Tuesday, 11 February 2014
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High risk vaccination practices: Supportive Supervision for immunizing the vaccinated. Medical Colleges can play a pivotal role in the capacity building of service providers through healthy and effective Partnership. Quantity and the ‘Quality of the quantity’ are the need of the hr/day/week/ month and yrs to close population immunity gap to prevent importation of wild polio virus (Recent lesson from Syria) to achieve Global eradication by 2018; minimize measles outbreaks; achieve Measles elimination in 5 WHO regions by 2020, avoid sporadic cases of diphtheria and other VPDs. Next to Polio, JE causes residual neurological defects among survivors of JE encephalitis. In- spite of 78% decline in measles burden, it is trying to comeback as fresh outbreaks. There is an urgent need to rope-in/consolidate/integrate and steer the medical fraternity, bring them on track of NIS (National Immunization Schedule) starting from Newborn vaccination specially HepB birth dose. Recent data from the field revealed that there is considerable gap between the NIS and the schedule followed in the private sector: divided opinion among different sectors of service providers compromises community participation. Under RMNCH+A, Call to action Chennai Express; both at the National level and State level forums, active participation by the Medical Colleges was expressed. Two examples are cited below. Regular monitoring, supportive supervision, hands on training, exploring training needs, advocacy with monitors and programme managers are essential for providing quality service to “Immunize the Vaccinated”. Situation 1: Often BCG/Measles/JE vials were collected but diluents were forgotten. Service providers will be in a dilemma whether to vaccinate or not. In this example saline was drawn from normal saline bottle for reconstituting BCG. Often water for injection was used for reconstitution. The ‘wrong’: 1) Diluent - at room temperature-gives thermal shock. 2) Quantity drawn was one ml, less than what the manufacturer recommends - quantity provided in the saline ampoule is a little more than 1 ml to compensate the dead space in the hollow of the needle and nozzle of the hub of the syringe. 3) Diluent is not isoosmotic. Hence the vaccinated are unlikely to get immunized (adequate seroconversion??). These children may or may not get a scar but absence of scar is not an indication for re-vaccination. Even the presence of scar in such children may not confer ‘immunity’. [Limitation: children who received BCG in this session were not followed up for noting scar formation]. Actions: 1) Remaining vaccine in the vial was discarded. 2) What is correct - explained to the service providers on the spot. 3) Noted as a training need. 4) Shared with programme managers who sent-out a circular to all districts. Situation 2: Wrong: Used syringes were re-sheathed, collected in a carry bag which was not puncture proof. On an average five hundred needles were re-sheathed daily by one staff nurse with 2 potential lethal pricks per day; endangering the lives of self and life partner. Action: Hub-cutter from the store was procured, using the hub cutter was demonstrated & so on……
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