COLLEGE OF NURSING

SILLIMAN UNIVERSITY
Dumaguete City

Topic: Expanded Program on Immunization (EPI)

Time Allotment: 1 hour
• Placement: NCM 105 2nd semester 1st rotation
Topic description: This topic deals mainly with one of the programs of the Department of Health which is Expanded Program on Immunization. It includes the elements,
importance, general principles and contraindication to immunization. Furthermore, it also discusses on the program’s target diseases, the cold chain system,
immunization schedule, administration of vaccine, procedures in giving the vaccine and nurse’s role in improving the implementation of this program.

Central Objective: At the end of 1 hour ward class, the learners shall acquire adequate knowledge, develop beginning skills and manifest positive attitude towards Expanded
Program on Immunization.

SPECIFIC OBJECTIVES CONTENT T/A T-L ACTIVITIES EVALUATION

At the end of the 1- Prayer
hour ward class, the
learners shall: I. Introduction 3 Lecture Oral evaluation at
The Expanded Program on Immunization was launched in July 1976 mins. discussion 75% level of
by the Department of Health in cooperation with the World Health competency.
Organization and the UNICEF. The original objective was to reduce
the morbidity and mortality among infants and children by “Last Word Sing-
the six childhood immunizable diseases. The four major along”
strategies includes: sustaining high routine FIC coverage of Mechanics: The
at least 90% in all provinces and cities, sustaining the polio facilitator will start
free country for global certification, eliminating measles by to sing a song and
2008 and eliminating tetanus by 2008. will ask the student
 State the 5mins Socialized on the first row to
importance of II. The Concept and Importance of Vaccination . discussion continue singing
immunization in Immunization is a process by which vaccines are introduced into using another song,
their own words the body before infection sets in. Vaccines are administered to beginning with the
induce immunity thereby causing the recipient’s immune system last word the
to react to the vaccine that produces antibodies to fight infection. facilatator sang. If
Vaccinations promote health and protect children from disease- he/she cannot
causing agents. Infants and newborns need to be vaccinated at an continue the song
early age since they belong to vulnerable age group which made within 5 seconds,
them susceptible to childhood diseases. then he/she must
answer the first
question. If the
There are several general principles which apply in vaccinating student next to
children: him/her can
♣ It is safe and immunologically effective to continue singing
administer all EPI vaccines on the same day at different sites of with the last word,
the body. then he/she will be
♣ Measles vaccines should be given as soon immuned from the
as the child is 9 months old, regardless of whether other next question. The
vaccines will be given on that day. Measles vaccines given at 9 songs that were
months provide 85% protection against measles infection. sang should not be
When given at one year and older provides 95% protection. repeated gain. This
♣ The vaccination schedule should not be goes on until all the
restarted from the beginning even if the interval between students will be able
doses exceeded the recommended interval by months or to sing.
years.
♣ Moderate fever, malnutrition, mild EVALUATION
respiratory infection, cough, diarrhea and vomiting are not QUESTIONS:
 contraindications to vaccination. Generally, one should
immunize unless the child is so sick that he needs to be 1) What does
hospitalized. E.P.I. stand
♣ The absolute contraindications to for? When
immunization are: was it
→ DPT2 or DPT3 to a child who has had launched?
convulsions or shock within 3 days the previous dose. And who
Vaccines containing the whole cell pertussis component launched it?
should not be given to children with an evolving neurological 2) What was the
disease (uncontrolled epilepsy of progressive original
encephalopathy) objective of
→ Live vaccines like BCG vaccines must the E.P.I.?
not be given to individuals who are immunosuppressed due 3) What are the
to malignant disease (child with clinical AIDS), therapy with four major
immunosuppressive agents, or irradiation. strategies of
♣ It is safe and effective with mild side E.P.I.?
effects after vaccination. Local reaction, fever and systemic 4) Why is
symptoms can result as part of the normal immune response. immunization
♣ Giving doses of vaccine at less than the important to
recommended 4 weeks interval may lessen the antibody you?
response. Lengthening the interval between doses of vaccines 5) Give at least
leads to higher antibody levels. 3 principles
 State at least 3 2mins Lecture and explain
♣ No extra doses must be given to
principles and . discussion its importance
children/mother who missed a dose of DPT/HB/OPV/TT. The
explain its in your own
vaccination must be continued as if no time had elapsed
importance in words.
between doses.
their own words. 6) Enumerate at
♣ Strictly follow the principle of never, ever
least 3
reconstituting the freeze dried vaccines in anything other than
elements of
the diluents supplied with them.
EPI correctly.
♣ False contraindications to immunizations 7) Enumerate
 Enumerate at are children with malnutrition, low grade fever, mild respiratory 2mins Lecture the 7 target
least 3 elements infections and other minor illnesses and diarrhea should not be . discussion diseases of
of EPI correctly. considered a contraindication to OPV vaccination. Repeat BCG EPI?
vaccination if the child does not develop a scar after the 1 st 8) State 2 target
injection. diseas andits
♣ Use one syringe one needle per child corresponding
during vaccination. causative
agent,
 Enumerate the 7 III. Principles of EPI reservoir and
target diseases of • The program is based on epidemiological 8 Socialized sources of
mins. discussion with infection.
EPI and give its situation: schedules are drawn on the basis of the occurrence and visual aids 9) Every what
corresponding characteristic epidemiological features of the disease. day does
causative agent, • The whole community rather than just the individual is to be immunization
reservoir and protected, thus mass approach is utilized. day fall?
sources of • Immunization is a basic health service and 10) What is
infection. such it is integrated in to the health services being provided for the
by the Rural Health Unit. importance of
cold chain
IV. Elements of EPI system?
• Target setting 11) What
• Cold chain logistic management vaccine is
most
• Information, Education and
sensitive to
Communication
heat? And
• Assessment and evaluation of the
what vaccine
program’s overall performance
is the least
• Surveillance, studies and research sensitive to
heat?
V. EPI target diseases 12) What is
Vaccination among infants and newborns (0-12 months) against the order of
the seven vaccine preventable diseases. These include: the proper
tuberculosis, diphtheria, pertussis, tetanus, poliomyelitis, measles procedure in
and Hepatitis. administering
the tetanus
A. WHO Standard Case Definition of EPI Target toxoid
Diseases vaccine?
a. Measles 13) State at
 Standard Case Definition: least 3
A highly communicable disease with the history of the nurse’s roles
following: in improving
a) Generalized blotchy rash, lasting for 3 or more the delivery
days of
b) Fever (above 38°C or “hot” to touch and immunization
c) Any of the following: cough, runny nose, red services in
eyes/conjunctivitis the
 Agent: virus community in
 Reservoir: humans your own
 Sources of Infection: close respiratory contact and level of
aerosolized droplets understandin
 Occurrence: g from the
• Worldwide discussion.
 • Mortality and morbidity higher in developing
countries
 Transmissible Period: 4 days before until 2 days after
rash
 Duration of Natural Immunity: lifelong after attack
 Risk Factor for Infection:
• Crowding
• Low socio-economic status

b. Tuberculosis
 Standard Case Definition:
d) A child with history contact with a suspect of
confirmed case of pulmonary tuberculosis
e) Any child who does not return to normal health
after measles or whooping cough
f) Loss weight, cough, and wheeze which does not
respond to antibiotic therapy for acute respiratory
disease
g) Abdominal swelling with a hard painless mass and
free fluid
h) Painful firm or soft swelling in a group of
superficial lymph nodes
i) Any bone or joint lesion or slow onset
j) Signs suggesting meningitis or disease in the CNS
 Agent: Mycobacterium tuberculosis
 Reservoir: man, diseased cattle
 Sources of Infection: droplet infection, that is through
inhalation of bacilli from patients
 Occurrence:
• Worldwide
• Mortality and morbidity higher in developing
countries
 Transmissible Period:
• A person who excretes tubercle bacilli is
communicable
• The degree of communicability depends upon:
- The number of bacilli in the air
- Virulence of bacilli
- Environmental conditions like overcrowding
  Duration of Natural Immunity: not known,
reactivation of old infection commonly causes disease
 Risk Factor for Infection:
• Low access to care
• Immunodeficiency
• Malnutrition
• Alcoholism
• Diabetes

c. Diphtheria
 Standard Case Definition:
It is an acute pharyngitis, acute nasopharyngitis or acute
laryngitis with a pseudo membrane.
 Agent: Corynebacterium diphtheria
 Reservoir: man
 Sources of Infection: by respiratory droplets from
discharge of a case or carrier
 Occurrence:
• Worldwide
• Endemic in developing countries with
unimmunized populations
 Transmissible Period:
• May last for 2-3 weeks
• Maybe shortened in patients with antibiotics
treatment
• Diphtheria transmission is increased in schools,
hospitals, households and in crowded areas
 Duration of Natural Immunity: usually lifelong
 Risk Factor for Infection:
• Crowding
• Low socioeconomic status

d. Pertussis
 Standard Case Definition:
History of severe cough and history of any of the following:
cough persisting 2 or more weeks; fits of coughing, and
cough followed by vomiting
 Agent: Bordetella pertussis
 Reservoir: man
  Sources of Infection:
• primarily by direct contact with discharges from
respiratory mucous membranes of infected persons
• airborne route probably by droplets
• indirect contact with articles freshly solied with the
discharges of infected persons
 Occurrence:
• Worldwide
• Morbidity higher in developing countries
 Transmissible Period:
• Highly communicable in early catarrhal stage
before paroxysmal cough
• Antibiotics may shorten the period of
communicability from 7 days after exposure to 3
weeks after onset of typical paroxysm to only 5 to 7
days after onset of therapy
 Duration of Natural Immunity: usually lifelong
 Risk Factor for Infection: young age, crowding

e. Poliomyelitis
 Standard Case Definition:
A suspect cases of polio is defined as any patient below 15
years of age with acute flaccid paralysis (including those
diagnosed to have Guillaine Barre Syndrome) for which to
other cause can be immediately identified.
 Agent: Poliovirus type 1, 2, and 3
 Reservoir: man, mostly children
 Sources of Infection:
• Fecal-oral route
• Oral route through pharyngeal secretion
• Contact with infected persons
 Occurrence:
• Cyclical
• Worldwide
• Mortality and morbidity higher in developing
countries
 Transmissible Period:
• 7 to 16 days before onset of symptoms
• First few days after onset of symptoms
  Duration of Natural Immunity: type specific
immunity- lifelong
 Risk Factor for Infection: poor environmental hygiene

f. Neonatal Tetanus
 Standard Case Definition:
A newborn with history of all of the following:
• Normal suck for the first two days of life
• Onset of illness between 3 to 26 days
• Inability to suck followed by stiffness of the body
and/or convulsions
 Agent: Clostridium tetany
 Reservoir:
• Soil
• Intestinal canals of animals (esp. Horses)
• man
 Sources of Infection:
• unhygienic cutting of umbilical cord
 Identify the EPI • improper handling of cord stump especially when 5mins Lecture
routine schedule treated with contaminated substance . discussion with
of immunization  Occurrence: visual aids
for infants and for • Worldwide
women
• morbidity higher in developing countries
satisfactorily.
• more common in agriculture and underdeveloped
areas where contact with animal excreta is more likely
 Transmissible Period:
• Susceptibility is general
• Immunity can be obtained after 2 primary doses of
tetanus toxoid at 4 weeks interval in mothers one month before
delivery. Three booster doses increase antibody levels in mother
 Duration of Natural Immunity: no immunity induced
by infection
 Risk Factor for Infection:
• contamination of umbilical cord
• agricultural work

g. Hepatitis B
 Standard Case Definition:
It is the liver infection caused by the B type of hepatitis
 virus. It attacks the liver often resulting in inflammation.
 Agent: hepatitis B virus
 Reservoir: man
 Sources of Infection: hepatitis B spreads through the
following:
• From child to child or mother to child after birth
• From mother to child during birth
• Through sharing of unsterilized needles, knives or
razors
• Through sexual intercourse
Occurrence:
• In the Philippines, approx. 12 % of the population
are chronic carriers
• Most Filipinos are infected before the age of 6
years
• Some infected infants are not able to develop
immunity and become chronic carriers
• Hepatitis B especially dangerous to children
 Transmissible Period:
• Infants born to immune mothers may be protected
up to 5 months
• Recovery from clinical attack is not always
followed by lasting immunity
• Immunity is often acquired through unapparent
infection or complete immunization series with
diphtheria toxoid
 Duration of Natural Immunity: If develops- lifelong
 Risk Factor for Infection: HBeAG + mother- multiple
sexual partners

VI. The EPI Routine Schedule of Immunization

Every Wednesday is designated as immunization day and is
adopted in all parts of the country. In a barangay health station
immunization is done monthly while in far flung areas it is done
quarterly. However, some areas adopted local practices to provide
everyday vaccination in their areas to cover all targets.

A. Routine Immunization Schedule for Infants

The standard routine immunization schedule for infants is adopted
to provide maximum immunity against the seven vaccine
 preventable diseases. A child is said to fully immunized when a
child receives one dose of BCG, 3 doses of OPV, 3 doses of DPT, 3
doses of HB and one dose of measles before a child’s first
birthday.

Vaccine Minimum age Number of Minimum Reason

at 1st dose doses interval
between doses
It is given at
BCG Birth or 1 earliest
anytime possible age to
after birth protect the
possibility of
 Explain the infection from 8mins Lecture
importance of other family . discussion with
cold chain system members visual aids
in their own An earlier start
words. DPT 6 weeks 3 4 weeks reduces the
chance of
severe
pertussis
The extent
OPV 6 weeks 3 4 weeks protection
against polio is
increased when
OPV is given
earlier
6 weeks An early start
Hep B At birth 3 interval from reduces the
1st dose to chance of
2nd dose and being infected
8 weeks and becoming
interval from a carrier.
2nd dose to
3rd dose
At least 85% of
Measles 9 months 1 measles can be
prevented by
immunization
at this age

B. Tetanus Toxoid Immunization Schedule for

 Women
Tetanus toxoid vaccination for women is important to prevent
tetanus in both mother and the baby. When doses of TT injection
given at one month interval between each dose during
pregnancy or even before pregnancy period, the baby is protected
against neonatal tetanus.

Vaccine Minimum age/ Percent Duration of Protection

interval protected
As early as
TT1 possible
during
pregnancy
Infants born to the
TT2 At least 4 80% mother will be
weeks later protected from
neonatal tetanus; gives
3 years protection for
the mother
Infants born to the
TT3 At least 6 95% mother will be
months later protected from
neonatal tetanus ;
gives 5 years
protection for the
mother
Infants born to the
TT4 At least one 99% mother will be
year later protected from
neonatal tetanus; gives
10 years protection for
the mother

Gives life time

TT5 At least one 99% protection for the
year later mother; all infants born
to that mother will be
protected

VII. The Cold Chain System

The cold chain system is a means for storing and transporting
 vaccines in a potent state from the manufacturer to the person
being immunized. This is a very important component of an
immunization programme, since all vaccines lose potency over
time, especially if exposed to heat, and in addition, some also lose
their potency when frozen. It is obviously pointless to immunize
with impotent vaccine, and efforts to reach extremely high levels
of immunization coverage will be useless if the vaccine being
administered has insufficient potency to give the necessary
protection. Attention to maintaining correct temperatures during
storage and transport of vaccine is thus a major task for health
workers. Not all countries have an identical system, but the
vaccine must always be maintained at a safe temperature
throughout its entire journey; - during transport, while waiting at
the airport, when being kept in cold store, freezer or refrigerator,
and finally, during the course of an immunization session at the
health facility. The cold chain system comprises three major
elements:
 List down • Personnel, who use and maintain the equipment and provide 10mi Lecture
accurately the the health service; ns. discussion with
characteristics of • Equipment for safe storage and transportation of vaccines; and visual aids
EPI vaccines, its • Procedures to manage the programme and control
dose, route and distribution and use of the vaccines.
site of
administration.
A. Vaccine Storage
During transport between one level and the next, all vaccines must
be maintained at a temperature between 0° and +8°C. If unopened
and OPV, Measles or Mumps vaccines become unfrozen during
transit, they can be safely re-frozen at the next level without any
harm or loss of potency to the vaccine.

Notes:
(1) Remember to check the expiry dates of all vaccines and ensure
that they will not expire during storage or before they can be
distributed and used.
(2) Rotate vaccine stock: vaccine received first should be
distributed or used first (“First In, First Out”) unless a Vaccine
Vial Monitor (VVM) shows that another batch should be
distributed or used first

B. Vaccine Potency
If a vaccine loses some or all of its potency due to exposure to heat,
 its outward appearance may be unchanged. Previously, a laboratory
test was needed to determine whether it could still be used. The
Cold Chain Monitor Card was the first device to give a visual
indication of possible loss of potency in a carton of vaccine because
of exposure to temperature. In 1996, a new kind of monitoring
device became available which gives a visual indication of vaccine
potency for individual vials of foreign manufactured OPV. The
Vaccine Vial Monitor (VVM) is a small indicator attached to each vial,
which keeps a constant record of its exposure to heat. If the vaccine
is exposed to temperatures above +8oC, the indicator progressively
changes color, and gives health staff an immediate warning that the
vaccine has been damaged. In 1997, this type of indicator was only
used on OPV vials, but similar indicators are being developed for
other vaccines also.

C. Vaccine stock quantities

It is important for the correct quantity of vaccine stock to be kept at
each level of the cold chain. If you keep too little vaccine, health
facilities may run out of stock and the immunization program may
be interrupted. On the other hand, if you keep too much vaccine,
there may be insufficient storage space in your cold chain, some
vaccine may be stored longer than recommended and risk expiry
before it can be used, and there may not be enough vaccine to
supply to other parts of the country.

D. Vaccine stock records

All vaccine storage points must keep a complete and updated stock
record book. Minimum information to be recorded for each vaccine
should include:
• Name of vaccine, batch number & expiry date, vial size;
• Quantity received and sources of supply, (in doses);
• Quantity issued and to whom sent, (in doses)
• For BCG, measles, and mumps: quantities of diluent received
and issued;
• Balance in stock after each transaction, (in doses); 5mins
• Date of each transaction; . Lecture
 Give briefly the • Physical stock check at the end of each page. (in doses). discussion with
order in proper visual aids
procedures in The record should be kept by the storekeeper or person responsible
administering the for looking after the vaccines, and must be updated every time
EPI vaccines. vaccine enters or is issued from the store. A record, which is not
 kept up to date, gives false information, and is of no value to the
manager. It can also lead to over or under-stocking of your store and
cause confusion and disruption to your program. The stock record
must also be checked regularly for accuracy. This can be done by
making a physical count of the actual quantities of vaccine in stock,
and comparing this to the amount shown in the stock record book.
Any difference must be immediately corrected by updating the
record to show the correct figures. The check for accuracy should be
done at the end of each page in the record book, or at the end of
each month, if this is reached before the end of one page.

E. Vaccine arrival report

A Vaccine Arrival Report is required for EVERY vaccine shipment,
whether it comes from a foreign manufacturer. The document
provides vital information for your own Ministry, but will also be
essential if this vaccine was provided through a program of
technical assistance or other donor support to your program.

VIII. The EPI vaccines and its characteristics

Vaccines are substances very sensitive at various temperatures. To

avoid spoilage and maintain its potency, vaccines need to be
stored at correct temperature. When handling, transporting and
storing vaccines, special care must given to provide quality potent
vaccines among the targets.

A) Types of Vaccines

Type of vaccines Storage temperature

Oral polio (live -15°C to -25°C (at the
Most sensitive to attenuated); freezer)
heat measles (freeze
dried)
DPT/Hep B +2°C to +8°C (in the body
Least sensitive to “D” toxoid which is of the refrigerator)
heat a weakened toxin
“P” killed bacteria
“T” toxoid which is
a weakened toxin
Hep B; BCG (freeze
dried); Tetanus
 toxoid

A “first expiry and first out” (FEFO) vaccine is practiced to assure

that all vaccines are utilized before its expiry date. Proper
arrangement of vaccines and/or labelling of vaccines expiry date
are done to identify those near to expired vaccines.

Temperature monitoring of vaccines is done in all levels of health

facilities to monitor vaccine temperature. This is done twice a day
early in the morning and in the afternoon before going home.
Temperature is plotted every day in a temperature monitoring
chart to monitor break in the cold chain.

Each level of health facilities has cold chain equipment for use in
the storage of vaccines. These are: cold room, freezer, refrigerator,
transport box, vaccine carrier. Other cold chain logistics supplies
includes: thermometers, cold chain monitor, ice packs,
temperature monitoring chart, safety collector box, etc. These are
essentials in proper management of vaccines and other EPI
logistics.

B) Administration of Vaccines

Vaccine Dose Route of Site of

administration administration
BCG Infants 0.05ml intradermal Right deltoid
region of the arm
DPT 0.5ml intramuscular Upper outer
portion of the
thigh
OPV 2 drops or oral mouth
depending on
manufacturer’s
instructions
Measles 0.5ml subcutaneous Outer part of the
upper arm
Hep B 0.5ml intramuscular Upper outer
portion of the
thigh
 Tetanus toxoid 0.5ml intramuscular Deltoid region of
the upper arm

IX. Procedures in the giving of vaccines:

4
A. BCG vaccine mins. Socialized
 Discuss critically discussion
the nurse’s role in A.1 Reconstituting the freeze dried BCG vaccine
improving the a. Always keep the diluents cold by sustaining with BCG
delivery of vaccine ampules in refrigerator or vaccine carrier
immunization b. Using 5ml syringe fitted with a long needle, aspirate
services in the 2ml of saline solution from the opened ampule of diluents
community. c. Inject the 2ml saline into the ampule of freeze dried
BCG
d. Thoroughly mix the diluent and vaccine by drawing
the mixture back into the syringe and expel it slowly into the ampule
several times
e. Return the reconstituted vaccine on the slit of the
foam provided in the vaccine carrier

A.2 Giving BCG vaccine:

a. Clean the skin with a cotton ball moistened with water
and let skin dry
b. Hold the child’s arm with your left hand so that your
hand is under the arm, and your thumb and fingers come around the
arm and stretch the skin
c. Hold the syringe with your right hand with the bevel
and scale pointing up towards you
d. Lay the syringe and needle almost flat along the
child’s arm
e. Insert the tip of the needle into skin, just the bevel
and a little bit more. Keep the needle flat along the skin and the bevel
facing upwards so that the vaccine only goes into the upper layers of
the skin
f. Put your left thumb over the needle end of the
syringe to hold it in position. Hold the plunger in with your right thumb
g. If the vaccine is injected correctly into the skin, a flat
wheal with the surface pitted like an orange peel will appear at the
injection site
h. Withdraw the needle gently
 B. Giving oral polio vaccine

a. Read the manufacturer’s instructions to determine

number of drops to be given. Use the dropper provided for 3
b. Let the mother hold the child lying firmly on his back. mins. Socialized
 Evaluate the ward c. If necessary open the child’s mouth by squeezing the discussion
class objectively. cheeks gently between your finger’s to make his lips point upwards
d. Put drops of vaccine straight from the dropper onto
the child’s tongue but do not let the dropper touch the child’s tongue
e. Make sure that the child swallows the vaccine. If he
spits it out, give another dose

C. Giving Hepatitis B and DPT

a. Ask mother to hold the child across her knees so that his thigh
id facing upwards. Ask her to hold child’s legs
b. Clean the skin with a cotton ball, moistened with
water and let skin dry
c. Place your thumb and index finger on each side of the
injection site and grasp the muscles slightly. The best injection site is
the outer part of the child’s mid thigh
d. Quickly push the needle into the space between your
fingers, going deep in the muscle
e. Slightly pull the plunger back before injecting to be
sure that the vaccine is not injected into the vein
f. Inject the vaccine. Withdraw the needle and press the
injection spot quickly with a piece of cotton

D. Measles

D.1 Reconstituting the freeze dried measles vaccine

a. Using a 10ml syringe fitted with a long needle,
aspirate 5ml of special diluents from the ampule
b. Empty the diluent from the syringe into the vial with
the vaccine
c. Thoroughly mix the diluents and vaccine by drawing
the mixture back into the syringe and expelling it slowly into the vial
several times. Do not shake the vial
d. Protect reconstituted measles vaccine from sunlight.
Wrap vial in foil
e. Place the reconstituted vaccine in the slif of the foam
provided in the vaccine carrier
 D.2 Giving measles vaccine
a. Ask mother to hold the child firmly
b. Clean the skin with a cotton ball moistened with
water and let the skin dry
c. With the fingers of one hand, pinch up the skin on the
outer side of the upper arm
d. Without touching the needle, push the needle into the
pinched-up skin so that it is not pointing
e. Slightly pull the plunger back to make sure that the
vaccine is not injected into a vein
f. Press the plunger gently and inject

E. Tetanus toxoid
a. Shake the vial
b. Clean the skin with a cotton ball, moistened with
water and let skin dry
c. Place your thumb and index finger on each side of the
injection site and grasp the muscles slightly. The best injection site for
a woman is outer side of the left upper arm
d. Slightly pull the plunger back before injecting to be
sure that the vaccine is not injected into a vein
e. Quickly push the needle into the space between your
finger going deep in the muscle
f. Inject the vaccine. Withdraw the needle and press the
injection spot quickly with a piece of cotton
Note: shake the vial before every injection

X. The Role of a Nurse in Improving the delivery of

Immunization Services in the Community

Health workers are vital to health care delivery system. The most
critical problem we are facing now is the lack of nurses and other
disciplines in carrying out health activities in immunization. Your
presence in the community is a big contribution to program health
development. For every child you have been immunized reduces
missed opportunity and help increase population immunity of the
population groups.

As a nurse you need to:

• Actively master list infants eligible for vaccination
in the community
 • Immunize infants following the recommended
immunization schedule, route of administration, correct dosage and
following the proper cold chain storage of vaccines.
• Observe aseptic technique on immunization and
use one syringe and one needle per child. This reduces blood-borne
diseases and promotes safety injection practices.
• Dispose used syringes and needles properly by
using collector box and disposing it in the septic vault to prevent
health hazard.
• Inform, educate and communicate with the
parents
- To create awareness/motivate to submit their
children for vaccination
- To provide health teachings on the importance
and benefits of immunization, importance of follow up dose to avoid
defaulters and normal course of vaccine.
- To inform immunization schedule as adopted
by local units
• Conduct health visits in the community to assess
other health needs of the community and be able to provide
package of health services to targets.
• Identify cases of EPI target diseases per standard
case definition
• Manage vaccines properly by following the
recommended storage of vaccines
• Record the children given with vaccination in the
Target Client list and GECD/GMC card or any standard
recording form utilized
• Submit report and record of children vaccinated,
cases and deaths on EPI diseases, vaccine received and
utilized and any other EPI related reports
• Identify and actively search cases and deaths of
EPI target diseases following standard case definition

XI. Evaluation/Open forum

References:
♣ Cuevas, F. (2007). Public health nursing in the Philippines. (10th ed). Publications committee national league of the Philippines government nurses, Inc.

♣ Deglin, J. & Vallerrand, A. (2005). Davis’ drug guide for nurses. (9th ed). F.A. Davis Company.

♣ Leifer, G. (2003). Introduction to Maternity and pediatric nursing: (4th ed). Saunders: Elsevier Science, USA.

♣ Reyala, J. et.al. (2000). Community health nursing services in the Philippines. (9th ed). Community health nursing section national league of Philippine
government Nurses Inc.

♣ http://www.who.int/vaccines-documents/DocsPDF/www9825.pdf

COLLEGE OF NURSING
SILLIMAN UNIVERSITY
Dumaguete City

A Resource Unit on
EXPANDED PROGRAM ON
Submitted by:
Delos Santos, Jessica France M.

Submitted to:
Asst. Prof. Chereisle G. Pyponco,RN

Date Submitted:
November 11, 2010

NCM 105 - Section G3

CHN Rotation

COLLEGE OF NURSING
SILLIMAN UNIVERSITY
Dumaguete City

Vision: As a leading Christian institution committed to total human

development for the well- being of society and environment.
Mission:
 Infuse into the academic learning the Christian faith anchored on
the gospel of Jesus Christ; provide an environment where Christian
fellowship and relationship can be nurtured and prompted.
 Provide opportunities for growth and excellence in every
dimension of the university life in order to strengthen character,
competence and faith.
 Instill in all members of the university community an enlightened
social consciousness and a deep sense of justice and compassion.
 Promote unity among people and contribute to national
development.