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8/6/2019 Cold Chain (3)
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FIJI SCHOOL OF NURSING
PRIMARY HEALTH CARE
Sr. Seini Ravea, Year 3 Manager, FSN
14th April 2010
COLD CHAIN SYSTEM
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COLD CHAIN
The key to potent vaccine
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TOPICS
Cold Chain
Equipment fridges
Packing vaccines in the fridge
Monitoring tools
Vaccines
Sensitivity
VVM vaccine vial monitor MDVP- multi-dose vial policy
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OBJECTIVES
At the end of the session, students will be able to:
1. Explain the meaning and levels of the cold chain
2. State the correct range of temperature for storing
each vaccines3. Describe the cold chain equipments available in our
health facilities
4. Demonstrate how to use and maintain Cold ChainEquipment.
5. Demonstrate how to position vaccines inrefrigerators and the proper way of transportingvaccines.
6. State the correct VVM, MDVP and vaccine sensitivity
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DEFINITION
Cold Chain:
The system of transporting, storing andhandling vaccines at the temperature of
+2C - +8C to maintain vaccine
potency from the manufacturer to the
point of vaccine administration.
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- -
Regional store Nadi YCS
Intermediate Vaccine Store
Health Centre/Nursing Station
From Manufacturer
National Level
FPSC
How long is the cold chain?
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Cold Chain Equipment Used in Health Facilities.
Fridges Absorption, Compression
(Gas, Electricity including Domestic)
Cold Boxes
Vaccine carriers
Foam pads
Ice packs
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Vaccine Refrigerator
Compression type
This type is operated byelectricity.
There is an electric motor
(compressor) at the back.
The compression type haspowerful cooling,approximately four timesmore than absorptionrefrigeration.
The compression typerequires less maintenance.
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Absorption Type RCW50EG
This type is operated by electricity and gas.There is a heating unit at the back.
This can alternatively be operated with Gas or
Electrical energy.
The device will not function and might be
damaged if it is operated with both energy
supplies simultaneously.
This has two compartments; one for vaccine
storage and one for ice-pack freezing and
storage of icepacks (4pcs. of 0.6 liter).
After setting into operation, the refrigerator
needs a minimum of 24 hours to reach suitabletemperature for storage of vaccines.
For gas operation, the gas cylinder of 13kg
should last 1 months, 45kg should last 3 months.
This will vary with conditions to use (The
approximate consumption rate for one day is
0.43kg)
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RCW50EG
Freezersection 4
icepacks
for
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Top-opening chest
refrigerators and Front-
opening models.
Top-opening chest
refrigerators
Front-opening
refrigerators
Insulation Better insulated Poorly
insulated
Ice-lined model Available (Holdover
time: more than 20hrs.)
Not available
(No holdover
time)
Lid open Less cold air is lost
when the lid is opened.
Cold air is lost
every time the
door is opened.
Access to the vaccine Awkward Easy to follow
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COLD BOXES
In addition to transport, cold box is used for temporary
storage for when a refrigerator is out of order or being
defrost.
Health facilities need one or more cold boxes.
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Foam Pad
Use Foam pad tokeep vaccine cool
during immunization
session.
Do not use ice pack
for this purpose
because the practice
may freeze vaccines.
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Ice-pack
Every health facility should have minimum two sets of ice-packs for each of their cold boxes and vaccines carriers.
1) one is to freeze ice-pack (reserve).
2) the other is to use in a cold box or vaccine
carrier.
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Cold Chain Monitoring Equipment
ThermometerThermometer
Health facility staff use dial or stem thermometers to monitor thetemperature of refrigerators.
On a dial thermometer the needle moves around the scale, pointing
to plus (+) numbers when it is warmer and to minus (-) numbers
when it is colder.
On a stem or bulb thermometer, coloured fluid in the bulb moves up
the scale as it becomes warmer, and down the scale as it becomes
colder.
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Freeze Tag Monitors
It consists of an electronic temperature. If the indicator is exposed to atemperature below 0C for more than 60 minutes the display will
change from the good status into the alarm status as indicated
below. The indicator is used to warn of freezing and is packed with
freeze sensitive vaccines. The shelf life is five years.
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General rules about refrigerators
Opening the refrigerator door raises thetemperature.
Before you open the door, plan whatyou are going to do.
When you open the door, do what you
have to do quickly and close the door
as soon as possible.
Try not to open the refrigerator door
more than three times a day.
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Vaccines and Cold Chain Equipment Management
There should be one person responsible for the
refrigerator and the following duties:
storing vaccines, diluents, and ice-packs
checking and recording the temperature twice
daily, even on week-ends
maintaining the facilitys cold chain equipment
ensuring only vaccines are stored in the
vaccines fridge
all health workers in a health facility, shouldknow how to monitor the cold chain and whataction to take if the temperature is too high or
too low.
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How to load cold chain equipment
1) Freeze and store ice-packs in the freezer compartment.2) Place all the vaccines and diluents in the refrigerator compartment ifspace permits.
3) Keep boxes of freeze-sensitive vaccine away from the freezingcompartment, fridge plate, sides and bottom of the fridge freezing mayoccur.
4) Make use first box to store opened vials to use first to ensure Multi-
dose vial policy.
5) Only keep vials that are good for use in the refrigerator.
6) Arrange boxes of vaccines so air can circulate between them.
7) Keep Vaccines with VVM showing heat exposure in a box labelled usefirst. Use these vials first in the next session.
8) Keep bottles of water in the bottom shelf to keep the fridge cool in case ofpower failure. (Domestic refrigerators)
9) Try not to open the fridge door more than three times a day.
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Loading vaccines in Compression Refrigerators
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What to do when a vaccine refrigerator is out of order
1) Protecting the vaccines.Move the vaccines to another place until the
refrigerator is repaired.
2) Restoring the refrigerator to work in order.Check the power or gas supply. If there is no
power, make other arrangements until power isrestored.
Check if the plug correctly in the socket or not.
Report to your repair technician or supervisor. Minor repairs should be carried out in the
health centre.
Major repairs, such as replacing a compressoror spark plug/burner jet (Gas), should be
carried out by a qualified technician.
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Routine maintenance of refrigerator
1) Every day
Check and record the temperature and
adjust the thermostat if necessary. Ensure that the vaccines are kept in order.
(Gas) Check that the colour of the burner
flame is blue. If orange, clean the Gas burner.
Keep the refrigerator area clean and free from
dust.
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Routine maintenance of refrigerator
2) Every week
(Gas) Check that there is enough gas in
the cylinder
Note: Always keep a spare, full gas
cylinder available and replace the cylinder
before it is completely empty. Check the lid sealing and verify that the
lid is locking tightly.
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Routine maintenance of refrigerator
2) Every month
Check ice on the evaporator. If the ice
layer is .5cm thick or more, defrost the unit.
Clean the refrigerator inside and out and wipe dry.
Clean and dry the rubber seal.
Check that the cooling unit is clean.
Remove any dirt or dust with a soft brush.
(Gas) Check that all gas lines connections are
free of leaks.
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Practical Cold Chain Equipment Operation
How to light a Gas refrigerator
1. If the refrigerator has been on electric operation turn the power off and pull the plugfrom the socket.
2. Make sure there are no draughts from doors or windows in the room, as these willmake it difficult to light the burner.
3. Identify the control knobs and other parts for gas operation.
4. Connect the gas bottle to the refrigerator with the gas supply line and ensure allconnections are tight.
5. Turn the gas on and check all connections for leaks (see below).
6. Turn the gas thermostat to the medium position.
7. Open the gas valve knob on the refrigerator (if there is one).
8. Push the button on the flame failure device as far as possible and keep it pushed infor 20 seconds.
9. Push or turn the igniter button to light the gas. You may need to do this a few timesbefore the gas will ignite. Look through the sight glass to see the flame.
10. Once the flame has ignited you need to keep the flame failure device pushed in forabout 20 seconds and then release it.
11. Check the flame stays lit; if it goes out repeat the same procedure.
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Checking Gas Leaks
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Cleaning The Flue and Baffle
1. Turn off the gas supply.2. Remove the burner protection plate if
there is one.
3. Cover the burner with a piece of cloth toprotect it and to collect the dirt.
4. Remove the flue top and remove thebaffle from the flue.
5. Clean the baffle with the special brushsupplied until dirt stops falling out.
6. Carefully wrap the dirt in the cloth beingvery careful not to spill any dirt on the
burner.7. Replace the baffle and flue top.
8. Replace the burner protection plate.
9. Light the burner.
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Monitoring of Temperature
To monitor the temperature of the main sectionof a refrigerator you need:
a thermometer;
a temperature chart, which you should tape to the outside of the
door or have close by the refrigerator.
To monitor the temperature, proceed as follows:
Read temperatures first thing in the morning and before you leave in
the afternoon. If the temperature is between +2C
to +8C
, do notadjust the thermostat.
Continue to do this everyday including workdays, weekends, andholidays.
Record the temperature for the day and time on the refrigeratortemperature chart.
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TEMPERATURE
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Points To Remember
If the temperature is too LOW (below +2C):
Move vaccines to another fridge or store in a cold box or
vaccine carrier
Turn the thermostat knob so that the arrow points to a
lower number. This will make the refrigerator warmer.
Check whether the door of the freezer closes properly.
The seal may be broken.
Check freeze-sensitive vaccines to see whether they
have been damaged by freezing by using the shake
test
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If the temperature is too HIGH (above +8C):
Move vaccines to another fridge or store in a
cold box/vaccine carrier.
Make sure that the refrigerator is working:
Check if gas or power supply is present.
Check whether the door of the refrigerator or the freezing
compartment closes properly. The seal may be broken.
Check whether frost is preventing cold air in the freezing
compartment from entering the refrigerator compartment.
Defrost if necessary.
Turn the thermostat knob so that the arrow points to a
higher number. This will make the refrigerator cooler.
If the temperature cannot be maintained between +2C and
+8C, store vaccines in another refrigerator until your vaccine
refrigerator is repaired.
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Vaccines sensitive to freezing
More of a problem if vaccines freeze than
if they get slightly warm
All vaccines withT: DTP, DT, DTP-HiB,HepaTiTis B and diluenT are sensitive to
freezing
Therefore vaccines are stored between
+2C - +8C
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Range
Vaccine
HepB
Hib (liquid) DTP-HepB+Hib,
TT, Hib lyophilised
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Cold chain monitoring equipment:
Vaccine vial monitors
VVM is a label made of heat-sensitive
material, placed on the vial to show
cumulative heat exposure over time
VVM reduces waste of vaccine, ensuring
that only good vaccine is used
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Reading Vaccine Vial Monitors
VVM is printed on the vial label or cap
Show cumulative, irreversibleheat exposure
As vial is exposed to more heat,the square becomes darker and
darker
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MULTI-DOSE OPEN VIAL POLICY
Opened vials of Hepatitis B, OPV and TT vaccines
May be used in subsequent imm. sessions for a
maximum of one month provided the following
conditions are met:
1.Expiry date has not passed
2.Vaccines cold chain not broken
3.Vaccine vial septum is not been submerged in
water4.Aseptic technique used to withdraw / administer
5.VVM does not reach discard point
Reconstituted vaccine is still within six hours.
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THE SHAKE TEST
The shake test can help give an idea whether
certain vaccines (OPV, TT or HBV) have been
subjected to freezing temperatures which are
likely to have damaged them. After freezing, thevaccine no longer has the appearance of a
homogenous cloudy liquid, but tends to form
flakes which settle at the bottom of the vial after
shaking.
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THANK YOU