Running a Vaccination Clinic

General operations

During the clinic, ensure:

• Staff is wearing identification cards or other identification (vests, shirts, etc.), as appropriate.
• Clinic updates and wait times are being communicated.

Vaccine storage and handling

Monitor and document vaccine temperatures as required throughout the day.

CDC's Vaccine Storage and Handling Toolkit provides guidance on safe and effective vaccine management practices for all health care providers.

Vaccination process

Before the vaccination encounter

• Determine staff training needs. 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)
• Consider offering clinic services by appointment. When possible, complete activities by phone, email, or online system prior to the clinic:
  • Review the patient's vaccination history in the IIS or electronic medical record
  • Screen for contraindications and precautions (no earlier than the day of vaccination)
  • Provide after-care instructions
  • Provide the appropriate Vaccine Information Statement (VIS) or Emergency Use Authorization (EUA) Fact Sheet for Recipients and Caregivers
  • Obtain health insurance information, if needed
  • Ask if the patient will need an accommodation when scheduling the appointment (e.g., extra time, an American Sign Language translator, 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 clinic restrictions [e.g., patient age, vehicle type, or number of patients per vehicle]). Include information on requirements and restrictions in all electronic communications and promotional materials and on websites.
• Consider creating an on-call or wait list of patients that can be notified and readily available for vaccination if extra doses are available.
• Gather supplies for the expected number of patients.

Vaccine preparation

• Prepare vaccine in a designated area. Draw up vaccines only after arriving at the clinic site or mass vaccination event. Do not prepare vaccines days or even hours before administering because general-use syringes are not designed for storage.
• Maintain cold chain until time for administration.
• Safely handle and dispose of needles and syringes.
• Draw up no more than 1 multidose vial or number of doses indicated by the manufacturer’s package insert at one time per vaccinator.
• Label predrawn syringes 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
• Monitor patient flow to avoid drawing up unnecessary doses.
  

During the vaccination encounter

• Staff should wear appropriate personal protective equipment and patients should wear face coverings, if tolerated.
• If not already completed, review patient vaccination history, screen for contraindications and precautions, obtain insurance information (if applicable), and provide the appropriate VIS or EUA Fact Sheet for Recipients and Caregivers. Make sure all information is provided in an accessible and easy-to-understand format.
• Ensure staff properly store and handle vaccines.
  • Store vaccine(s) in a portable unit or container qualified to maintain vaccine(s) at recommended temperatures.
  • Use a digital data logger (DDL) that displays minimum/maximum temperatures. Follow temperature monitoring guidance found in CDC's Vaccine Storage and Handling Toolkit.
• Inform patients they will need to wait 15-30 minutes before leaving the clinic area.
• Ensure staff follows proper vaccine administration practices:
  • Prepare and administer vaccine using aseptic technique.
  • Properly position patient. Some patients may need additional assistance with positioning. Consider using pictures, modeling, or providing personal assistance as needed.
  • Identify the recommended injection site for children and adults. Adjust the car window or open the door as needed to administer vaccine.
  • Make sure patients are seated to prevent injury from a fall if the patient faints.

After the vaccination encounter

• Give patients a record of the vaccine(s) they received.
• Document all vaccinations in the IIS and electronic medical record (if possible).
• Observe all patients who received vaccine for 15-30 minutes in a dedicated parking area for observation.
  • Direct patients to park in the observation area.
  • Instruct patients how to let staff know medical assistance is needed.
  • Assign a safety monitoring team competent in responding to anaphylaxis to roam the observation area and consistently monitor patients.
  • Arrange signage to indicate when the observation period ends and check patients before they leave. For example, sit a traffic cone in front of each care and attach a piece of paper or small white board indicating completion time.

End of clinic workday

Ensure that you:

• Discard all remaining vaccine in syringes according to your state requirements; contact your immunization program to ensure disposal compliance.
• Store and handle any remaining viable vaccine appropriately to protect the cold chain.

Post-clinic activities

Submit information on vaccinations administered to the jurisdiction's IIS, as required by your state or local immunization program. 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.

All patient medical information must be placed in a secure location for privacy protection.

Report any suspected adverse events 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