8 Standards for Military Immunization

The Immunization Healthcare Branch (IHB) has developed immunization guidance adapted from the March 2000, Quality Standards and Guidance for Program Evaluation in Adult Immunization Programs in Non-traditional Settings, from the Centers for Disease Control and Prevention (CDC) to assist facilities in assessing their compliance with the immunization standards, ensuring that they use the best clinical practices when administering vaccines. The Department of Defense (DoD) adopted these standards and incorporated them within the Joint Instruction on Immunization and Chemoprophylaxis (AR 40-562, BUMEDINST 6230.15B, AFI 48-110_IP, CG COMDTINST M6230.4G) as the eight Standards for Military Immunizations. The standards are located in Appendix B of the Joint Instructions.

The IHB Agency further developed the immunization guidance and created a user-friendly tool called the Continuous Quality Immunization Improvement Process (CQIIP) to assist facilities in assessing their compliance with the immunization standards, ensuring that they use the best clinical practices when administering vaccines.

Standard #1: Immunization Availability
  1. Immunizations are available with minimum disruption of deployment or training schedules.
  2. Immunizations are available at convenient times, without unnecessary barriers. Immunization services are available on a walk–in basis, as staffing permits. Physical examinations and temperature measurements before immunizationare not routinely required if they would delay or impede the timely receipt of immunizations. As clinically appropriate, beneficiaries receive simultaneously the vaccine doses required.
  3. Immunizations services are responsive to the needs of beneficiaries.
  4. Providers incorporate immunization screening and services as a routine part of clinical care for all beneficiaries.Standing orders with quality assurance procedures are implemented, rather than depending on individual written orders or referral from a primary care provider.
Standard #2: Information and Education Before Immunization
  1. Current versions of DOD information brochures or CDC VISs are provided before immunization and conspicuously available in waiting areas of immunization clinics.
  2. Immunization personnel know how to readily obtain answers to patients’ immunization questions. Personnel are available to accurately address questions and concerns posed by the vaccines.
  3. Before immunization, the vaccinee (individually or collectively) is given information about benefits and risks associated with immunization. For complicated topics (for example, anthrax, smallpox), detailed educational programs and brochures are provided. This information is culturally appropriate and at an appropriate level.
Standard #3: Vaccine Storage and Handling
  1. Staff members adhere to cold chain management principles, including both transportation and storage. A temperature monitoring process is used.
  2. Vaccine inventories exceeding $25,000 are connected to temperature recording devices and alarm systems.
Standard #4: Indications and Contraindications to Immunization
  1. Each patient is asked about allergies, health status, and previous adverse events before immunization. Eachpatient is provided an opportunity to ask questions about potential contraindications. Patients are referred for appropriate medical evaluation as needed.
  2. During screening, the patient receives a comprehensive screening for all vaccine needs.
  3. Immunization personnel understand the patient’s personal situation before immunization. If a contraindication toimmunization exists, this information is documented in the health record and ITS. Women are screened with regard to pregnancy.
Standard #5: Immunization Recordkeeping
  1. Immunizations are recorded accurately in a DOD–approved electronic tracking system according to Service–specific policy. Immunization records are updated at the time of immunization.
  2. The immunization clinic or military unit has 1 or more mechanisms for notifying patients when the next dose of an immunization series is needed (that is, a reminder system).
  3. The immunization clinic or military unit has 1 or more mechanisms for notifying patients when they are overduefor immunization (that is, a recall system).
  4. Electronic ITS are the preferred immunization record for DOD and USCG personnel. All Services record military immunization data into an electronic database that communicates with a centralized DOD registry. Reminder and recall systems may be automated or manual and may include mailed, emailed, or telephone messages.
Standard #6: Training
  1. Persons who administer vaccines must be appropriately trained.
  2. Medical personnel administer vaccines after training to a standard acceptable to the MTF commander, command surgeon, or other appropriate medical authority. Training will include vaccine storage and handling, vaccine characteristics, patient interviewing techniques, distinguishing valid and invalid contraindications, injection technique, documentation, managing and reporting of adverse events, and anaphylaxis.
  3. Persons who administer vaccines complete at least 8 hours of annual continuing education and training on currentimmunization recommendations, schedules, and techniques. Training resources include online and resident courses (http://www.vaccines.mil/training), the selfpaced project immune readiness (http://www.vhcinfo.org), and video training from CDC.
  4. Persons who administer vaccines have ready access to information resources regarding current recommendationsfor childhood, general adult, travel, and military–specific immunizations.
Standard #7: Adverse Events After Immunization
  1. Epinephrine (such as auto–injectable epinephrine), properly stored, is readily available along with other suppliesdetermined locally.
  2. Staff members have ready access to reporting options for the VAERS. For consultation or assistance contact the Worldwide DHA Immunization Healthcare Support Center at (877) GET-VACC or (877) 438-8222.
  3. A quality improvement process assures adverse events are reported to VAERS promptly.
  4. Persons who administer vaccines are close to a telephone or radio, so emergency medical personnel can besummoned. Medical providers document adverse events in the health record at the time of the event or as soon aspossible thereafter.
Standard #8: Vaccine Advocacy to Protect the Military Family
  1. The medical facility knows the extent of influenza and pneumococcal immunization coverage among its high risk patients and has a plan to optimize that level.
  2. The medical facility implements a plan to optimize immunization rates among cardiac, pulmonary, diabetic, asplenic, and other patient groups at elevated risk of complications from vaccine–preventable infectious diseases.
  3. The medical facility conducts a quality improvement program to optimize its performance in immunizing children, adolescents, and adults against the preventable infections that most threaten them.
  4. Commanders use immunization databases to identify and resolve the vulnerabilities of their units.
  5. Commanders have plans to help their beneficiaries optimize their personal protection against preventable infec-tious diseases and meet national goals for optimal delivery of influenza and pneumococcal vaccines. All health careproviders (not just those in immunization clinics) routinely determine the immunization status of their patients, offervaccines to those for whom they are indicated, and maintain complete immunization records.