Vaccine storage, handling, accountability:

• At least 85% of clinics stored vaccines properly by: a) maintaining adequate storage temperatures; b) using vented storage baskets to allow adequate airflow; c) placing filled water bottles in refrigerator doors to maintain stable temperatures in the storage unit; and d) rotating vaccine stock so that short-dated vaccine is used first.
• Only 5% of clinics lacked adequate refrigerator/freezer thermometers; daily temperature logs were maintained by 97% of clinics, though some clinics neglected to send the logs routinely to Public Health.
• Less than one half of all storage units had a method for securing the refrigerator and/or freezer doors, such as with Velcro straps. The primary reason for vaccine wastage results from storage unit doors that are inadvertently left open for an extended period of time. Almost two-thirds of clinics had clearly identified "DO NOT DISCONNECT" labels on storage unit doors and electrical cords.
• Only about half of clinics assessed were prepared for handling vaccines during power outages and other emergencies. These clinics had a written protocol that identifies staff responsible for vaccine retrieval and transfer to an alternative storage site (such as local hospital, grocery store, or pharmacy). The clinics also had appropriate coolers/ice packs for short-term storage and vaccine transfer.
• Less than 5% of clinics reported having more than 5% of their total inventory lost, expired, or wasted. Providers are responsible for replacing, at their own expense, vaccines that are wasted due to mishandling or negligence.

Administration and documentation of vaccines:
VFC stipulates that the following categories must be documented when administering public funded vaccine: Vaccine name, dose, date administered, manufacturer, lot number, site and route of injection, signature and title of person administering the vaccine, facility address, and Vaccine Information Statement (VIS) publication date.

• Only about one-third of providers record dose and route.
• Fourteen percent of facilities do not properly document vaccine name, e.g. there is no distinction made between IPV and OPV, or DTaP and DTP.
• Although three-quarters of clinics report that they provide the VIS to parents/guardians for each vaccine given, only 41% record the VIS publication date in the medical chart.
• Nearly 73% of the clinics assessed in King County have an immunization recall system (such as a manual postcard "tickler" file, or a computerized system, such as CHILD Profile).
• Approximately 80% of clinics charge a vaccine administration fee of $10 per dose (fee must not exceed $15.60 per dose, as stipulated by VFC); approximately one out of five clinics require a well-child exam prior to immunization.
• Almost 82% of clinics were aware of the Vaccine Adverse Event Reporting System (VAERS), though very few indicated ever having used it.
• Nearly 10% of clinics were not prepared with appropriate emergency medications, such as epinephrine (adrenaline) 1:1000 (injectable) and benadryl (diphenhydramine HCL) 50 mg/cc injectable. VFC guidelines require clinics to maintain a current supply of emergency medications along with a written protocol on how and when to administer them.

Immunization training and resources:

• The vast majority of clinics had appropriate immunization resources on-site (e.g. current immunization schedule; valid contraindications; adverse events; administration techniques), however only half reported having had the opportunity to send staff to immunization course offerings on current vaccine recommendations.
• Only one-third of clinics were aware of immunization videotapes available through the CDC.

For 2002, VFC is requesting that Public Health visit 20% of sites that receive public funded vaccines. For King County, this would equate to 58 clinic sites. If you have specific questions about the VFC assessment process, or for more details on site visit data from 1999-2001, please call Marcus Grandjean at 206-296-4855.