo-scans for screening, cleaning

equipment, visual reminders/signage, physical barriers (to aid spatial separation).
 | 21

The seven steps to 1. Clean workspace

safe injections
2. Hand hygiene

3. Sterile safety-engineered (auto-disabled -

AD) syringe

4. Sterile vial of vaccine and diluent

5. Skin cleaning

6. Appropriate collection of sharps waste

7. Appropriate waste management

WHO guideline on the use of safety-engineered syringes for intramuscular,
intradermal and subcutaneous injections in health care settings (2016).
https://apps.who.int/iris/handle/10665/250144
 | 22

1. Perform hand hygiene between each

Administration of vaccine administration.
intramuscular (IM) 2. Hold the AD syringe barrel with fingers and
injection thumb on the sides of the barrel and with the
bevel of the needle facing upwards.
3. Gently stretch and support the skin with the
other hand and quickly push the needle at a
90° angle down through the skin into the
muscle.
4. Depress the plunger smoothly, do not move
the needle under the skin.
5. Pull the needle out quickly and smoothly at
the same angle as it went in.
6. Discard the needle and syringe straight into
the safety box.

https://apps.who.int/iris/bitstream/handle/10665/193412/9789241549097_eng.pdf
 | 23

Safe waste disposal o Drop the used AD syringe needle end down
into a safety box immediately after use.
at health facility and in
o Never recap the needle.
outreach/campaign
o When the safety box is full (¾ of the box),
keep in a secure place until final disposal.
o Dispose of empty vaccine vials and other
waste in a separate container or a waste
bag.
o Contaminated PPE is infectious waste and
should be disposed of in a separate
container or a waste bag as all other
hazardous waste.

©WHO/Olivier Asselin
 | 24

Closing the vaccination site

o Discard in a separate waste bag or container any used reconstituted

COVID-19 vaccine vials.
o Count the unopened COVID-19 vaccine vials and diluents and write
down the number on the tally sheet.
o If in outreach/campaign, return unopened COVID-19 vaccine vials
and diluents, the vaccine carrier, and coolant-packs to the distribution
point.
o Calculate on the tally sheet the number of COVID-19 vaccines
administered, number of vials received, opened, discarded, and
returned and submit the tally sheet to the 1st level supervisor.
 | 25

Summary of 1. Respect standard infection

key points prevention and control precautions
for vaccination sessions,
regardless of delivery strategy.
2. Administer intramuscular (IM)
injection vaccine in the arm (site).
3. Safely dispose of sharps and
other infectious waste.
Resources | 26

Refer to vaccine explainers for vaccine-specific information

o Immunization in Practice (2015 update):
https://apps.who.int/iris/bitstream/handle/10665/193412/9789241549097_eng.pdf
o The WHO Field Guide for planning and implementing high-quality supplementary immunization activities
(SIA):
https://www.who.int/immunization/diseases/measles/SIA-Field-Guide.pdf
o Immunization in the context of COVID-19 pandemic (May 2020):
https://www.who.int/publications/i/item/immunization-in-the-context-of-covid-19-pandemic
o Infection Prevention and Control core documents
https://www.who.int/health-topics/infection-prevention-and-control#tab=tab_1
o Infection Prevention and Control COVID-19 technical guidance documents
https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance-
publications?publicationtypes=d198f134-5eed-400d-922e-1ac06462e676
o Aide memoire: Infection prevention and control principles and procedures for COVID-19 vaccination
activities
https://www.who.int/publications/i/item/who-2019-ncov-vaccination-IPC-2021-1
o OpenWHO IPC Channel – with additional trainings https://openwho.org/channels/ipc
o Mask use in the context of COVID-19 (Interim guidance 1 December 2020):
https://apps.who.int/iris/bitstream/handle/10665/337199/WHO-2019-nCov-IPC_Masks-2020.5-eng.pdf
o WHO guide to local production – WHO recommended handrub formulations
https://www.who.int/gpsc/5may/Guide_to_Local_Production.pdf