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Immunisations

Please see the following list of authoritative resources on immunisations. If you are having any difficulties applying this to your role, please call us.

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General guidance

RCN guidance on immunisations. This includes information on administration of vaccines, immunisation training, storage and cold chain, keeping up to date and travel health vaccination.

Immunisation policy for the UK is available in the Department of Health (DH) publication Immunisation Against Infectious Diseases: The Green Book.

Immunisation policy in the UK is informed by the Joint Committee on Vaccination and Immunisation (JCVI). The JCVI's remit is to advise UK health departments on immunisations following due consideration of the evidence on the burden of disease, on vaccine safety and efficacy and on the impact and cost effectiveness of immunisation strategies.

Department of Health guidance “What to expect after vaccinations”

BMA vaccinations and immunisation guidance

NICE pathway - Immunisation for children and young people

The World Health Organization (WHO) provides country-specific immunisation schedules.

The European Centre for Disease Prevention and Control (ECDC) vaccine scheduler provides European vaccination schedules.

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Storage and cold chain

In the event of a cold chain failure, see the Public Health England vaccine handling protocols and guidance.

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The technical and clinical practice of administering an injection

Green Book, chapter four.

WHO Best Practices for Injections and Related Procedures Toolkit.

All staff administering vaccines need to be appropriately trained and competent.

Wearing gloves

The WHO guidance advises that gloves should not be worn for routine intradermal, subcutaneous or intramuscular injections providing the health worker’s skin is intact as gloves do not provide protection against needle stick injury. See the WHO Best Practices for Injections and related procedures Toolkit.

Further advice on glove use and dermatitis is provided in our publication Tools of the Trade.

Observation times after administering a vaccine

There is a common misconception that individuals should wait 20 minutes after receiving a vaccine. The majority of reactions will occur within two minutes and some occur hours later. The advice from the RCN is that there is no need to keep patients waiting unless this is specifically indicated in the summary of product characteristics for a particular vaccine.

Patients should be given advice on adverse reactions and possible sides effects either from the patient information leaflet included with the vaccine or by giving appropriate leaflets such as the DH leaflet “What to Expect after Vaccinations”.

Practice nurses administering vaccines in patients' homes

The RCN supports practice nurses administering vaccines in a patient's home where it complies with their workload demands, workload priorities and when it is in the patient’s interests.

Practice nurses should also check that the patient is not being visited by the district nurses. It is inefficient for both district nurses and practice nurses to visit the same household.

Administering vaccines in a General Practice setting

There is no reason for a medical practitioner to be on site when vaccines are being administered. Nurses should only administer immunisation and vaccines if they are trained and competent and this includes being up to date with anaphylaxis management. In all cases of anaphylaxis, an ambulance should be called. It is good practice to have another person available who is also trained in managing anaphylaxis.

6-8 week developmental assessment and baby immunisations

People often wonder whether it is necessary to defer routine childhood immunisations in babies who have not yet had their 6 to 8 week checks.

The 6 to 8 week check forms part of the newborn and infant physical examination screening programme (NIPE). The newborn element aims to identify and refer all children born with congenital abnormalities of the eyes, heart, hips, and testes, within 72 hours of birth. The second examination is designed to identify abnormalities that may become detectable in older infants – that is at 6-8 weeks of age.

As none of the conditions screened for would constitute a contra-indication to immunisation, there is no requirement for the examination to be undertaken before the first vaccines are given. Babies will need the normal assessment of suitability for vaccines as outlined in the relevant documents e.g. vaccine PGDs. If a baby presents for vaccination at eight weeks having not had the 6 to 8 week check, then this is an opportunity to do the check at the same visit.

See the Newborn and infant physical examination: programme handbook.

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Anaphylaxis and adverse events

Green Book, chapter eight.

Guidance on managing anaphylaxis is also available from the Resuscitation Council UK with quality standards for primary care on resuscitation and basic life support https://www.resus.org.uk/quality-standards/primary-care-quality-standards-for-cpr/#training

All staff in primary care organisations, including non-clinical staff, should undergo regular training in resuscitation of both adults and children to the level appropriate to their role. Staff should undergo such training at induction and at appropriately regular intervals thereafter to maintain knowledge and skills, clinical staff should have annual updates.

There is no definitive requirement on the frequency of updates for anaphylaxis training and would be a risk assessment per practitioner. However, if management of anaphylaxis is identified in your role, there should be update training at the local level and this could form part of resuscitation training.

The Anaphylaxis Campaign have an e-learning course accredited by the RCN http://www.anaphylaxis.org.uk/information-resources/allergywise-training/for-healthcare-professionals/ - there is a fee for this course.

NB Adrenaline and Hydrocortisone are listed exemptions under the Human Medicines regulations 2012 http://www.legislation.gov.uk/uksi/2012/1916/contents/made and can be administered by anyone in an emergency for the purpose of saving life. This means there is no requirement for prescription or PGD in order to administer them. See the RCN guidance on medicines optimisation https://www.rcn.org.uk/clinical-topics/medicines-optimisation

Details of the yellow card system for reporting adverse events following vaccine administration are available on the Medicines and Healthcare products Regulatory Agency (MHRA) section of the gov.uk website. The yellow card scheme is the key source of data for real-time safety surveillance, nurses have a responsibility to make sure that any adverse events are reported through this process. This is important to strengthen vaccine safety through effective pharmacovigilance.

For guidance on reporting adverse incidents, please see the MHRA website.

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Disposal of equipment and management of sharps injuries

Green Book, chapters three and four.

For advice on the management of and prevention of sharps injuries, members should refer to their local policies. Injuries from a source patient known to have a blood borne virus or those which result in a blood borne infection need to be reported to the Health and Safety Executive under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR).

Health and Safety Executive (HSE) information on sharps and 'RIDDOR in health and social care'

The Health and Social Care Act 2008: Code of Practice on the Prevention and Control of Infections and Related Guidance: Criterion Ten, available on the Department of Health website.  

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Employers and occupational health vaccination

The RCN maintains that any organisation which provides health care is responsible for ensuring that their staff and patients are safe. Appropriate vaccination is in the interest of staff, employers and patients/clients. This is underpinned by extensive legislation:

The British Medical Association (BMA) has produced guidance for GPs on which vaccines they should provide:

  • Focus on vaccines and immunisations - Guidance for GPs (June 2014)
  • Focus on hepatitis B immunisations – Guidance for GPs (August 2012)
  • Focus on travel immunisations – Guidance for GPs (November 2012)
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Travel health vaccination

The National Travel Health Network and Centre (NaTHNaC) provides advice on travel health, including travel vaccination.

TRAVAX from Health Protection Scotland (HPS) provides similar information to NaTHNaC.

NHS Wales has an organisational subscription to TRAVAX which is therefore freely available to NHS Wales users (via HOWIS (Health of Wales Information Service)).

The Department of Health (DH) publication, Health Information for Overseas Travel: The Yellow Book, provides information for health professionals on health risks to travellers and how to reduce them. Copies of this book can been ordered via the NaTHNaC publications online ordering service.

The British Medical Association (BMA) publication, Focus on Travel Immunisation offers clarity around the immunisation issues within the General Medical Services (GMS) contract and how travel immunisations may be funded.

More people in the world are migrating today than at any other point in human history and the Health Protection Agency (now part of Public Health England) has produced a Migrant Health Guide, which supports practitioners making decisions around best protecting the health of migrants. An accompanying video looks at how to catch up immunisations for migrants to the UK.

The RCN guidance, Travel Health Nursing: Career and Competence Development provides information on current guidelines and standards and defines the standards of care expected for a competent registered nurse, an experienced/proficient nurse and a senior practitioner/expert nurse working in travel health nursing.

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