Table 1 International recommendation for Pfizer and AstraZeneca vaccines transportation, handling and storage, preparation, pre-vaccination, administration, and post-vaccination processes*
From: Vaccination process evaluation at COVID-19 vaccination centers in Lebanon: a national study
Recommendation for vaccine transportation | Reference |
 Vaccines should be transported using a portable vaccine refrigerator or qualified container designed to transport vaccines within the temperature range recommended by the manufacturers between + 2 °C and + 8 °C | [13] |
 Vaccines should be transported by following the manufacturer instructions for packing configuration and proper conditioning of coolants | [13] |
 The vaccine should be received in a good condition | [13] |
 Immediately upon arrival at the vaccination center, the time and minimum/maximum temperature must be recorded | [13] |
 The amount of vaccine transported should be limited to the amount needed for the workday | [13] |
 Total score for vaccine transportation = 5 points | |
Recommendation for vaccine handling and storage | Reference |
 Upon arrival at the vaccination center, vaccines should be immediately unpacked and placed in proper storage equipment (i.e., a portable vaccine refrigerator or qualified container) | [13] |
 Vaccine should be stored in their original packaging until ready for administration. Loose vials or syringes may be exposed to unnecessary light, potentially reducing potency, and may be more difficult to track for expiration dates | |
 Upon arrival at the vaccination center, expiration dates of the vaccines should be checked that they had not expired | [13] |
 Vaccines should be stored within the manufacturer-recommended temperature range between + 2 °C and 8 °C | [13] |
 Vaccine temperature should be reviewed and documented a minimum of 2 times during each workday (preferably at the beginning and middle of an 8-h shift) to ensure they remain at correct temperatures (i.e., between + 2 °C and + 8 °C) | [13] |
 Vaccine temperature should be monitored using a digital data logger | [13] |
 A backup power source should be available to handle power outage | [27] |
 Avoid placing or storing any items other than vaccines, diluents, and water bottles inside the storage units | [27] |
 Between + 2 °C and + 8 °C, unpunctured Pfizer-BioNTech vials should be stored in the refrigerator for up to 1 month (31 days) | [12] |
 Unpunctured AstraZeneca vials should be stored in cold chain conditions of + 2 °C to + 8 °C for a maximum of 6 months | [16] |
 Sometimes unused vaccine and diluent doses, unopened vials, expired vials, and potentially compromised vaccine may be returned for credit, even if they must be discarded. Contact the vaccine manufacturer/distributor for vaccine-specific information | [27] |
 Total score for vaccine handling and storage = 11 points | |
Recommendation for vaccine preparation | Reference |
 Perform hand hygiene before vaccine preparation and follow aseptic technique | [12] |
 Expiration dates of vaccines should be checked again during preparation, and only vaccines that have not expired should be administered | |
 All staff members who receive vaccine deliveries as well as those who handle or administer vaccines should be trained in vaccine-related practices and procedures | [27] |
 Vaccines should be prepared in a clean, designated medication area, away from any potentially contaminated items | [13] |
 Note the date and time the vaccine was prepared on the vial | [12] |
 Name of the vaccine and lot number should be documented | [13] |
 Once drawn up, vaccines should be kept in the recommended temperature range | [13] |
 Total score for vaccine preparation = 7 points | |
Recommendation for Pfizer preparation | Reference |
 Vials should be held at room temperature for up to 2 h before mixing | [12] |
 Inject 1.8 mL 0.9% sodium chloride (normal saline, preservative-free) diluent into the vaccine vial | [12] |
 Using a new, sterile alcohol swab for each vial, wipe off the stoppers of the diluent | [12] |
 Use a 21-gauge (or narrower) needle to withdraw the diluent into a mixing syringe | [12] |
 Using a new, sterile alcohol prep pad for each vial, wipe off the stoppers of the vaccine vials | [12] |
 Inject 1.8 mL 0.9% sodium chloride (normal saline, preservative-free) diluent into the vaccine vial | [12] |
 Using the mixing syringe, remove 1.8 mL of air from the vaccine vial to equalize the pressure in the vaccine vial | [12] |
 Gently invert the vaccine vial 10 times before and after adding the diluent | [12] |
 Withdraw 0.3 mL of mixed vaccine into the syringe | [12] |
 Remove any significant air bubbles with the needle still in the vial to avoid loss of vaccine | [12] |
 Keep mixed vaccine between 2 °C and 25 °C. Administer within 6 h. Discard any unused vaccine after 6 h | [12] |
 Total score for Pfizer preparation = 11 points | |
Recommendation for AstraZeneca preparation | Reference |
 The vaccine vial should not be shaken while inspecting it | [16] |
 The vaccine vial stopper should be cleansed with a single-use 70% alcohol swab | [16] |
 Using aseptic technique, equalize the pressure by injecting 0.5 mL of air into the vial then draw up 0.5 mL of the vaccine into the syringe | [15] |
 Any air bubbles should be removed prior to removing the needle from vial to avoid losing any vaccine dose | [15] |
 Doses should be used within one hour if stored at room temperature, or within six hours if stored at + 2 °C to + 8 °C | [16] |
 Total score for AstraZeneca preparation = 5 points | |
Recommendation for pre-vaccination | Reference |
 Staff should administer the vaccines to the correct age groups | [13] |
 Physical distancing and enhanced infection control measures should be implemented | [28] |
 Review the history of allergic reaction(s) | [29] |
 Patients should be screened for contraindications and precautions for the specific vaccine(s) in use before receiving that vaccine(s) | [13] |
 Immunization history and vaccine schedule are checked to ensure appropriate vaccine administration | [29] |
 Total score for pre-vaccination = 5 points | |
 Recommendation for vaccine administration | Reference |
 Patient’s name and date of birth should be verified prior to vaccination | [13] |
 Staff should complete a training on vaccine administration | [29] |
 Staff are administering vaccines using the correct route: intramuscular injection in the deltoid muscle | |
 Staff should administer the correct dosage (volume) of vaccine | [13] |
 Staff should use proper hygiene techniques to clean hands before vaccine administration, between patients, and anytime hands become soiled | [13] |
 Needles should not be recapped before disposal | [13] |
 Used needles and syringes should be immediately placed in a sharps container following administration | [13] |
 If vaccine administration errors are observed, corrective action should be taken immediately | [13] |
 Total score for vaccine administration = 8 points | |
Recommendation for post-vaccination | Reference |
 Patients should remain for observation at the vaccination center for for 15–30 min post-vaccination | |
 Provide patient with relevant post-vaccination advice | [16] |
 All vaccination providers at the site are certified in cardiopulmonary resuscitation (CPR), are familiar with the signs and symptoms of anaphylaxis, know their role in an emergency, and know the location of epinephrine and are trained in its indications and use | [13] |
 There is a designated area at the site for management of patients with urgent medical problems | [13] |
 Total score for post-vaccination = 4 points | |