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Cold Chain (3)

Apr 07, 2018

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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 t

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