Vaccinating Homebound Persons With COVID-19 Vaccine
COVID-19 vaccination of homebound persons presents unique challenges to ensure the appropriate vaccine storage temperatures, handling, and administration to ensure safe and effective vaccination. Homebound persons include those that need the help of another person or medical equipment such as crutches, a walker, or a wheelchair to leave their home, or their medical provider believes that their health or illness could get worse if they leave their home, and they typically do not leave their home.
The information below provides guidance on management of vaccines and vaccination for persons vaccinated at home or in small group settings (e.g., residential facilities, group homes).
It is essential that healthcare professionals receive training to effectively meet the demands of their roles. Training must be ongoing because new COVID-19 vaccine products are likely to become available, and vaccine recommendations can change as we learn more about the vaccines and work to improve the vaccination process. Training may be required for medical and administrative support staff, in addition to healthcare professionals, depending on their involvement in vaccination activities.
Guidance for storage, handling, preparation, and administration is different for each COVID-19 vaccine product, and healthcare professionals administering COVID-19 vaccines should be knowledgeable about requirements and best practices. It is critical that healthcare professionals and other staff are familiar with the COVID-19 vaccine product in their facility’s inventory. Non-clinical staff members who receive vaccine deliveries as well as those who handle vaccines should be trained in vaccine storage and handling requirements and best practices. Training requirements and recommendations are outlined on CDC’s COVID-19 Training and Education web page.
It is also important to include training on accessibility-specific issues, such as working with people who are blind or have limited vision; those who are deaf or hard of hearing; those who work with service animals; and those with various language, physical, social, or sensory needs.
Pre-vaccination planning for vaccination of homebound persons
Providers vaccinating homebound persons should carefully pre-plan to understand how they can most efficiently prevent vaccine wastage and ensure safe and effective vaccination by:
Estimating the number of doses needed as accurately as possible. Contact recipients or their caregivers in advance to determine those who wish to be vaccinated to best estimate how many doses will be needed. Plan to use all doses in a vial transported for home vaccination to minimize wasting vaccine doses, such as having contingency plans for vaccination of caregivers, or other persons in the home to avoid vaccine wastage
Providing information in a variety of accessible formats (e.g., American Sign Language, multiple languages, braille, large font, low literacy, materials with pictures or visual cues).
Mapping out travel plans to ensure vaccine is utilized within the approved time frames for use of vaccine at different temperatures, including factoring in pre-vaccination preparation time, and post-vaccination observation time.
Ensuring readiness to maintain, monitor, and report temperature of vaccine from the time the vaccine is taken out of a clinic facility, during transportation, and up to the time that vaccine is administered.
Vaccine administration involves a series of actions: assessing patient vaccination status and determining needed vaccines, screening for contraindications and precautions, educating patients, preparing and administering vaccines properly, and documenting the vaccines administered.
Vaccines should be prepared and administered following aseptic technique. Prepare the injection in a designated, clean medication preparation area that is not adjacent to potential sources of contamination, including sinks or other water sources. Keep in mind that water can splash or spread as droplets more than a meter from a sink. In addition, any item that could have come in contact with blood or body fluids, such as soiled equipment used in a procedure, should not be in the medication preparation area.
Give each recipient a copy of the EUA fact sheet (Pfizer, Moderna, or Janssen) for recipients and/or caregivers.
V-safe is a smartphone-based tool that uses text messaging and web surveys to provide personalized health check-ins for recipients after COVID-19 vaccination. Through v-safe, recipients can quickly tell CDC if you have any side effects after getting the COVID-19 vaccine. Depending on the answers, someone from CDC may call to check on recipients that have signed up for the program.
Ask the person if he or she has any questions or concerns prior to vaccination, and address them, as appropriate.
Although there are no federal requirements for documenting informed consent (or assent for people who work with a medical proxy), best practices are to document consent/assent in the medical records.
Before administering vaccine, screen recipients for contraindications and precautions (use the prevaccination checklist for COVID-19 vaccination in English or Español), even if you are administering the second dose. The recipient’s health condition or recommendations regarding contraindications and precautions for vaccination may change from one visit to the next.See Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Authorized in the United States at Interim Clinical Considerations for Use of COVID-19 Vaccine for more information.
For homebound persons who might be at increased risk for anaphylaxis following vaccination (i.e., persons with a for vaccination or a history of anaphylaxis due to any cause), consider whether they can be vaccinated in a setting where medical care is immediately available if they experience anaphylaxis following vaccination. If home vaccination is the only option for these persons and, through risk assessment, it is determined that the benefits of vaccination outweigh the potential risk for anaphylaxis, home vaccination providers should be able to manage anaphylaxis. This includes appropriate screening; post-vaccination observation; medications and supplies; staff qualifications for recognition and treatment of anaphylaxis; and ability to contact and availability of emergency medical services in the area.COVID-19 vaccination provider should have at least 3 doses of epinephrine on hand when administering vaccine. CDC currently recommends that persons without contraindications to vaccination who receive a COVID-19 vaccine be observed after vaccination for the following time periods:
30 minutes: Persons with a history of an immediate allergic reaction (within 4 hours) of any severity to a vaccine or injectable therapy, and persons with a history of anaphylaxis due to any cause.)
15 minutes: All other persons. Additional information about potentially managing an anaphylactic reaction is available.
COVID-19 vaccination providers must document vaccine administration in their medical record systems within 24 hours of administration and use their best efforts to report administration data to the relevant system for the jurisdiction (i.e., immunization information system) as soon as practicable and no later than 72 hours after administration.
Adverse events that occur in a recipient after COVID-19 vaccination must be reported to the Vaccine Adverse Event Reporting System (VAERS). FDA requires vaccination providers to report vaccine administration errors, serious adverse events, cases of multisystem inflammatory syndrome, and cases of COVID-19 that result in hospitalization or death after administration of COVID-19 vaccine under an EUA. Reporting is encouraged for other clinically significant adverse events, even if it is not clear that a vaccine caused the adverse event. Complete and submit reports to VAERS online.
To prevent wasting vaccine doses, as appropriate and approved by jurisdictions, healthcare personnel may administer vaccine to caretakers and family members, given their high risk of exposure.