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Multi-dose vials and the H1N1 vaccine in Australia

A small group of nurses and media staff from RCNA and the Australian Nursing Federation have been meeting by teleconference intermittently over the last three years to discuss issues relating to the planning and management of an influenza pandemic.

The group focuses particularly on ensuring that the interests of nurses and their clients are adequately represented in all aspects of planning and response and that nurses are kept well informed.

In part, the group had its origins in frustrations experienced with the lack of nursing representation at most levels during planning for a possible human influenza pandemic that commenced in earnest in Australia in late 2005.

Collaboration between the two organisations ensures that there is consistency of response from both parties when a national nursing voice is needed. In late August 2009, the group prepared advice that resulted in a letter being sent jointly from Debra Cerasa, the Chief Executive Officer of RCNA and Ged Kearney, the ANF Federal Secretary, to Ms Jane Halton who is Secretary in the Department of Health and Ageing.

This letter expressed concerns, shared at that time with the Australian College of Physicians, regarding the potential risk to the public from the use of multi-dose vials. It was acknowledged that use of multi-dose vials had been part of pandemic plans for some time, but there was still a need for:

• development of clear guidelines for all health professionals engaged in delivering the vaccinations form the multi-dose vials
• endorsement of a collaborative approach to the development of guidelines on use of multi-dose vials
• commitment to investment in education for all health professionals engaged in the pandemic (H1N1) 2009 vaccinations.

It is now nearly three months later. The government launched a national pandemic (H1N1) influenza vaccination program to provide free vaccine initially targeted primarily at, but not restricted to, those most at risk.

Around the country, educators and policy makers rapidly swung into action to ensure that the Influenza A (H1N1) 2009 vaccine could be administered as safely as possible to as many people as possible. Many Nursing Review readers will have participated in the administration of the vaccine in health centres, general practices and other locations.

There has been little follow-up media coverage or commentary now that multi-dose vials are in widespread use. The potential for time and cost savings has been claimed at the national and local level but we must never forget the dangers that multi-dose vials present, however small.

The main problem is the potential for cross-contamination when using multi-dose vials. Multi-dose vials are prone to bacterial contamination and the potential exists even with the use of preservatives such as thiomersal (which is one of the constituents of PanvaxTM).

A second, less publicised, potential problem has arisen with the development of guidelines and education programs often by health professionals other than nurses. For example, the Guideline for the administration of pandemic (H1N1) influenza vaccine from multi-dose vials prepared by the Australian Technical Advisory Group on Immunisation (ATAGI) leaves open the potential for administration errors since the guideline includes a recommendation that sanctions the administration of vaccine by a person who may NOT have drawn up the dose: “Ensure that the person administering the vaccine (if they did not draw up the dose) can readily identify that the syringe contains H1N1 influenza vaccine” (Australian Technical Advisory Group on Immunisation, 2009).

This is not an accepted practice within the nursing profession and neither RCNA nor ANF condones this practice.

To ensure that we continue to provide the highest standard of care to our clients, if multi-dose vials must be used, monitoring and continuing education are the keystones of safety. Regular staff education should be provided remembering that new staff members may not be familiar with the use of multi-dose vials.

In addition, frequent and random monitoring for good infection control and medication safety practices will keep everyone alert and minimise the potential for tragic and costly mistakes.
Don’t forget RCNA has a webpage with H1N1 information that include major documents, articles and updates on the current pandemic situation in Australia and overseas. It can be found at:

By Anne Gardner RN PhD, Professor of Nursing, James Cook University, Townsville, Queensland on behalf of the ANF/RCNA Influenza Pandemic Working Group.

1. Australian Technical Advisory Group on Immunisation (ATAGI) 2009, Guideline for the administration of pandemic (H1N1) influenza vaccine from multi-dose vials, viewed November 2009, www.health.gov.au/internet/healthemergency/publishing.nsf/Content/national-vaccination-program

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