Vaccinating Homebound Persons With COVID-19 Vaccine

Introduction

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).

CDC Training and Clinical Resources

Training

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.

Accessibility Specific Resources

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.

Storage and Handling

Follow proper vaccine storage and handling best practices. CDC requires COVID-19 vaccination providers to:

Have clearly written, detailed, and up-to-date storage and handling standard operating procedures.
Designate a primary vaccine coordinator and an alternate vaccine coordinator.
Store vaccines using a purpose-built or pharmaceutical-grade unit designed to either refrigerate or freeze.
- Do not store any vaccine in a dormitory-style or bar-style combined refrigerator/freezer unit under any circumstances.
Use a digital data logger to monitor vaccine storage unit temperatures.
Read and document temperatures daily on the appropriate temperature log.
Immediately unpack, document, and store vaccines and diluents at recommended temperatures when they arrive.

Detailed guidance can be found in CDC’s Vaccine Storage and Handling Toolkit.

When transporting vaccines, follow guidelines and practices for proper storage and handling.

Follow transport guidance for the specific vaccine product.
Transport vaccine using a portable vaccine refrigerator or qualified packout. Soft-sided containers specifically engineered for vaccine transport are also acceptable.
- A qualified packout includes a container and supplies specifically designed for use when packing vaccines for transport. A qualified packout does not require a power source and is “qualified” through laboratory testing under controlled conditions to ensure it can achieve and maintain desired temperatures for a set amount of time.
- Do not use commercially available soft-sided food or beverage coolers because most are poorly insulated and likely to be affected by room or outdoor temperatures.
A digital data logger should be used to monitor the temperature of the vaccine. Place the probe near the vaccine.
- A digital data logger with an external readout that can read minimum and maximum (min/max) temperatures is preferred. This type of temperature monitoring device allows the temperature of the vaccine to be checked without frequently opening the transport container.
Document the min/max temperatures when transport begins, every time the container is opened, and upon return to the facility.
- Each temperature reading should be documented on a temperature log.

A punctured vial may be transported from one home to another by the same health care professional if the cold chain is properly maintained. However, a partially used vial cannot be transferred from one provider to another or across state lines.
Additional transport guidance:
- If using a company or personal vehicle, only transport vaccines inside the passenger compartment (not in the trunk or bed of a truck, which may be too hot or too cold).
- Move transport containers directly to a vehicle that is already at a comfortable temperature–neither too hot nor too cold.
- Keep containers out of direct sunlight.
- Pack loose vials carefully to prevent them from breaking.
- Never leave the container unattended in the vehicle.

Bring the appropriate supplies needed to mix and administer the vaccine, including diluent and mixing supplies (if needed), administration needles/syringes, sterile alcohol prep pads, proper sharps disposal equipment, a prevaccination checklist for contraindications and precautions, and EUA fact sheets for recipients and caregivers.
CDC recommends transporting vaccine in vials. However, there may be instances when the only option is to transport vaccine in a predrawn syringe. U.S. Pharmacopeia includes guidance for transporting predrawn vaccine in syringes in the COVID-19 Vaccine Toolkit: Operational Considerations for Healthcare Practitioners.

Guidance for transporting vaccines can be found in CDC’s Vaccine Storage and Handling Toolkit, COVID-19 Vaccine addendum.

Vaccine Administration

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.

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