PRINCIPLES OF IMMUNIZATION

Kuliah Blok VII (Infeksi Imunologi) FK UNSRI

Palembang, Juli 2009
Objective
At the end of this lecture the student should be able to describe:
Active and Passive Immunizations
Types of Vaccines (eg.whole-cell vaccines and subunit vaccines).
Use of Adjuvants in Immunization.
Problems in Immunization
Understand the term Cold-chain monitoring and storage
conditions for the different types of vaccines.
Mode of Administration
Contraindications in Immunizations (side-effects).
The Extended Program of Immunization (EPI) in Indonesia.
Targeted-Immunizable Diseases in Indonesia
Immunization schedule
Introduction
Immunization
remarkably successful
very cost-effective
Infectious disease
Introduction
Immunity and Immunization
Immunity to contagious disease protect individu from
infection.
Types of Immunity:
Innate immunity
Acquired immunity
Active immunity organism exposure, vaccine
Passive immunity temporary, maternal
antibody transmission to fetus, immune
globulins or antitoxin
Introduction
High immunization rates reduced incidence
of diphtheria, measles, mumps, polio, rubella,
Tetanus, and Haemophilus influenzae type b
disease (Table)
Introduction
Table. Baseline 20
th
Century Annual Morbidity and 2004 Morbidity From 10 Diseases With Vaccines
Recommended Before 1990 for Universal Use in Children: United States
Disease Baseline 20
th
Century
Annual Morbitiy
2004 Morbidity % Dicrease
Smallpox
Diphtheria
Pertusis
Tetanus
Poliomielitis
Measles
Mumps
Rubella
Congenital rubella
syndr
H. Influenza type b
48 164
175 885
147 271
1 314
16 316
503 282
152 209
47 745
823
20 000
0
0
25 827
34
0
37
258
10
0
196
100
100
82
97
100
>99
>99
>99
100
>99
Basic Principle of Immunization
Produce antibody (immune globulins)
Activates limphocyte and macrofag
Defining Aims / Goals
Prevention of disease in individuals or groups
(immediate goal)
Reducing prevalence of disease (changed disease
epidemiology)
Eradication of disease (ultimate goal)
Defining Aims / Goals
Potential goals for reducing vaccine-preventable disease
burden: eradication, elimination, or control
Eradication:
reduction of the worldwide incidence of infection by a
specific agent to zero as a result of deliberate efforts;
intervention measures are no longer needed
Defining Aims / Goals
Elimination:
reduction to zero, or to the level at which it is no longer
a public health problem, of the incidence of a specified
disease, or of infec-tion caused by a specific agent, in a
defined geographic area;
continued intervention measures are required to
prevent reintroduction.
Control:
reduction of disease incidence, prevalence, morbidity,
or mortality.
Continue intervention maintaining reduction
Defining Aims / Goals
Herd immunity:
indirect protection observed in the
unimmunised segment of a population in
which a large proportion is immunised
Tujuan Imunisasi
Definition and General Concept
Vaccination:
administration of any vaccine or toxoid (inactivated toxin)
for prevention of disease.
Immunization:
process of inducing immunity artificially by either
vaccination (active immunization) or administration of
antibody (passive immunization).
Consist of:
Active immunization
Passive immunization
Definition and General Concept
Active immunization:
administration of all or part of a microorganism or a
modified product of that microorganism (eg, a toxoid,
a purified antigen, or an antigen produced by genetic
engineering) to evoke an immunologic response that
mimics that of natural infection but that usually
presents little or no risk to the recipient.
stimulating the immune system to produce antibodies
and cellular immune responses that protect against
the infectious agent.
Definition and General Concept
Passive immunization:
provides temporary protection through
administration of exogenously produced
antibody, such as immune globulin.
also occurs naturally through transplacental
transmission of antibodies to a fetus, which
provides protection against many infectious
diseases for the first several months of the
infant's life.
Definition and General Concept
Immunizing agents protection against disease:
Nearly complete lifelong protection
Partial protection
Immunizing agents include vaccines, toxoids,
antitoxins, and immune globulins derived from
human or animal donors (Table 1.)
Definition and General Concept
Table 1. Immunizing Agents
Agent Definition
Vaccine A preparation of proteins, polysaccharides, or nucleic acids of pathogens
that are delivered to the immune system as single entities, as part of
complex particles, or by live-attenuated agents or vectors, to induce
specific responses that inactivate, destroy, or suppress the pathogen
Toxoid A modified bacterial toxin that has been made nontoxic but retains the
capacity to stimulate the formation of antitoxin
Immune
globulin
An antibody-containing solution derived from human blood obtained by
cold ethanol fractionation of large pools of plasma and used primarily for
the maintenance of immunity of immunodeficient persons or for passive
immunization; available in intramuscular and intravenous preparations
Antitoxin An antibody derived from the serum of humans or animals after
stimulation with specific antigens; used to provide passive immunity
Definition and General Concept
Most immunizing agents contain preservatives, stabilizers,
antibiotics, adjuvants, and a suspending fluid (Table 2).
Component Use and Examples
Preservatives,
stabilizers,
antibiotics
Constituents can inhibit or prevent bacterial growth or
stabilize the antigen. Materials such as mercurials or
antibiotics are used. Allergic reactions to any of the
additives may occur.
Adjuvants An aluminum salt is used in some vaccines to enhance the
immune response (e.g., toxoids, hepatitis B).
Suspending
fluid
Sterile water, saline, or more complex fluids derived from
the growing media or biologic system in which the agent is
produced (e.g., egg antigens, cell culture ingredients,
serum proteins).
Vaccine Preventable Disease
Disease
Type of
Organism
Incidence
(2000) Mode of Transmission Symptoms Complications
Diphtheria Gram-
positive
bacteria
1 Person-to-person direct
contact or contact with
airborne droplet usually
affects children under 15
years.
Sore throat, fever.
Characterized by formation of
yellow-white membranes on tonsils
and pharyngeal walls.
Potential respiratory
distress.
Haemophilus
influenzae b
Gram-
negative
bacteria
1,398
(invasive
disease)
Person-to-person
contact or droplet.
Bacteria may cause otitis media,
sinusitis, epiglottis and upper
respiratory infections.
Bacterial meningitis;
most cases of invasive
disease occur in
children 3 months to 3
years of age.
Hepatitis B Virus 8,036 Exposure to infected
blood or body fluids. In
children primarily
prenatally spread.
General flu-like symptoms (may be
asymptomatic). Liver may be
enlarged, dark urine, light stool,
jaundice. Symptoms last 4-6 weeks.
Chronic hepatitis;
cirrhosis; liver cancer.
Measles Virus 86 Person-to-person
contact or droplet.
Flu-like symptoms, high fever
(greater that 101), cough, and
conjunctivitis. Rash usually starts
on the face and spreads to the
body. Kopliks spots in the mouth
are bluish with very fine red spots.
Pneumonia and
encephalitis. Persons
allergic to eggs may
have severe reactions to
the vaccine.

Vaccine Preventable Disease
Disease
Type of
Organism
Incidence
(2000) Mode of Transmission Symptoms Complications
Mumps Virus 338 Person-to person contact
or droplet. Communicable
6 days before to 9 days
after swelling. Most often
occurs in children.
Low-grade fever, headache,
earache, pain and swelling of
parotid glands (may be unilateral
or bilateral). Swelling lasts about
a week.
Infrequent complications
are encephalitis and
meningitis. Orchitis may
occur in males who
have reached puberty,
but sterility is rare.
Pertussis Gram-
negative
bacteria
7,867 Person-to person contact
or droplet. Very
contagious.
Characteristic cough is
nonproductive with quick
expiratory phase followed by
inspiratory "whoop." Small scleral
and conjunctival hemorrhages
can occur because of severe
coughing.
Infants younger than 1
year are severely
affected. Pneumonia,
seizures, and ear
infections may occur.
Pneumococcus Gram-
positive
bacteria
Not a
reportable
disease
Person-to-person, likely
by droplet contact; in
many persons are
colonized in the upper
respiratory tract.
Causes otitis media, sinusitis,
and invasive bacterial infections.
Pneumonia meningitis
Polio Virus 0 Direct contact of virus with
mouth.
Low-grade fever and sore throat
(most cases are asymptomatic).
Muscle weakness
progressing to paralysis
in 0.1-2% of cases. May
affect any muscle group
including limbs and
respiratory muscles.
Adults may develop
postpolio syndrome 30-
40 years after the
disease.

Vaccine Preventable Disease
Disease
Type of
Organism
Incidence
(2000) Mode of Transmission Symptoms Complications
Rubella Virus 176 Person-to-person contact or
droplet. Communicable 4 days
before to 4 days after rash
appears. Highly contagious.
Mild in adults and young
children; macular rash on
scalp, trunk, and limbs lasting
1-3 days.
Severe complications in
early fetal
developmentmay
result in congenital
malformations and
death. Vaccine is live so
it must NOT be given to
pregnant women.
Tetanus Neurotoxin
produced by an
anaerobic,
Gram-positive
bacteria
35 Exposure of wound to the
bacterium. Deep-puncture
wounds are at greatest risk.
Neonatal tetanus results from
contamination of the umbilical
stump.
Severe generalized muscle
spasms.

Varicella Virus 27,382 Person-to-person contact or
contact with airborne droplets.
Very contagious.
Communicable 2 days before to
6 days after vesicles appear.
Primarily affects children.
Low-grade fever, listlessness.
Lesions appear within 2-4
days. Rash has three phases:
raised spots, fluid-filled
vesicles, and scabs. Rash
itches and is found over entire
body.
Grandparents and older
adults should avoid
caring for children
because they may
develop herpes zoster
(shingles).

Types of Vaccine
BCG OPV
Measles
MMR
Varicella
Yellow fever
Diphtheria
Tetanus
Pertusis
Cholera
Meningococ
Pneumococ
Hib
Typhoid Vi
Influenza
IPV Rabies
Hepatitis B
Hepatitis A
Bacterial Vaccine
Viral Vaccine
Heat-sensitive
vaccines
Freeze-
sensitive
vaccines
Freeze-
sensitive
vaccines
Types of Vaccine
Vaccine
Live-attenuated or killed microorganisms
Inactivated products
Specific component
Recombinant DNA segmen
Types of Vaccine
Live attenuated vaccine:
Virus atau bakteri liar yang dilemahkan
(attenuated) di lab, biasanya dengan
pembiakan berulang-ulang
Mampu replikasi & menimbulkan kekebalan,
tidak menyebabkan sakit
Respons imun pejamu ~ infeksi alamiah
primer lifelong immunity
Types of Vaccine
Inactivated vaccine:
Bakteri / virus dibiak dibuat tidak aktif
(inactivated)
Keseluruhan atau fraksi virus / bakteri
Basis vaksin fraksi: protein atau polisakarida
lifelong immunity (-) perlu booster
secara berkala
Types of Vaccine
Inactivated vaccine:
Types:
Whole organism
Purified protein atau antigen polisakarida
dari whole organism
Purified antigen yang dihasilkan dari
genetically altered organism
Chemically modified antigen
Vaccine Recomendations
Development of recomendations and
schedule for vaccine administration:
epidemiology of the disease,
age-specific morbidity and mortality,
vaccine immunogenicity,
risks of vaccine-related adverse reactions,
cost effectiveness,
ages of recommended routine health care
visits.
Vaccine Recomendations
Priority:
delivering the primary childhood
immunization series and
protecting adult women and their
newborns against tetanus.
Vaccine Recomendations
Each country has each own policies
Indonesia:
PPI (Program Pengembangan Imunisasi):
BCG, Polio, Hepatitis B, DPT, Campak
IDAI (Ikatan Dokter Anak Indonesia):
PPI (diwajibkan)
Non PPI (dianjurkan)
Vaccine Recomendations
Expanded Program of Immunization (EPI) or Pengembangan Program
Imunisasi (PPI)
Goverements program in immunization to achieve international
commitment: Universal child immunization (UCI):
Polio eradication = ERAPO
Maternal and neonatal tetanus elimination
Measles reduction
Improve immunization service quality
Establish safe injection practices standard
Safe waste disposal management
Vaccine Recomendations
Vaccination
PPI
BCG
DTP
Polio
Measles
Hepatitis B
Recommended
Hib
MMR
Hepatitis A
Typhoid
Influenza
IPD
Rotavirus
Vaccine Recomendations
Immunization schedule in Indonesia
recommended by IDAI (non PPI) and
government (EPI/PPI) (Table 4 dan Table 5)
Vaccine Recomendations
Vaccine Recomendations
Vaccine Recomendations
Vaccine Recomendations
Vaccine Recomendations
Vaccine Recomendations
BCG Vaccine
Live attenuated Mycobacterium bovis
Administration:
< 2 month, repeated BCG not recommended
> 3 month, tuberculin test to screen TB infection
Store:
Reconsituted, 2-8
o
C (not in freezer), only 3 hours
Dried: 2-8
o
C, better in freezer
Protected from light
BCG Vaccine
Contraindication:
HIV, immunocompromise, steroid th,
immunosuppresive th, radioth, bonemarrow or lymph
node, skin infection malignancy, severe malnutrition,
high fever, skin infection
Protection
8 12 weeks after vaccination
Level of protection only 42% (WHO 60-78%)
70% severe TB have BCG scar
Adult: positive AFB 25-36% regarding BCG (+)
BCG Vaccine
BCG Vaccine
BCG Vaccine
BCG Vaccine
Oral Polio Vaccine
Live attenuated vaccine
Poliomyelitis virus type 1,2,3, Sabin Strain
Store:
Before opened: -20
o
C 2 years;
2 8
o
C 6 months
After opened: 2 8
o
C 7 days
Side effect
< 1%: headache, diarrhea, or muscle pain
VAPP & VDPP
2-4/1 million children immunized: VAPP
Oral Polio Vaccine
ERAPO:
routine immunization coverage ,
NID/PIN 3 yr,
AFP surveilans,
mopping up,
polio certification
Mopping up:
Polio (+)
stop wild polio virus transmision
Oral Polio Vaccine
Oral Polio Vaccine
Oral Polio Vaccine
Inactivated Polio Vaccine (IPV)
Imovax, killed polio virus
Gut mucosal immunity <
VAPP and VDPP risk (-)
Store:
2 8
o
C 3 years
Seroconversion: IPV > OPV (Kenya)
Already used in developed country since 2002
When using IPV?
Immunization coverage > 90%
High AFP coverage (AFP rate 2)
Wild polio virus (-) for 3 years
DTP Vaccine
Diphtheria & tetanus: purified toxoid
Pertusis: killed bacteria, adsorbed in Al phosphat
Each 1 ml: 40 Lf Td, 24 OU pertusis, 15 Lf TT, Al phosphat
3 mg, thimerosal 0,1 mg
Store & transport vaccine in 2 8
o
C, should never be
frozen
Vaccine has been damaged by freezing? shake test
Contraindication:
Anaphylaxis history
Post DTP encephalopathy
DTP Vaccine
DTP Vaccine
Dose: 3x, 2 month, interval 4-6 week
Repeat dose:
18-24 month
5-7 year (DTP)
12 year (BIAS)
Level of protection:
Diphtheria:
1
st
dose: 71-94% protection level (<0,01
IU/mL)
3
rd
dose: 68-81% protection level
Pertusis:
3
rd
dose: 65,8-80% protective
Tetanus
3
rd
dose: 65-80% protective
DTP Vaccine
DTP Vaccine
Tetanus Toxoid Vaccine
Tetanus Toxoid Vaccine
Goal:
Neonatal tetanus elimination
Prevent tetanus
Tetanus immunization target: > 5x
3 doses (infant) + 2 doses (adult)
4th dose (18-24 month) immunity > 5 yr
5th dose (7 yr) immunity > 10 yr
6th dose (12 yr; TD or TT) immunity > 20 yr
Tetanus Toxoid Vaccine
Tetanus Toxoid Vaccine
Hepatitis B Vaccine
Hepatitis B Vaccine
Hepatitis B Vaccine
Heat marker /
Vaccine Vial
Monitor
Hepatitis B Vaccine
Hepatitis B Vaccine
Hepatitis B Vaccine
Hepatitis B Vaccine
Hepatitis B Vaccine
Hepatitis B Vaccine
Hepatitis B Vaccine
DPT-Hep B Combo Vaccine
DPT-Hep B Combo Vaccine
Heat marker /
Vaccine Vial
Monitor
Measles Vaccine
Measles Vaccine
Measles Vaccine
Measles Vaccine
Mumps-Measles-Rubella Vaccine
Vaksin Mumps-Measles-Rubella
MMR Vaccine
Hib Vaccine
Prosedur Vaksinasi
Penyimpanan & transportasi vaksin
Persiapan alat & bahan: untuk vaksinasi & mengatasi
gawat darurat
Persiapan pemberian:
Anamnesis, umur, jarak dengan vaksinasi
sebelumnya, riwayat KIPI, indikasi kontra dan
perhatian khusus
Informed consent: manfaat, risiko KIPI
Pemeriksaan fisik
Prosedur Vaksinasi
Cara pemberian:
Dosis, interval
Lokasi, sudut, kedalaman
Pemantauan KIPI
Sisa vaksin, pemusnahan alat suntik
Pencatatan
Prosedur Vaksinasi
Vaksin = produk biologis
Rentan/ mudah rusak
Mengurangi efektifitas vaksin
Prosedur Vaksinasi
Faktor-faktor yang mengurangi efektivitas
vaksin
Jenis Vaksin
Paparan suhu yang tidak sesuai
Waktu penyimpanan/ batas
kadaluwarsa
Paparan sinar matahari langsung
Penyimpanan dan Distribusi
Vaksin bakteri/ virus inaktif:
Vaksin yg sangat sensitif thd panas/sinar
dibuat berupa bubuk ( freeze-dried powders)
Vaksin (yang bukan cairan) dapat disimpan di
freezer atau pd +2C sampai +8C
Setelah dicampur segara disuntikkan;
Vaksin OPV/polio Sabin simpan beku
Penyimpanan dan Distribusi
JANGAN DIBEKUKAN
Vaksin Ajuvan
Berupa suspensi yg Ag diadsorbsi oleh
garam Al (Al salts)
Simpan pada suhu +2
o
C to + 8
o
C
Penyimpanan dan Distribusi
Vaksin Sensitif / Labil pada Suhu Ruangan
BCG (Bacille Calmette-Gurin)
Measles-mumps-rubella (MMR)
Oral Polio Vaccine (OPV)
Varicella
Yellow fever
Semua vaksin rekonstitusi
Penyimpanan dan Distribusi
Diphtheria-tetanus-pertussis
Haemophilus influenzae type b
Hepatitis B
Hepatitis A
Vaksin Influenza
Pneumococcal (polysaccharide and conjugate)
Meningococcal (polysaccharide and conjugate)
Semua vaksin kombinasi
Pelarut vaksin
Penyimpanan dan Distribusi
Vaksin yang sensitif pada paparan sinar
BCG (Bacille Calmette-Gurin)
Vaksin rekonstitusi measles-Mumps-Rubella
(MMR)
Oral Polio Vaccine (OPV)
Semua vaksin akan rusak bila terkena sinar
matahari langsung
Penyimpanan dan Distribusi
Amati adakah perbedaan bentuk vaksin
yang terpapar panas atau beku dengan
vaksin yang tersimpan baik, selama kurang
lebih 30-60 menit
CARA MENGETAHUI VAKSIN YANG RUSAK
DALAM PENYIMPANAN
Penyimpanan dan Distribusi
DPT, TT dan hepatitis B dapat
rusak karena beku.
Dengan mengocok 2 vial secara
bersamaan, satu yang
diperkirakan sudah pernah
beku, dan satu lagi belum,
CARA MENGETAHUI VAKSIN
YANG RUSAK DALAM
PENYIMPANAN
Penyimpanan dan Distribusi
CARA MENGETAHUI
VAKSIN YANG RUSAK
DALAM PENYIMPANAN
VACCINE VIAL MONITOR (VVM)


Segiempat lebih terang dari lingkaran
sekitar.
Bila belum kadaluarsa: GUNAKAN
vaksin;

Segiempat berubah gelap tetapi lebih
terang dari lingkaran sekitar.
Bila belum kadaluarsa: SEGERA
GUNAKAN vaksin;

Segiempat sama warna dengan lingkaran
sekitar.
JANGAN GUNAKAN vaksin: Lapor
kepada pimpinan;

Segiempat lebih gelap dari lingkaran
sekitar.
JANGAN GUNAKAN vaksin: Lapor
kepada pimpinan.
Vaccine Vial Monitor
(VVM): Cara menguji
vaksin yang sudah
terpapar panas >8C
VACCINE VIAL MONITOR (VVM)
Heat marker /
Vaccine Vial
Monitor
VAKSIN HEPATITIS B
VACCINE VIAL MONITOR (VVM)
Perubahan warna vaksin polio
karena perubahan pH
Boleh diberikan
VACCINE VIAL MONITOR (VVM)
Heat marker /
Vaccine Vial
Monitor
VAKSIN DPT-HB
VACCINE VIAL MONITOR (VVM)
VAKSIN CAMPAK
Cold Chain
Vaccines sensitive to heat & freezing kept at
correct temperature from the time they are
manufactured until used.
The system used for keeping and distributing
vaccines in good condition = cold chain.
The cold chain consists of a series of storage and
transport links, all designed to keep vaccines
within an acceptable range until it reaches the
user.
Cold Chain
PENYUNTIKAN DAN PENETESAN VAKSIN
Bicara pada bayi dan anak
Tentukan lokasi penyuntikan : paha, lengan
Posisi bayi / anak : nyaman dan aman
Desinfeksi
Pegang; peregangan kulit, cubitan
PENYUNTIKAN DAN PENETESAN VAKSIN
Penyuntikan: dosis, sudut, cara
Tetesan: dosis, hati-hati dimuntahkan
Penekanan bekas suntikan
Membuang alat suntik bekas
Penulisan tanggal vaksinasi di kolom yang sudah
disediakan
Tempat Penyuntikan
Tempat Penyuntikan
POSISI ANAK KETIKA DIVAKSINASI
POSISI ANAK KETIKA DIVAKSINASI
POSISI ANAK KURANG AMAN
PENETESAN VAKSIN POLIO
Kontraindikasi Imunisasi
Anafilaksis atau reaksi hipersensitivitas berat
KI absolut pemberian dosis vaksin
berikutnya
Alergi komponen vaksin Vaksinasi
Bayi dengan tanda dan gejala AIDS tidak
boleh diberikan vaksin BCG dan yellow fever
Kontraindikasi Imunisasi
KIPI
(Kejadian Ikutan Pasca Imunisasi)
KIPI
KIPI
KIPI
KIPI
KIPI
SISA VAKSIN
BCG
setelah dilarutkan harus segera diberikan
dalam 3 jam(simpan dalam suhu 2 8 C)
Polio
Setelah dibuka harus segera diberikan dalam
7 hari(simpan dlm suhu 2 8 C)
SISA VAKSIN
DPT
Bila ada penggumpalan atau partikelyang tidak
hilang setelah dikocok jangan dipakai
Campak
Setelah dilarutkan harus diberikan dlm 8
jam(simpan dlm suhu 2 8 C)
PEMANTAUAN SETELAH VAKSINASI
Perhatikan keadaan umum
Tunggu 30 menit di ruang tunggu
SAFE INJECTION
Mengapa perlu?
Estimasi WHO : 30 % suntikan imunisasi tidak aman (WHO bull.
Oktober, 1999)
Imunisasi rutin(Soewarta,1999: 4 propinsi): tidak disterilkan
: spuit 38%, jarum 23 %alat suntik pakai ulang :krn tidak ada
jarum (18%), tidak ada spuit (4%)
Aman bagi
Yang disuntik
Penyuntik
lingkungan
SAFE INJECTION
Suntikan dapat menularkan : hepatitis B, Hepatitis
C, HIV, jamur, parasit, bakteri, menyebabkan abses
Penyebaran melalui suntikan lebih cepat daripada
melalui udara, mulut atau seks
SAFE INJECTION
TIDAK AMAN BAGI YANG DISUNTIK
Vaksin
Suhu > 8C, atau VVM telah terpapar panas
Botol vaksin bocor, retak, atau terpasang jarum
Ada partikel dalam larutan
Telah dilarutkan lebih dari 6 jam
Beku : DPT, DT, TT, HepB, Hib (tidak boleh beku)
Uji kocok tetap menggumpal (kecuali HepB atau Hib)
SAFE INJECTION
Alat suntik
Spuit disposable dipakai ulang
Hanya mengganti jarum
Tidak dibersihkan dulu langsung disterilkan
Hanya dengan desinfektan
Membakar jarum di api
Merebus dalam panci terbuka
Menyentuh ujung jarum
SAFE INJECTION
Cara melarutkan / pengambilan vaksin
Cairan pelarut untuk vaksin lainatau > 8C
1 spuit diisi beberapa dosis sekaligus
jarum ditinggalkan menancap di vial
Mencampur isi 2 vial
Lokasi, posisi , kedalaman penyuntikan
Tidak ada alat / obat gawat -kedaruratan
SAFE INJECTION
Menekan luka berdarah dengan jari (semua cairan
tubuh dapat menularkan kuman)
Membawa atau meletakkan alat suntik bekas
sembarangan (tidak langsung membuang ke kotak
limbah)
Menyentuh atau mencabut jarum suntik
SAFE INJECTION
Menutup kembali (recapping) jarum suntik
Mengasah jarum bekas
Memilah-milah tumpukan jarum bekas
Tidak ada alat / obat gawat darurat
Tidak aman bagi lingkungan: Meninggalkan alat
suntik bekas sembarangan
TEMPAT PEMBUANGAN LIMBAH
PEMUSNAHAN KOTAK DAN ISI LIMBAH
Dibakar dalam insinerator khusus (suhu 600 -1100C)
risiko pencemaran kecil
Rp. 10 30 juta, BBM / kayu bakar
Dibakar dalam lubang atau drum
Digiling
Milling atau shreeding
Serbuk masih infeksius
375-750 alat suntik / jam
listrik 750 w
PENCATATAN
Nama dagang dan produsen
No. lot / seri vaksin
Tgl penyuntikan
Bagian tubuh yang disuntik (deltoid kiri,
paha kanan mis)