Vaccination Site Care for Health Care Workers

Draft guidance for work and home

The Centers for Disease Control and Prevention’s Healthcare Infection Control Practices Advisory Committee in Atlanta recently drafted the following measures for infection control of vaccinia virus:

• Keep the vaccination site covered with gauze or a similar absorbent material (secured with medical tape) in combination with a semipermeable dressing until the scab separates on its own. As an alternative, products combining an absorbent base with an overlying semipermeable layer can be used to cover the site. Using a semipermeable dressing alone is not recommended because it might cause maceration of the vaccination site and prolong irritation and itching, which subsequently lead to increased touching, scratching, and contamination of hands.

• As an extra precaution to prevent the transmission of vaccinia virus, especially in situations of close physical contact or contact with young children, wear long-sleeved clothing that covers the vaccination site. Short-sleeved scrubs do not protect the vaccination site from the hands of children or combative patients.

• Change the dressing every three to five days or as soon as fluid accumulation is noted. This will prevent buildup of exudates and consequent maceration of the skin at the vaccination site. Daily dressing changes might be required during the period of maximum inflammatory response. When the dressing is changed by another individual, gloves are worn and changed prior to placing the clean dressing. If an individual is changing his/her own dressing, gloves are worn only if there are open skin areas on the hands.

• After any contact with the vaccination site or dressings, wash hands with antimicrobial soap and water or use an approved alcohol-based hand-rub solution (greater than or equal to 60% alcohol). When hands are visibly contaminated, use antimicrobial soap and water, instead of an alcohol-based hand rub.

• Dispose of contaminated dressings promptly. In health care settings, dispose of the dressing in accordance with regulations for medical waste. In nonhealth care settings, carefully enclose dressings in a sealed plastic bag before disposal in the trash. Wash hands or use an alcohol hand rub after disposal of the bag.

• Avoid touching, rubbing, or otherwise performing any maneuvers that might transfer vaccinia virus to the eyes or surrounding skin.

• Avoid contact of the vaccination site or contact with contaminated materials from the vaccination site by any other person.

• Do not use any salves, creams, or ointments on the vaccination site.

• If maceration of the vaccination site occurs, leave the lesion open to air to allow the site to dry. Do this only during a period that includes no contact with patients or other people.

• When the scab separates, dispose of it in a sealed plastic bag. Wash hands or use a waterless hand rub after disposal of the bag.

Home management

• Cover the vaccination site with gauze or a similar absorbent material, and wear long-sleeved clothing.

• Pay careful attention to hand hygiene, which should be done with antimicrobial soap and water or an approved hand-rub solution (greater than or equal to 60% alcohol).

• Keep the vaccination site dry. Cover the vaccination site with water-resistant plastic wrap when bathing. Change back to the gauze dressing after bathing. Dispose of the contaminated plastic wrap promptly. Carefully enclose the plastic wrap in a sealed plastic bag before disposal in the trash. Wash hands or use an alcohol hand rub after disposal of the bag.

• After bathing, blot the vaccination site with gauze. Dispose of the contaminated gauze promptly. Carefully enclose the gauze in a sealed plastic bag before disposal in the trash. Wash hands or use an alcohol hand rub after disposal of the bag.

• If a towel if used to dry the site, the towel should not be used to dry the rest of the body. An alternative is to allow the site to air dry before replacing the dressing.

• Do not use any salves, creams, or ointments on the vaccination site.