BCG Vaccination Policy

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Arthur Hamilton
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describe the process for assessment, neonatal referral and BCG vaccination for neonates less than 24 weeks old.

1 Document ID: MATY011 Version: 1.0 Facilitated by: Anne Watts, BCH Nurse Issue Date: August 2011 Approved by: Maternity Quality Committee Review date: August 2018 BCG Vaccination Policy Purpose The purpose of this policy is to describe the process for assessment, neonatal referral and BCG vaccination for neonates less than 24 weeks old. Scope All LMC/ access holders All midwives and nurses employed by Hutt Valley District Health Board Maternity Department BCG vaccinators Definitions BCG (Bacille Calmette-Guerin vaccine), the vaccination for tuberculosis. TB (Tuberculosis): Human TB is caused by infection with Mycobacterium tuberculosis complex. Principles This policy describes 1. How assessment of neonatal eligibility for BCG vaccination is made 2. How consent is obtained 3. The administrative requirements following vaccination at Hutt Valley District Health Board Background TB is a notifiable disease that occurs in New Zealand. Higher rates of TB exist in New Zealand among population groups and recent immigrants from high incidence countries e.g. Asia, Africa, and the Pacific. BCG immunisation was first introduced to New Zealand in 1948 for nurses and later extended to all adolescents. BCG immunisation of neonates was introduced in 1976 (see eligibility criteria below for current recommendations). LMC s and staff in the antenatal and postnatal area have a responsibility to ensure that all infants who are eligible to receive this vaccine are offered vaccination and that the nurse working for the BCG service as vaccinator has access to the information they require. Vaccine The BCG contains a live attenuated strain of Mycobacterium Bovis. It is administered via the intradermal route. BCG can be given simultaneously with any other vaccine; however, it must be administered into a separate site and not in the same syringe.

2 As there is a risk of local lymphadenitis, no other immunisations should be given in the arm used for BCG for at least 3 months. (MOH, 2011, p.259) Vaccination Only gazetted vaccinators may administer this vaccine to neonates. The vaccine is administered by intradermal injection over the point of insertion of the left deltoid muscle. Procedure All pregnant women should be assessed by their Lead Maternity Carer as to the risk of TB for their baby. (MOH, 2011, p.259) Neonatal BCG should be offered to infants at increased risk of tuberculosis, defined as those who: Will be living in a house or family/whānau with a person with either current tuberculosis or a past history of tuberculosis. Have parents or household members or carers, who within the last five years lived for a period of 6 months or longer in countries with a rate > 40 per 100,000 During the first five years will be living for three months or longer in a country with a rate > 40 per 100,000 (MOH, 2011, p. 259) Countries with high rates of TB are: most of Africa, much of South America, Russia and the former Soviet states, Indian subcontinent, China (including Hong Kong; Taiwan, South East Asia (NOT Singapore), some Pacific nations (NOT Cook Islands, Fiji, Niue, Samoa, Tokelau and Tonga) Neonates at risk should be identified antenatally by Lead Maternity Care providers. (MOH, 2011, p.260) Documentation Procedure eligibility assessment form Antenatal period All LMC s are to complete a Regional Public Health BCG eligibility assessment form (appendix 2) for all babies with the parents to determine if the baby is eligible for vaccination. The BCG eligibility assessment form is to be filed with the woman s booking in documentation in the hospital antenatal notes. After Birth The BCG eligibility assessment form is taken out of the notes by the LMC. The BCG eligibility assessment form is then placed on the clipboard in postnatal or delivery suite for collection by the vaccinator. If the birth is by caesarean section, then the midwife who is looking after the woman when she returns from theatre is to remove the BCG eligibility assessment form and place it on the clipboard on postnatal ward for collection by the vaccinator. BCG Vaccination Policy (MATY011) Page 2 of 6

3 BCG vaccinator The vaccinator is responsible for: Collection of all forms from postnatal, delivery suite and maternity enquiries. Sighting, completing and signing the BCG assessment forms. Administration of vaccines. Documentation after vaccine. The vaccinator assesses each completed form. If the baby is not eligible for vaccination then the form is signed and kept by the vaccinator. If the baby is eligible for vaccination, then the eligibility form is signed and kept by the vaccinator. Consent Mother and baby in the postnatal ward The vaccinator visits the parents and discusses the BCG vaccination with them. The vaccinator provides an information leaflet to the parents (Information for parents for babies at risk of catching tuberculosis) and then completes a consent form for each baby. BCG information has been translated into various languages (appendix 1) Once consent has been obtained, the vaccination can be administered by the gazetted vaccinator. It is not the purpose of this policy to describe the process of actual vaccination. After the vaccination, parents are provided with guidelines for aftercare for their baby. When baby is in SCBU A tracking form is used to identify babies that need vaccination and arrangement is made to vaccinate in consultation with medical staff and the mother. The SCBU book is also completed and kept in SCBU. When mother and eligible baby have been discharged from the maternity unit before the BCG vaccine has been given The mothers of eligible babies are contacted by the BCG vaccinator. An outpatient appointment is made for mother and baby to come to the Children s clinic, Paediatric Department where the baby is vaccinated. After vaccination it is imperative that babies remain in the clinic for 20 minutes to ensure that the baby does not react to the vaccine. Post vaccination documentation Once the baby is vaccinated, the following are completed: BCG vaccination eligibility form is completed with details of the vaccination. The date and time the vaccine was administered and the dosage of the vaccine that was given is recorded in the baby s notes. Consent form completed with the necessary vaccination information and authorised copy is filed in the baby s notes. BCG Vaccination Policy (MATY011) Page 3 of 6

4 For babies who are inpatients, the hospital discharge summary is completed. A copy of this is forwarded to the GP, advising them that the BCG vaccination has been given. Letters are also sent to GP s following outpatient BCG s. The well child book is completed with the necessary documentation recording that the BCG vaccination has been given. Information of the BCG is also recorded by Maternity Enquiries and on the NIR. Register. Vaccinators must also complete the following forms Regional public health BCG clinic form. Weekly clinic ethnicity audit form. Outpatient s appointment form. Audit The number of babies receiving the BCG vaccination and the completeness of eligibility assessment forms should both be audited on an annual basis as a quality initiative. References Tuberculosis Act 1948 Tuberculosis Regulations 1951 Guidelines or Tuberculosis Control in New Zealand 2010 Ministry of Health (1996). Technical Guidelines for Tuberculin testing and BCG vaccination Wellington: Ministry of Health M.O.H. Immunisation Handbook 2011 Records NIR consent form for Neonatal BCG vaccination form (Appendix 1) Associated Policies Guidelines for routine postnatal care Hutt Maternity Policies provide guidance for the midwives and medical staff working in Hutt Maternity Services. Please discuss policies relevant to your care with your Lead Maternity Carer. BCG Vaccination Policy (MATY011) Page 4 of 6

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