Published Date: 2003-03-14 23:50:00
Subject: PRO> Smallpox vaccination, adverse events - USA (06)
Archive Number: 20030314.0635
SMALLPOX VACCINATION, ADVERSE EVENTS - USA (06)
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Fri, 14 Mar 2003 18:32:12 -0600
From: Kathy LeDell <Kathy.Ledell@state.mn.us>
I would like to respond to moderator JWW's questions regarding my
submission on smallpox vaccination dressings [Smallpox vaccination, adverse
events - USA (05) 20030311.0592]:
"Since OpSite is significantly more permeable to water vapor than ordinary
films in the presence of moisture, would this make it more permeable to
vaccinia virus as well?"
I had this exact question myself. Smith Nephew had not done viral barrier
testing prior to my request, and I would not have ordered their product
unless it passed the testing criteria. I am trusting that this test was a
suitable way to determine the answer to this question.
As far as the price of these products being lower when ordered in bulk, the
price quote we received for both OpSite and Tegaderm reflected a
significant discount from the "retail" price. I can't answer the question
of whether or not an even lower price could be negotiated for a larger bulk
In terms of assessing the barrier quality of a vaccinated healthcare
worker's dressing prior to the beginning of their work day, this is the
guidance we gave to hospitals:
It is anticipated that most dressing checks will not require that the
dressing be touched. However, if contact with the dressing, vaccination
site, or other materials that have been in contact with the dressing site
is anticipated, gloves must be worn. In addition, hands must be cleaned
with antimicrobial soap and water or a >60 percent alcohol-based hand rub
(if hands are not visibly soiled) after any contact with the dressing,
vaccination site, or other materials that have been in contact with the
dressing site. Gowns should be worn if there is a risk that clothing could
become contaminated. In the workplace setting, these precautions must be
taken for all dressing changes, including those done by the vaccinee.
Assessing dressing for barrier quality:
Healthcare workers must wear the provided gauze and semipermeable membrane
dressings, and the barrier quality of these dressings should be assessed
once every 24 hours when healthcare workers are present in healthcare
The dressing must cover all lesions. Lymphangitic streaking or areas of
erythema that involve intact skin are not infectious and do not need to be
covered by the dressing.
The dressing must be adherent on all sides.
The dressing must be changed if exudate or drainage is approaching the edge
of the gauze island.
The dressing must be changed if it is saturated with water or drainage.
The dressing must be changed if there is any other indication that its
barrier quality is compromised.
Long sleeves must be worn when vaccinees are providing direct patient care.
Messages to vaccinees about the need for meticulous hand-hygiene should be
reinforced at the time of the dressing check.
The 2/10/2003 ACIP recommendations on this issue can be accessed at:
Kathleen LeDell, MPH, RN
Acute Disease Investigation and Control Section
Minnesota Department of Health
717 Delaware Street SE
Minneapolis, MN 55414
[The use of trade names and commercial sources is for identification only
and does not imply endorsement by ProMED-mail. ProMED-mail would like to
thank Ms. LeDell again for this excellent discussion on the evaluation of
existing options and studies addressing appropriate barrier dressings for
use following smallpox vaccination. As more individuals are being
vaccinated, we are starting to see more contact vaccinia cases, serving to
remind us of the importance of attention to the vaccination site to prevent
transmission of the vaccinia virus to others. - Mod.MPP]