Australian Government Department of Health and Ageing Immunisation HandbookAustralian Government Department of Health and Ageing crest. Link to the Immunise Australia Program homepage.

1.4 Administration of vaccines

1.4.4 Preparation for Vaccine Administration

Please note: due to continuous updates being made to the Immunisation Handbook, the page number on the electronic version will not always match the hard copy version.

Skin cleaning


Provided the skin is visibly clean, there is no need to wipe it with an antiseptic (eg. alcohol wipe).3,4 If the immunisation service provider decides to clean the skin, or if the skin is visibly not clean, alcohol and other disinfecting agents must be allowed to dry before vaccine injection (otherwise there may be some increased injection pain).

Distraction techniques


The routine use of distraction, relaxation and other measures have been shown to reduce distress and pain following vaccination in young children.5-8 Reducing infant distress may enhance parents’ timely attendance for subsequent vaccinations.

Distraction measures that may decrease discomfort following vaccination in young children include:5-8
  • swaddling and holding the infant securely (but not excessively),
  • shaking a noisy toy (for infants and very young children),
  • playing music,
  • encouraging an older child to pretend to blow away the pain using a windmill toy or bubbles, or
  • administering sweet-tasting fluid orally immediately before the injection (with parental consent). In infants, 15–20% sucrose drops have been used.
Topical anaesthetic agents, including vapocoolant sprays, are available but to be effective must be applied at the correct time before vaccine administration. Topical anaesthetics, such as EMLA, are not recommended for routine use, but could be considered in a child with excessive fear or dislike of needles, and require application 30 to 60 minutes before an injection.9 Vapocoolant sprays are applied 15 seconds before vaccination. Topical lignocaine/prilocaine is not recommended for children younger than 6 months due to the risk of methaemoglobinaemia.5

References


3. Del Mar CB, Glasziou PP, Spinks AB, Sanders SL. Is isopropyl alcohol swabbing before injection really necessary? Medical Journal of Australia 2001;174:306.

4. Hutin Y, Hauri A, Chiarello L, et al. Best infection control practices for intradermal, subcutaneous, and intramuscular needle injections. Bulletin of the World Health Organization 2003;81:491-500.

5. Centers for Disease Control and Prevention (CDC). General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). [erratum appears in MMWR Morb Mortal Wkly Rep. 2006 Dec 8;55(48):1303]. MMWR - Morbidity & Mortality Weekly Report 2006;55(RR-15):1-48.

6. Felt BT, Mollen E, Diaz S, et al. Behavioral interventions reduce infant distress at immunization. Archives of Pediatrics & Adolescent Medicine 2000;154:719-24.

7. Halperin SA, McGrath P, Smith B, Houston T. Lidocaine-prilocaine patch decreases the pain associated with the subcutaneous administration of measles-mumps-rubella vaccine but does not adversely affect the antibody response. Journal of Pediatrics 2000;136:789-94.

8. Reis EC, Roth EK, Syphan JL, Tarbell SE, Holubkov R. Effective pain reduction for multiple immunization injections in young infants. Archives of Pediatrics & Adolescent Medicine 2003;157:1115-20.

9. Jacobson RM, Swan A, Adegbenro A, et al. Making vaccines more acceptable - methods to prevent and minimize pain and other common adverse events associated with vaccines. Vaccine 2001;19:2418-27.

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