BCG Vaccination in Neonates 4.0
BCG Vaccination in Neonates 4.0
BCG Vaccination in Neonates 4.0
Ratification Issue Date: 2nd September 2019 Review 1st September 2022
(Date document is uploaded onto the Date:
intranet)
Professionally Approved by: (Asset Dr Ahmed Hassan, Date: 2nd September 2019
Owner) Consultant Paediatrician
Executive and Clinical Directors Date: August 2019 Distribution Intranet & Website.
(Communication of minutes from Method: Notified on Staff
Document Ratification Group Focus
Administration of the Bacillus Calmette-guerin (BCG) Vaccination in Neonates/10007/4.0
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INDEX
1. Purpose
2. Introduction
5. Referral Pathway
11. Documentation
17. Communication
18. References
19. Appendices
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1.0 Purpose
1.1 To identify infants who have a high risk of acquiring tuberculosis (TB) and who will
therefore require the Bacillus Calmette-Guerin (BCG) vaccination.
1.2 To ensure that those identified as requiring BCG vaccination have a referral for the BCG
outpatient clinic completed prior to discharge from the postnatal or labour ward.
2.0 Introduction
2.1 The Department of Health advises the BCG vaccination for all neonates at higher risk of
TB, with opportunistic vaccination of older children as necessary.
2.2 The BCG immunisation programme is now a risk-based programme, the key part being a
neonatal programme targeted at those children most at risk of exposure to TB, aiming to
protect them in particular from the more serious childhood forms of the disease.
2.4 Neonatal BCG vaccination provides 50-70% protection against all forms of TB and
70- 80% protection against miliary TB and TB meningitis.
4.1 Infants eligible for BCG vaccination should be identified prior to birth ideally through
maternity services.
4.2 Discuss neonatal BCG vaccination for any baby with increased risk of TB with parents or
legal guardian prior to discharge from the Postnatal or labour ward.
4.3 When BCG vaccination is being recommended, discuss the benefits and risks of
vaccination or remaining unvaccinated with the person (or, if a child, with the parents), so
that they can make an informed decision. Tailor this discussion to the person, use
appropriate language, and take into account cultural sensitivities and stigma.
4.4 In areas with low incidence of TB BCG immunisation should only be offered to:
All infants living in areas of the UK where the annual incidence of TB is 40/100,000 or
greater;
(Refer to Appendix D)
All infants with a parent or grandparent who was born in a country where the annual
incidence of TB is 40/100,000 or greater;
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4.5 Preferably vaccinate babies at increased risk of TB before handover from midwifery to
primary care. Otherwise, vaccinate as soon as possible afterwards.
At parental request, unless the infant falls into any of the high risk groups above,
those without any of these risk factors should be advised as to current policy and
given written information. If they still want BCG immunisation they must go through
their GP for an appointment in a paediatric clinic.
5.2 Infants who are born at St. Peters and William Julian Courtauld (WJC) Midwife-led Units,
St Michael’s Community Hospital should have their details forwarded to the postnatal
team at Broomfield for an appointment.
7.2 There is no need for a heaf test prior to immunisation if <12 months of age.
7.3 Neonatal BCG is to be administered by suitably trained nursing staff in a dedicated BCG
clinic run within the maternity department. Prior to the infant attending BCG vaccine
should be prescribed on the relevant prescription chart. The mother’s history and blood
test reports should be checked for HIV status and contraindications for immunisation.
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7.4 The healthcare professional should decontaminate their hands and wear an apron and
gloves.
(Refer to the Trust guideline for ‘Prevention and management of latex allergy in health
care workers)
7.5 Use an intradermal BCG – draw up 0.05ml of vaccine and administer intradermally
using a 26G needle. Introduce the needle just under the skin over the left deltoid area.
There should be some resistance and it should raise a tense bleb. See Green book.
7.6 Sharps should be disposed of in a sharp’s bin in accordance with the ‘Safe handling and
disposal of sharps policy; register number 10004)
7.7 Record on page 18b of the infant’s child health record booklet (red book).
10.2 Injection site reactions – large ulcers, abscesses commonly caused by faulty injection
technique (i.e. dose given subcutaneously instead of intradermally).
10.3 Keloid scars at injection site (occurrence increases when injection given too high up the
arm.)
10.5 All serious or unusual adverse reactions associated with BCG vaccination including
abscess and Keloid scarring should be recorded and reported using the yellow card
system.
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11.0 Documentation
11.1 (Refer to the ‘Guideline for maternity record keeping including documentation in
handheld records’. Register number 06036).
11.2 Following the giving of BCG vaccination the prescription chart with the BCG batch no.
and the consent form will be filed in the maternal notes.
11.3 Record in the red child health record booklet page 18b or the unscheduled immunisation
form to include the batch number and date given.
(Refer to Appendix A)
11.4 If the Red book is not available Child Health should be notified via the unscheduled
immunization form. The top copy should be sent to Child Health by the ward clerk in the
designated area, the second copy should be filed in the patient’s/infant’s health care
records and the third copy; along with the consent form should be filed in the patient’s
handheld maternity records.
(Refer to Appendix B)
13.2 All medical staff will have training in the identification of at risk infants and the rationale
for treatment of these infants.
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15.2 The findings of the audit will be reported to and approved by the Multi-disciplinary Risk
Management Group (MRMG) and an action plan with named leads and timescales will be
developed to address any identified deficiencies. Performance against the action plan will
be monitored by this group at subsequent meetings.
15.3 The audit report will be reported to the monthly Directorate Governance
Meeting (DGM) and significant concerns relating to compliance will be entered on the
local Risk Assurance Framework.
15.4 Key findings and learning points from the audit will be submitted to the Clinical
Governance Group within the integrated learning report.
15.5 Key findings and learning points will be disseminated to relevant staff.
17.0 Communication
17.1 A quarterly ‘maternity newsletter’ is issued to all staff to highlight key changes in clinical
practice to include a list of newly approved guidelines for staff to acknowledge and
familiarise themselves with and practice accordingly. Staff who are on maternity leave or
‘bank’ staff have letters sent to their home address to update them on current clinical
changes.
17.2 Approved guidelines are published monthly in the Trust’s staff newsletter that is sent via
email to all staff.
18.0 References
Immunisation against infectious disease: Tuberculosis: the green book, chapter 32 (2018)
Public Health England
www.gov.uk/government/publications/tuberculosis-the-green-book-chapter-32
National Institute for Health and Clinical Excellence NG33 Tuberculosis (2016)
www.nice.org.uk
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Appendix A
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Appendix B
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Appendix C
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Appendix D:
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A change in a service to patients A change to an existing policy X A change to the way staff work
Something else
A new policy
(please give details)
Questions Answers
3. Who benefits from this change and how? Patients and clinicians
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