Cold chain

Cold Chain

Definition

“Cold Chain is a system of keeping Vaccines at their recommended temperature from the

point of manufacturing to the point of vaccination of the beneficiary”

Cold Chain

Importance of cold chain

• Vaccines are sensitive biological products which may become less effective, or even destroyed, when exposed to temperatures outside the recommended range.

• Cold-sensitive vaccines experience an immediate loss of potency following freezing.

• Vaccines exposed to temperatures above the recommended temperature range experience some loss of potency with each episode of exposure.

• Repetitive exposure to heat episodes results in a cumulative loss of potency that is not reversible.

The Effective Cold ChainThree main elements combine to ensure proper

vaccine transport, storage, and handling.• Trained personnel• Transport and storage equipment• Efficient management procedures

Equipment

People

Procedures

OPV

Measles, MR, MMR

DPT, DPT+HepB, DPT+Hib, DPT+HepB+Hib , Yellow fever V

BCG

DT, Hib

TT , Td, hep B, JE

Vaccines vulnerable to heat

Vaccines vulnerable to freezing

hep B

Hib liquid

DPT, DPT+HepB, DPT+Hib, DPT+HepB+Hib

DT,

Td

TT

Light sensitive vaccines• BCG• Measles• MR• MMR

Vaccine Heat Light Freezing Temperature at PHC

OPV(live attenuated)

Sensitive Sensitive Okay to freeze +2˚C to +8˚C(-15˚C to -25˚C at

state, regional and district stores)

BCG(live attenuated)

Sensitive Sensitive Okay to freeze (before reconstitution)

+2˚C to +8˚C

Measles(live attenuated)

Sensitive Sensitive Okay to freeze (before reconstitution)

+2˚C to +8˚C(-15˚C to -25˚C at

state, regional and district stores)

DPT(toxoid, killed)

Relatively heat stable

Freezes at -3˚C. Discard if frozen.

+2˚C to +8˚C

Hep B(recombinant)

Relatively heat stable

Freezes at- .5˚C. Discard if frozen.

+2˚C to +8˚C

TT(toxoid)

Relatively heat stable

Freezes at -3˚C. Discard if frozen.

+2˚C to +8˚C

Summary of vaccine vulnerability

Walk in cooler and freezer• They are located at the regional/ Divisional level.• Store vaccines up to 3 months and 4-5 districts.

Walk-in Freezer(-15o to -25o C)

Walk-in Cooler(+2o C to +8o C)

Size: 300 ltr / 140 ltr

Level: District (300 ltr) / PHC, CHC(140 ltr)

Temperature: -15o to -25o C

Utilization: 1. Preparation of ice packs (at the

PHC, CHC)

Holdover time: 18- 22 hours In case of power cut.

Storage capacity: 300 ltr: 150, 000 to 200, 000 doses 140 ltr : Approx. 20-25 Ice Packs

with 8 hour of continuous supply

Deep freezers

Size: 300 ltr / 140 ltr

Level: District (300 ltr) / PHC (140 ltr)

Temperature: +2˚C to +8˚C

Utilization: At PHC for storing all vaccine for 1 month

Holdover time: 24 hrs after 8 hrs continuous power supply

Storage capacity: 300 ltr: 60,000 doses of mixed antigen & 20,000 doses of OPV140 ltr : 25,000 doses of mixed antigen & 18,000 doses of OPV*

Ice line refrigerators (ILR)

Arrange the vaccine In the order Top to bottom in ILR

Dos (for ILR and Deep freezer)

• Keep the equipment in cool room away from direct sun light.

• Keep the equipment labeled• Fix the equipment through the voltage stabilizer• Keep the vaccine nearly with space between the

stacks for circulation of air.• Keep the equipment locked and open only when

necessory.• Defrost periodically.• Supervise the temperature records

Donot (for ILR and Deep freezer)

• Donot keep any object on these equipment • Donot store any drug• Donot keep food and drinking water in them• Donot keep moor then one month requirments at

PHC level.• Donot keep expiry date vaccine.

Size: 20 ltr and 5 ltr

Level: all peripheral level

Temperature: +2˚C to +8˚C

Utilization: All vaccines can be stored for transportation or in case of power failure

Storage capacity: 20 ltr: 52 Ice Packs & 6000 doses of mixed antigens 5 ltr: 20 Ice Packs & 1500 doses of mixed antigens

Cold boxes

• Before the vaccines are placed in the cold boxes, fully frozen ice packs are placed at the bottom and sides.

• The vaccine are kept in the cartons and polythene bags.

• The vials of DPT, DT, TT vaccines and diluents should not placed in direct contact with frozen ice packs.

Size: 1.7 ltr

Level: PHC/ Sub Centre

Temperature: +2˚C to +8˚C

Utilization: All vaccines can be carried in small quantity for vaccination sessions

Holdover time: 12 hours Storage capacity: 4 Ice Packs &15-20 vials of mixed antigens

Vaccine carriers

Size: 763 X 90 X 33 mm

Ice capacity: 360 ml

Weight: 80 gm

Level: District / PHC/ Sub Centre

Temperature: +2˚C to +8˚C

Utilization: line the walls of vaccine carrier/cold box/day boxes

Time to Freeze: 48 hours in DF at - 20˚C

Ice packs

• Fill icepacks with water to mark• Fit the sealing plug and screw on the lid

tightly• Hold each ice-pack upside down and

squeeze it to make sure it does not leak.• Place the icepacks in the deep freezer.• Ice-packs need not be refilled every time

they are used. The same water can be used repeatedly.

• Do not use saline water for filling

Preparing icepacks for use

• On the session day, take the frozen ice-packs you need from the freezer and place on a table

• Allow ice-packs to sweat at room temperature for 15 minutes

• Shake the ice pack to listen to melted for water.

• This will prevent freeze-sensitive vaccines from freezing.

A Conditioned an ice-pack

Conditioning of ice packs

Verify Daily the Temperature of the Cold Chain Storage at the

Health Centers and Out PostsHealth Centers and Out Posts

+2°C to + 8°C

DPT,DT & Tetanus Toxoid

OPV (Polio), BCG, Measles,

0°C

-15°C to -25°C

Ice Packs in deep Freezers

Full ILR can not maintain potency of vaccine

Do not open lid of ILR too often

Discard frozen DPT, DT and TT vials

Ice Packs in Deep Freezer- Side View

Freezing Ice packs in deep freezer

Over filling Deep freezer damages equipment

Never put vaccines in direct touch with ice packs

Maintenance of Equipment• Breakdown/Repairs:

• Early reporting & timely repairs is good cold chain management.

• Handy spares reduces down time & speeds repair. • Condemned units to be removed/ replaced by standby

units.

• Contingency/Emergency Plan: • Identify alternate storage points incase of equipment

failure.• Funds approval, manpower & mobility to be geared up in

advance.

Vaccine Basics.............• Follow “First-in-First - out rule” (FIFO)

• Also “First to expire - First out” (FEFO)

• T series, Hep B and Hib and diluents should never be frozen.

• BCG, OPV & Measles (light) are sensitive to heat & lose potency fast.

• Potency lost due to heat exposure does not change the appearance of the vaccine.

• VVM is an effective tool in monitoring OPV potency.

• Damage to vaccine cannot be reversed by re-freezing.

• Discard frozen T series vaccine & Hepatitis B Vaccines.

Vaccine Vial Monitor - Interpretation

Thanks

• Aj ka din wo din hai jab ma papa ko ek doosre ko pehli baar dekhe 25 saal

poore ho gaye• In saalo me, papa jada time ghar pe nahi the, aur mummy se jitni ladaiya ki

hai, shayad ab zindagi me kisi se nahi hongi…• Ma ne humesha meri choti badi galti ko sudhara hai• Poora ghar akele chalana, aur 2 ladkiyo ko bada karna, shayad isiliye, unka

pyar daant k form me hi bahar aata tha, aur tb ye baat mere smjh me nahi aati thi

• Unhe hmesha is baat ki chinta rehti hai ki unke bachho se koi galti na ho jaye, kisi ko bhi kabhi koi kami nikalne ka mauka na mile

• Papa ne hume humesha support kiya hai, ki jo karne ka mann kare. Karo. Papa humesha tumhare sath hain

• Dono ne aj tk meri koi bhi farmaish adhoori nahi chodi, ab to ye bolna padta hai, ki bachho k muh se nikli baat poori nahi karte, bachhe bigad jate hain