Running a Vaccination Clinic

Before the Vaccine Encounter

Assess staff capabilities

• Determine who can provide vaccinations in your setting.
  • If using a standing order protocol, ensure the protocol is current and available at the clinic or facility site.

• Assess staff knowledge and skills. Clinic staff should demonstrate competence in:
  • Infection control procedures
  • Proper vaccine storage and handling, preparation, and administration for each vaccine offered
  • Accessing patients in a potentially limited space (including multiple patients in a vehicle, different vehicle heights)
  • Vaccine safety monitoring, recognizing and managing anaphylaxis, and contacting EMS in event of a severe acute reaction

Consider population needs

Make sure to gather supplies for the expected number of patients.

Consider offering clinic services by appointment to account for vaccine supply and administration timing.

If demand for appointments is greater than capacity, consider creating an on-call or wait list to notify patients when vaccine is in stock or if additional appointment times become available.

When appropriate, complete activities by phone, email, or online system prior to the clinic:

• Provide relevant education material for each type of vaccine available.
  • Vaccine Information Statement (VIS)
  • Emergency Use Authorization (EUA) Fact Sheet for Recipients and Caregivers
  • Vaccine manufacturer package inserts

• Review the patient’s vaccination history in the immunization information system (IIS) or electronic medical record.
• Screen for contraindications and precautions (no earlier than the day of vaccination).
• Provide after-care instructions.
• Ask if the patient will need any accommodations (e.g., extra time, translation services, information in accessible formats, modified procedures for patients using mass transit, etc.
• Inform patients of any clinic requirements (such as wearing masks, post-vaccination waiting periods, and any clinic restrictions such as patient age, vehicle type, or number of patients per vehicle). Include this information in all communications, promotional materials, and on websites.

During Vaccination

Ensure appropriate staff perform the following actions:

• All staff should be familiar with and practice standard precautions for patient care
• If not already completed, staff should:
  • Review patient vaccination history and eligibility.
  • Verify patient’s age.
  • Assess patient eligibility and screen for contraindications and precautions. A standardized screening tool like the checklists for children and teens, and adults can be a quick, printable resource for this
  • Provide the appropriate VIS or EUA Fact Sheet for Recipients and Caregivers.
  • Obtain insurance information (if applicable).
  • Make sure all information is provided in an accessible and easy-to-understand format.
• Obtain consent, based on state or local requirements. There is no federal requirement for signed consent.

Vaccine storage and handling

Ensure staff properly store and handle vaccines.

• Store vaccine(s) in a portable unit or container qualified to maintain vaccine(s) at recommended temperatures.

• Monitor and document vaccine temperatures as required throughout the day.
• Use a digital data logger (DDL) that displays minimum and maximum temperatures.
• Follow the temperature monitoring guidance found in CDC's Vaccine Storage and Handling Toolkit.

Vaccine preparation and administration

Ensure staff properly prepares and administers vaccines.

• Prepare vaccine in a designated area.
• Draw up vaccines only after staff arrive at the clinic site or event.
• Maintain cold chain until time for administration.
• Do not prepare vaccines days – or even hours – before administering because general-use syringes are not designed for storage.
• Draw up no more than 1 multidose vial, or the number of doses indicated by the manufacturer’s package insert, per vaccinator, at one time. Pre-drawn syringes should be labeled with:
  • Name and amount of vaccine
  • The exact beyond-use date and time
  • Type of dose (if applicable)
  • Age range (if applicable)
  • Lot number
  • Initials of preparer
• Safely handle and dispose of needles and syringes.
• Monitor patient flow to avoid drawing up unnecessary doses.
• Perform hand hygiene before vaccine preparation, between patients, and any time hands become soiled. If gloves are worn, change and perform hand hygiene between patients.
• Follow manufacturer instructions and federal vaccine administration guidance related to dose, site, and route (see Pink Book Vaccine Administration chapter and vaccine specific package inserts.
• Inform patients they will need to wait 15-30 minutes before leaving the clinic area.

After the Vaccine Encounter

Observation

• Tell patients how to let staff know if medical assistance is needed.
• Assign a safety monitoring team competent in responding to anaphylaxis to monitor patients in the observation area.
• Arrange signage to indicate when the observation period ends and check patients before they leave. For example, drive-through clinics can set a traffic cone in front of each car and attach a piece of paper or small white board indicating completion time.
• For drive-through clinics, direct patients to park in the observation area.
  

Documentation

• Give patients a record of the vaccine(s) they received.
• Document all vaccinations in the IIS and electronic medical record (if possible).
  
  

Vaccine Storage and Handling

• Appropriately store and handle any remaining, usable vaccine to protect the cold chain.
• CDC's Vaccine Storage and Handling Toolkit provides guidance on safe and effective vaccine management practices for all health care providers.

Syringe Disposal

• Dispose of all remaining vaccine in predrawn syringes (if used) according to your state requirements. Contact your immunization program to ensure disposal compliance.
• Follow guidelines for safe and proper sharps disposal.

End of clinic workday

At the end of the clinic workday, you should:

• Place all patient medical information in a secure location for privacy protection.
• Submit information on vaccinations administered to the jurisdiction's IIS. If it is not possible to document the vaccination in the IIS, vaccination information should be sent directly to the patient's primary care provider, as directed by state or jurisdiction regulations.
• Report any possible adverse events or vaccine administration errors to the Vaccine Adverse Event Reporting System (VAERS).
• Develop an after-action report (AAR) or evaluation to capture lessons learned from the clinic and make recommendations for improvements. The health department may have a template you can use. The Homeland Security Exercise and Evaluation Program has a standard format for development of an AAR.

Resources

• General Best Practice Guidelines for Immunization
  
• Vaccine Storage and Handling
• Vaccine Administration
• You Call the Shots web-based training courses
• Information for Healthcare Professionals about COVID-19
• U.S. COVID-19 Vaccine Product Information
• Immunization Information Systems