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    Cold chain   tot Cold chain tot Presentation Transcript

    • Cold Chain – An Overview1www.drjayeshpatidar.blogspot.in
    • Cold Chain is a system oftransporting and storingvaccines at recommendedtemperature from the point ofmanufacture to the point ofuseDefinition2www.drjayeshpatidar.blogspot.in
    • Essential Elements of Cold Chain PERSONNEL to organize andmanage vaccine distribution EQUIPMENT for storage andtransport of vaccines. Transport facilities Maintenance of equipment Monitoring3www.drjayeshpatidar.blogspot.in
    • In general• All Vaccines tend to lose potencyon exposure to heat above +80 C• Some Vaccines lose potency whenexposed to freezing temperatures• The damage is irreversible4www.drjayeshpatidar.blogspot.in
    • OPVMeaslesBCGVaccines sensitive to heat5www.drjayeshpatidar.blogspot.in
    • Hep- BDPTDTTTVaccines sensitive to freezing6www.drjayeshpatidar.blogspot.in
    • Ice lined refridgerators (ILRs)•Capacity: 140 litres at PHC level(1200 vials)•Ideal Temperature: +2 C to 8 C(Effective with electricity supply of 8/24 hrs)•Safe Storage: Always in the basket section(Always T series, Hepatitis-B and Diluents)(OPV/Measles/BCG may be kept below basket in casespace is not available)•Thermometer: Place in the ILR-basket7www.drjayeshpatidar.blogspot.in
    • Right way of keeping vaccinesin ILR• Keep all vaccines in baskets• Place a thermometer in thecenter of the ILR.• Avoid placing vaccines at bottomof ILR. (never diluents, freeze sensitive)• Leave space between thevaccine boxes• Same vaccines in same area.• Diluent / freeze sensitive/ Closer expiry date vaccines on top• Heat sensitive / Further expiry date vaccines in the bottom of basket8www.drjayeshpatidar.blogspot.in
    • Deep freezers (DF)• Capacity: 140 litres at PHC level• Ideal Temperature: -18 C to -20 C(In case of power failure - maintaintemperature for 18-20 hrs)• Ice Pack Freezing Capacity:freezes 20 ice packs every 24 hours.9www.drjayeshpatidar.blogspot.in
    • Cold Boxes• Type: Insulated boxes of 5 litre capacity• Usage: Stores & transports vaccine. Also storesfrozen Ice Packs• Capacity: 1500 doses (mixed antigen) or 5000doses (only OPV) with 24 ice packs.• Holdover Time:3 days (Keep thermometerinside)• Vaccine Layout: Direct contact of frozen Icepacks spoil the vaccine. Give cartonspacers/surround vaccine by OPV vials.• Label Protection: Place vaccine in cartons orpolythene bags.10www.drjayeshpatidar.blogspot.in
    • Vaccine Carrier• Type: Insulated boxes used for carrying smallquantities of vaccine.• Capacity: 16-20 vials• Holdover Time: Maintain +2 to+80 C for about24 hours (one day)• Ice packs: A maximum of 4 frozen packs• Vaccine Layout: Keep vaccines in a plastic bag(not in direct touch with the Ice packs)11www.drjayeshpatidar.blogspot.in
    • Ice PacksWater Fill:• Do not fill 100%.• Leave 10 mm room forexpansion as water freezes.• Close the cap tightly• Clean the outer surface drybefore freezing12www.drjayeshpatidar.blogspot.in
    • Ice Pack Freezing• Ice Packs to be frozen ROCK Solid• Freezing is faster & uniform if gap/breathing space is left between ice packs• Ice Packs are best frozen in Deep Freezers• Condition before use13www.drjayeshpatidar.blogspot.in
    • Preparing icepacks for use: ConditioningA Conditioned ice-pack•On the session day,take the frozen ice-packsyou need from thefreezer and place on atable•Allow ice-packs tosweat (droplets of water)at room temperature•Shake the ice pack tolisten to sound of water.14www.drjayeshpatidar.blogspot.in
    • Maintenance of Equipment• Defrosting/Cleaning: Ice deposit 5mm & over infreezer or at the bottom of ILR results in rise intemperature. Periodic defrosting & cleaning ensurestrouble free performance for a long period.• Cold boxes/Vaccine Carriers: Cold box hinges, lidknobs & chains are often damaged. Replace or repairlocally. Minor insulation casing cracks/gaps can also berepaired with fresh PUF insulation• Ice Packs: Fill clean water for freezing & leave 10mmroom for expansion as water freezes. Cap tightly to avoidleakage. Keep pack clean & dry.15www.drjayeshpatidar.blogspot.in
    • Vaccine Distribution• Follow first-in-first - out rule (FIFO)• Also: first to expire - first out. (FEFO)• Vaccines are not stored at the sub-centre leveland must be supplied on the day of use• Note manufacturer, batch no, VVM status• Use VVM stage-II vaccine near the cold chainpoint (do not distribute to remote areas) 16www.drjayeshpatidar.blogspot.in
    • Storage Temperature• Monitor temperature twice daily.• All vaccines at PHC are storedbetween +2 to+8 C17www.drjayeshpatidar.blogspot.in
    • Shake testShake the control and test samples• Hold the Control and theTest sample together inhand and vigorously shakethe samples• Place both vials to rest ona flat surface, side-by-sideobserve them for 30minutes.• Compare for rate ofsedimentationUSETestControlTest ControlDiscard18www.drjayeshpatidar.blogspot.in
    • Shake Test: Summary19www.drjayeshpatidar.blogspot.in
    • Vaccine Vial Monitor3 = bad:Don’t Utilize4 = bad:Don’t UtilizeThe central square is equal to, ordarker than the surrounding circleXX1 = good:Utilize2 = good:UtilizeThe central square is lighterthan the surrounding circle20www.drjayeshpatidar.blogspot.in
    • Potency• T series, Hep B and diluents should never be frozen.• BCG, OPV & Measles are sensitive to heat and light & losepotency fast.• Potency lost due to heat exposure does not change theappearance of the vaccine.• VVM is an effective tool in monitoring OPV potency.• Damage to vaccine cannot be reversed by re-freezing.• Discard frozen vaccine.21www.drjayeshpatidar.blogspot.in