Immunization Orientation and Competency Verification Procedure for Non-VDH Employee Vaccinators
Purpose
The purpose of this document is to outline the procedure for Medical Reserve Corps (MRC) volunteers and other healthcare professionals who provide vaccinations under the auspices of the Virginia Department of Health (VDH).
Background
Proper vaccine administration is vital for preventing many common, vaccine-preventable diseases. Vaccine administration errors may result in the need to revaccinate patients, missed opportunities to prevent communicable diseases, and the potential for significant financial loss due to wasted vaccines. Furthermore, since public health entities are considered “gold standards” of vaccination knowledge and techniques, inappropriate vaccine administration can result in damage to the public’s confidence in vaccine effectiveness and the reputation of the health department.
Applicability
This procedure is applicable to all non-VDH employee vaccinators, including MRC volunteers (RNs, NPs, LPNs, pharmacists, physician assistants, and physicians), nursing students, and Emergency Medical System (EMS) staff. All individuals who function in the capacity of vaccinators for VDH serve under the supervision of fully trained public health nurses who have completed the VDH immunization training or a contract/volunteer immunization nurse who has completed training and has been trained by the district nurse manager, IAP or their designee. Vaccinators who receive vaccines purchased by the Office of Emergency Preparedness for closed Points of Dispensing (POD) operations that are not supervised by a fully trained VDH public health nurse or contractor/volunteer designee, will be responsible for cold chain management of the vaccine, responding to emergency events at the POD, and entering data into the Virginia Immunization Information System (VIIS).
Special note: There are additional personnel who may administer COVID-19, Mpox, and limited other vaccines under the PREP act that are not addressed in this document. Guidance for training these individuals is located in the document, “Training and Preparation for Administering COVID-19 Vaccines Under the Auspices of VDH” and Mpox guidance documents.
Medical Reserve Corps Volunteer Vaccinators
The MRC Coordinator or their designee is responsible for making sure that each Medical Reserve Corps volunteer has a current and unencumbered MD, PA, NP, RN, LPN, or Pharmacist license in Virginia.
Nurses with out-of-state licenses may practice with a current and unencumbered license issued from an Enhanced Nursing licensure compact (eNLC) state. States that are members of the eNLC allow nurses in member states to practice physically, electronically and/or telephonically across a state border in other states that are members of the eNLC. LPNs may provide immunizations under the supervision of an RN.
The MRC Coordinator or designee must ensure that prior to the start of any work within VDH, all MRC volunteer vaccinators have
- A volunteer orientation,
- Passed background investigation
- Current CPR certification
- Current, unencumbered healthcare professional license
Emergency Medical Services (EMS) Vaccinators
In order for EMS providers to support VDH vaccination clinics, according to §54.1-3408 of the Code of Virginia, they must:
- Hold a valid, unrestricted Virginia certification as an Intermediate or Paramedic
- Be affiliated with the Virginia EMS agency developing the vaccination program
- Be individually approved by their agency Operational Medical Director (OMD) as a vaccinator
- Follow protocols approved by their OMD for vaccine administration
The Virginia EMS Agency, where the EMS provider is affiliated, shall provide confirmation to VDH that the provider meets the requirements above. Virginia EMS providers supporting VDH vaccination clinics must complete the VDH Procedures for Evaluating Immunization Knowledge and Skills for Vaccinators listed below. Virginia EMS Agencies are encouraged to use VDH Procedures for Evaluating Immunization Knowledge and Skills for Vaccinators for their vaccination program and closed POD vaccination efforts.
MRC volunteers that are EMS providers can ONLY provide vaccinations under the direction of their EMS Agency and OMD as outlined above. MRC coordinators will NOT be responsible for managing EMS providers as MRC volunteers.
Nursing Students as Vaccinators
“Nurses comprise the largest healthcare workforce, and opportunities exist to strengthen disaster readiness, enhance national sure capacity, and build community resiliency to disasters.” (Veenema et al., 2016). For this reason, VDH hosts schools of nursing for community health rotations, including nursing students in immunization events to provide an introduction to emergency preparedness, the role of immunization in disease prevention, and epidemiology. Per 18VAC90-27-110, “In accordance with §54.1-3001 of the Code of Virginia, a nursing student, while enrolled in an approved nursing program, may perform tasks that would constitute the practice of nursing.”
There are additional requirements for nursing students and their faculty or preceptors, which are outlined in 18VAC90-27-110 and/or in the VDH Memorandum of Agreement (MOA) that are required of all schools of nursing. Provision of adult immunizations may be included in the MOA; all MOA’s preclude the immunization of children.
VDH nurses, including volunteers, may serve as preceptors as long as they are licensed at or above the level for which the student is preparing. Some degree programs or schools, however, require the preceptor to be licensed and educationally prepared at or above the level for which the student is preparing.
Nursing students are welcome to join a Medical Reserve Corps unit, but they are ONLY able to vaccinate when affiliated and supervised by their nursing program. Nursing students must perform the skill in the simulation lab and be checked off by their instructor or preceptor prior to vaccinating under their instructor or preceptor.
Pharmacists
In addition to administering a vaccine to a person of any age pursuant to a valid prescription which directs the pharmacist to administer the vaccine as part of the dispensing process, there are two areas of law which address pharmacist administration of immunizations. Section I of §54.1-3408 of the Drug Control Act authorizes a pharmacist to administer immunizations to adults under a Board of Nursing-approved protocol, and Section W authorizes a pharmacist to administer an influenza vaccine to minors under guidelines developed by the Virginia Department of Health. While certification to provide immunizations is prudent, it is not a requirement by the Board of Pharmacy (Virginia Board of Pharmacy, 2020).
Pharmacists who serve as MRC volunteer vaccinators must complete the required training and skills check off as outlined in the training plan.
VDH Procedure for Evaluating Immunization Knowledge and Skills of Vaccinators (Training)
Initial training for administering all vaccines for MRC Vaccinators: Providing immunizations against vaccine preventable diseases is a critical skill. Therefore, all MRC Volunteers eligible to provide immunizations by their licensing, as listed above, must complete all the following training modules.
Note: In an urgent situation, Just in Time Training (JITT) may need to be deployed as described in this document. The use of JITT should not be used routinely as a substitute for the completion of the training modules.
- Understanding the Basics: TRAIN Course ID# 1065440
- Vaccine Administration: TRAIN Course ID# 1101060
- Responding to Anaphylaxis TRAIN Course ID# 1095208
- Bloodborne Pathogens TRAIN Course ID# 1028520
–MRC volunteers who will be administering Influenza vaccines should complete the above training modules and:
- Influenza: TRAIN Course ID# 1065390
- Annual influenza season update (TRAIN Course ID# XXXXXXX) released annually with Influenza updates)
Note: The Centers for Disease Control (CDC) recommends offering annual influenza vaccine with SARS-CoV-2 vaccine if applicable
–MRC volunteers who will be administering SARS-CoV-2 vaccines should complete the basic modules (a-d above) and the following modules:
e. SARS-CoV-2 Trainings:
- Pfizer BioNtech COVID-19 vaccine: TRAIN Course ID# 1095215
- Moderna COVID-19 vaccine: TRAIN Course ID# 1095345
- Novavx COVID-10 vaccine : TRAIN Course ID# 1107395
- COVID-19 Vaccine Interim COVID-19 Immunization Schedule for 6 Months of Age and Older (https://www.cdc.gov/vaccines/covid-19/downloads/COVID-19-immunization-schedule-ages- 6months-older.pdf)
*COVID-19 vaccination guidance changes frequently. Please visit CDC COVID-19 Vaccine Training Modules for the most up-to-date training available.
f. How to use an epi pen TRAIN Course ID# 1095208.
As the availability of formulations and variety of SARS-CoV-2 vaccines continues to grow, MRC volunteers may be assigned to review only the module that pertains to the vaccine or booster they will be administering.
Note: All vaccinators must complete all training modules and pass with a score of at least 80% on the module posttests and complete the skills assessment portion prior to administering vaccines.
-Initial training for administering MPox vaccines only for MRC Vaccinators:
- Understanding the Basics: TRAIN Course ID# 1065440
- Vaccine Administration: TRAIN Course ID# 1101060
- How to use an Epi pen TRAIN Course ID# 1095208
- Jynneos Intradermal (Links to CDC) Course ID# 1105563
- Intradermal Vaccination Administration Course ID# 1105563
-Initial training for MRC volunteers who will be providing adolescent school-required vaccines must include:
- The initial training modules as listed under the general training requirements.
- Tdap: TRAIN Course ID# 1065716
- HPV: TRAIN Course ID# 1067205
- Meningococcal: TRAIN Course ID# 1066729
Note: Adolescents may require additional vaccines if they are not currently up to date. Coordination with the clinical lead is crucial in identifying additional training requirements prior to the event.
Although training prior to planned exercises is expected, emergency situations may arise and necessitate the use of “just-in-time” training (JITT). When possible, JITT should include:
- Infectious disease targeted by the vaccine
- Contraindications or precautions for the vaccine
- Administration route and technique/skills verification
- Review of emergency procedures, including responding to anaphylaxis and vasovagal events.
- OSHA considerations for vaccination.
The following courses have been provided as a resource that will allow the district to respond to a wide variety of vaccine preventable disease outbreaks or prevention exercises. Consultation with the expert clinical lead for the event is critical to identify the appropriate course assignment to safely respond to the identified event. A complete listing of additional modules that are current in TRAIN includes the following:
| Topic | Revision date | TRAIN Course ID# |
| Understanding the Basics | 2/2019 | 1065440 |
| DTaP | 3/2020 | 1101084 |
| Polio | 10/2019 | 1101085 |
| Hib | 7/2021 | 1066747 |
| Influenza | Annual | Changes annually |
| Hep A | 5/2021 | 1085543 |
| MMR | 6/2019 | 1067101 |
| HPV | 1/2020 | 1067205 |
| Tdap | 3/2020 | 1065716 |
| Vaccine Storage & Handling | 1/2021 | 1065485 |
| Hep B | 2/2020 | 1067197 |
| Meningococcal | 6/2018 | 1066729 |
| Varicella | 8/2020 | 1067042 |
| Rotavirus | 3/2020 | 1101053 |
| Pneumococcal | 2/2020 | 1067207 |
| Vaccines for Children (VFC) | 1/2021 | 1101056 |
| Zoster | 3/2018 | 1101059 |
| Vaccine Administration | 3/2021 | 1101060 |
| Pfizer/BioNtech | Links to CDC | 1095215 |
| Moderna | Links to CDC | 1095345 |
| J & J | Links to CDC | 1096541 |
| Novavax | Links to CDC | 1107395 |
| Vaccine Interim COVID-19 Immunization Schedule for 6 Months of Age and Older | Links to CDC | |
| Jynneos intradermal | Links to CDC | 1105563 |
| ACAM2000 | Links to VDH | 1105807 |
| How to use an Epi pen | 1095208 |
Safety of the volunteer vaccinators and the public is paramount. The resources below have been provided to assist with that effort. Consultation with the expert clinical lead for the event is critical for identifying the appropriate courses for the event. This list should not be considered all-inclusive. A unique pathogen response may require additional training. A listing of additional modules that may be taken depending on the vaccinator response efforts are as follows:
| Topic | Revision date | TRAIN Course ID# |
| Needle stick prevention | 1101015 | |
| Intradermal Vaccination Administration | 1105563 | |
| Intramuscular injection skills | 1096822 | |
| Blood borne Pathogens | 1028520 | |
| Airborne Pathogens | 1087669 | |
| Confidentiality | 1032033 | |
| POD Essentials | 1094136 | |
| CDC: Comfort and Restraint Techniques
|
1103883 | |
| CDC: Intramuscular (IM) Injection: Sites
|
1102625 | |
| VDH: Vastus Lateralis Intramuscular Injection | 1103885 | |
| CDC: Intramuscular (IM) Injection: Supplies for Adults
|
1103882 |
2. Annual training for COVID-19 and Influenza vaccinators who have completed the initial training must include:
- Current flu season training module update and test (TRAIN Course ID# XXXXXX and knowledge assessment will be provided when CDC MMWR is made available) if they will be administering influenza vaccine.
- Vaccinator must also view the updated versions of the COVID-19 vaccine training modules, if they will be administering COVID-19 vaccines or boosters.
- Vaccinator must have had a skills verification within 12 months. This can be accomplished by a subject matter professional at a vaccination event or before attending.
- Verification of vaccinator’s current licensure and CPR certification.
Note: If it has been greater than 12 months since they last vaccinated with the vaccine they are scheduled to administer, vaccinator should review the vaccine module and pass the knowledge assessment with a score of at least 80% prior to administering the vaccine.
3. Maintaining current clinical competency is crucial for patient safety. All vaccine training shall have occurred within 12 months of assignment to administer the vaccine. If training is not completed within 12 months of assignment, the vaccinator would need to retake the initial training modules.
4. The Medical Reserve Corps Coordinator or designee is responsible for ensuring the volunteer has passed the knowledge assessment for each module with a score of 80% or higher in TRAIN. If the volunteer does not pass the test the first time, he or she should review the materials and repeat the test. TRAIN will only allow them to retake the test one time; therefore, those who complete the paper assessment may only do so for a total of two times before viewing the module again. After successfully completing the knowledge assessments, the MRC coordinator or designee will provide the volunteer name to the district nurse manager or their designee and coordinate the completion of the skills assessment. If the skills assessment is not completed within 12 months of the assignment the vaccinator would need to retake the skills assessment.
5. The skills portion of the test may be administered by an MRC member who is licensed as an RN, MD, DO or NP, is trained in vaccine administration, and has demonstrated skill competency, as evidenced by documentation by the district IAP, nurse manager, or her designee. The nurse manager or his or her subject matter professional designee is responsible for verifying that the volunteer has the appropriate skills to administer vaccines. The skills checklist (Appendix A) will be used to verify competence. Upon successful completion, the volunteer’s competencies will be documented in the Virginia Volunteer Health System, and they will be assigned to the corresponding group and role.
Additional Training Information
Proper vaccine storage and handling is vital for protecting the vaccine supply. Vaccinators who will serve in roles that include transporting and monitoring the storage of vaccines are required to complete training outlined in the policy developed jointly by Community Health Services and the Office of Emergency Preparedness: Maintaining Immunization Cold Chain (note: this link with take you to the CHS policy page on the intranet. You will need to scroll down to the policy and click on it to open the link the policy.)