Immunisation in a RACF

Residential aged care facility residents may have a higher risk of severe illness if they develop COVID-19, influenza, respiratory syncytial virus (RSV) or other infections. Aged care facility providers need to balance their responsibilities to reduce the risk of infections entering facilities, while meeting the physical, emotional and social needs of residents.

Residents

Keeping residents up to date with vaccinations, is an important strategy to reduce the risk of severe illness to older adults living in facilities.

There are four age-recommended vaccines for older adults currently funded by the National Immunisation Program (NIP). 

COVID-19
Influenza
Pneumococcal, and
Shingles.

Older adults are also recommended to receive the following vaccines which are currently not funded by the government:

Respiratory syncytial virus (RSV) – a single dose of RSV vaccine is recommended for adults aged 75 years and over (60 years and over for Aboriginal and Torres Strait Islander adults)
Tetanus - tetanus-containing vaccine booster every 10 years for adults aged 50 years and over (and if they previously completed a primary course)
Pertussis – single booster dose of a pertussis-containing vaccine for adults aged 65 years and over if their last dose was more than 10 years ago.

For more information, visit the Australian Immunisation Handbook.

Staff

Staff, healthcare workers, contractors and volunteers entering an aged care facility are strongly encouraged to stay up to date with all recommended vaccines including COVID-19 and influenza.

Influenza vaccination protects staff and provides an additional layer of protection for residents. Best practice targets are 95% vaccination coverage, in both staff and residents, prior to the beginning of the winter season. 

Australian Government-subsidised providers of residential aged care are required to:

Provide staff and volunteers with access to free influenza vaccination each year. Providers are required to cover the cost of the program. 
Actively promote the benefits of an annual vaccination for their staff and volunteers, and for the health outcomes of care recipients. 
Keep records of the number of staff that receive an influenza vaccination each year (whether or not it was under the approved provider’s influenza vaccination scheme).

Unvaccinated staff are at higher risk of acquiring and transmitting influenza. Therefore, during a confirmed influenza outbreak, it is recommended that any unvaccinated staff only be allowed to work if asymptomatic, wearing a mask, and taking appropriate antiviral prophylaxis.

For more information, visit the Influenza in residential aged care page on the NSW website.

Managing Adverse Events following Immunisation (AEFI)

An AEFI is any negative reaction that happens after a vaccination. It does not necessarily mean the vaccine caused the reaction.

Expected side effects of vaccines, that are generally mild and last 2-3 days, include:

Pain, redness, itching or swelling at the injection site
Low-grade fever, body ache and tiredness.

Inform the resident of the expected side effects and how to manage them, for example, paracetamol for fever and pain, cool compress for injection site reactions, encourage fluid intake and rest.

Seek medical advice for a severe AEFI or if you are concerned about a resident following immunisation.

To report an AEFI

Submit an AEFI form and email it to adr.reports@tga.gov.au

The adverse event will be investigated, and if needed, the resident will be advised on what to do regarding future vaccinations.

Ordering vaccines

Residential aged care facilities can order their own influenza, shingles and pneumococcal vaccines if they have a Vaccine Account Number (VAN) through the State Vaccine Centre.

To apply for a VAN, complete the New vaccine ordering account online form or call NSW Vaccine Centre on 1300 656 132.  

Only primary healthcare providers like general practitioners and pharmacists can order the COVID-19 vaccines.

Cold chain maintenance and cold chain breaches

Follow the requirements for cold chain management and vaccine storage.

For a cold chain breach:

Follow the Managing a Cold Chain Breach guidelines.
Tape fridge shut and place a sign on the fridge door - "DO NOT USE". You must inform all GPs, facility and care managers, and IPC leads that NIP vaccines cannot be used until further advice from the public health unit (PHU).
Do not discard any NIP vaccines until receiving advice from the PHU.
Continue to monitor the temperature of the affected vaccines. If a cooler is used to store vaccines during a cold chain breach, use the vaccine cooler temperature chart to monitor the temperatures while vaccines are in the cooler.
Download the 5 minutely temperature records from the data logger. Check and review the data (the numbers as well as the graph).
Complete the reporting survey (Note: reporting form is now an online survey)
Save the data logger recordings as a PDF. The document should be in table format with the temperature logged every 5 minutes. The data logger recordings should cover the period 24 hours prior to, during, and after the cold chain breach.
Attach data logger recordings and min/max recordings for the previous and present month in an email to SESLHD-PublicHealthUnit-IMMTeam@health.nsw.gov.au.