Vaccine Storage And Handling Atkinson


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Vaccine Storage And Handling Atkinson

  1. 1. <ul><li>Vaccine Storage and Handling </li></ul>William L. Atkinson, MD, MPH National Immunization Program North Carolina Immunization Conference Greensboro, NC 18 August 2005
  2. 2. Effect of Temperature on Vaccines <ul><li>Live vaccines </li></ul><ul><ul><li>tolerate freezing </li></ul></ul><ul><ul><li>deteriorate rapidly after removal from freezer </li></ul></ul><ul><li>Inactivated vaccines </li></ul><ul><ul><li>damaged by exposure to freezing temperatures </li></ul></ul><ul><ul><li>tolerate short time out of refrigeration </li></ul></ul>
  3. 3. Vaccine Storage and Handling Guidelines <ul><li>Develop and maintain detailed written protocol </li></ul><ul><li>Assign responsibilities to one person </li></ul><ul><li>Designate a back-up person </li></ul><ul><li>Provide training on vaccine storage and handling </li></ul>
  4. 4. Vaccine Shipments <ul><li>Examine shipment on arrival </li></ul><ul><li>Crosscheck contents with packing slip </li></ul><ul><li>Check vaccine expiration dates </li></ul><ul><li>Examine contents for damage </li></ul><ul><li>Was shipping time <48 hours? </li></ul><ul><li>Is there evidence of excessive heat or cold exposure? </li></ul>
  5. 5. Vaccine Inventory Log <ul><li>Name of each vaccine </li></ul><ul><li>Number of doses of each vaccine received </li></ul><ul><li>Date received </li></ul><ul><li>Condition upon arrival </li></ul><ul><li>Vaccine manufacturers </li></ul><ul><li>Lot numbers </li></ul><ul><li>Expiration dates for each vaccine </li></ul>
  6. 6. Vaccine Storage Requirements <ul><li>Maintain required temperature range throughout the year </li></ul><ul><li>Separate doors for refrigerator and freezer </li></ul><ul><li>Large enough to hold year’s largest vaccine inventory </li></ul><ul><li>Dedicated to biologics (no food or beverages!) </li></ul><ul><li>Dorm-style refrigerators should NOT be used to store varicella vaccine or LAIV </li></ul>
  7. 7. Temperature Monitoring <ul><li>Separate thermometer for refrigerator and freezer compartments </li></ul><ul><li>Use good quality calibrated thermometer (biosafe liquid, continuous graphic, or minimum/maximum) </li></ul><ul><li>Manually check temperatures twice a day even if using continuous graphic thermometer </li></ul>
  8. 8. Temperature Monitoring <ul><li>Use temperature log for both refrigerator and freezer compartments </li></ul><ul><li>Check and record the temperatures twice a day </li></ul><ul><li>Keep temperature logs for at least 3 years </li></ul><ul><li>Take immediate action when the temperature is outside the recommended range </li></ul>
  9. 9. Recommended Temperatures <ul><li>Refrigerator </li></ul><ul><li>35 o - 46 o F </li></ul><ul><li>or </li></ul><ul><li>2 o - 8 o C </li></ul><ul><li>Average 40 o F (5 o C) </li></ul><ul><li>Freezer </li></ul><ul><li>< +5 o F </li></ul><ul><li>or </li></ul><ul><li>< -15 o C </li></ul><ul><li>(varicella & LAIV) </li></ul>
  10. 10. Preventive Measures <ul><li>Use a plug guard or safety-lock plug </li></ul><ul><li>Post a warning sign above the plug and on the refrigerator </li></ul><ul><li>Label fuses and circuit breakers </li></ul><ul><li>Install a temperature alarm </li></ul>
  11. 11. Preventive Measures <ul><li>Remove vegetable bins and replace with bottles of water to stabilize refrigerator temperature </li></ul><ul><li>Keep extra cold packs or blue ice in the freezer </li></ul><ul><li>Never store vaccines in the door of the refrigerator or freezer </li></ul>
  12. 12. <ul><li>Multi-dose Vials </li></ul><ul><li>Contain a bacteriostatic </li></ul><ul><li>Good until expiration date unless contaminated </li></ul><ul><li>Single-dose Vials </li></ul><ul><li>Do NOT contain a bacteriostatic </li></ul><ul><li>Once opened use or discard within 24 hours </li></ul>
  13. 13. After reconstitution use within: <ul><li>30 minutes – varicella, ActHIB </li></ul><ul><li>8 hours – MMR </li></ul><ul><li>24 hours - PedvaxHIB </li></ul>
  14. 14. Unreconstituted Varicella Vaccine <ul><li>Can store at refrigerator temperature for 72 hours, then discard if not used </li></ul><ul><li>Do NOT refreeze </li></ul>
  15. 15. LAIV Storage and Handling <ul><li>Must be stored at < 5 o F (-15 o C) to maintain expiration dates </li></ul><ul><li>Can be stored in a standard frost-free freezer </li></ul><ul><li>Manufacturer-supplied freezer box no longer required </li></ul><ul><li>May be stored at refrigerator temperature for 60 hours – cannot be refrozen </li></ul>
  16. 16. Vaccine Handling <ul><li>Open only one vial at a time </li></ul><ul><li>Store vaccine vials separate from other medications or biologics </li></ul><ul><li>Do NOT store food/beverages in refrigerator or freezer with vaccines </li></ul><ul><li>Keep MMR, varicella and yellow fever vaccines in their box until ready to use </li></ul>
  17. 17. Prefilling Syringes <ul><li>Increased risk for administration errors </li></ul><ul><li>Increased vaccine wastage </li></ul><ul><li>Risk of inappropriate vaccine storage conditions </li></ul><ul><li>Bacterial growth in vaccines that do not contain a preservative </li></ul><ul><li>Reduced vaccine potency </li></ul>
  18. 18. Preparing for a Mass Clinic <ul><li>Administer only one type of vaccine </li></ul><ul><li>Separate vaccine administration stations by vaccine type </li></ul><ul><li>Transport the vaccine to the clinic in the manufacturer-supplied packaging at the recommended temperature </li></ul><ul><li>Use an insulated barrier (such as bubble wrap) between the vaccine and the cold or frozen packs </li></ul><ul><li>A single layer of towel over ice is NOT adequate protection </li></ul>
  19. 19. Prefilling Syringes at a Mass Clinic <ul><li>Upon arrival draw up <1 vial or 10 doses </li></ul><ul><li>Replenish supply throughout the day </li></ul><ul><li>Monitor patient flow to avoid drawing up unnecessary doses </li></ul><ul><li>Discard any syringes other than those filled by the manufacturer at the end of the clinic day </li></ul>
  20. 20. Vaccine Inventory Control <ul><li>Conduct a monthly vaccine inventory </li></ul><ul><li>Avoid stocking excessive vaccine supplies </li></ul><ul><li>Include diluents in the stock control procedure </li></ul><ul><li>Monitor expiration dates </li></ul><ul><li>Rotate stock to avoid waste from expiration </li></ul><ul><li>Expired vaccine and diluent should never be used </li></ul><ul><li>Limit access to authorized personnel only </li></ul>
  21. 21. Top Ten Vaccine Storage and Handling Errors <ul><li>10. Only one person in the office is responsible for vaccine </li></ul><ul><li>9. Vaccine stored in the wrong part of the refrigerator </li></ul><ul><li>8. No emergency plans for a power outage or natural disaster </li></ul><ul><li>7. Discarding multi-dose vials after they are opened for 30 days </li></ul><ul><li>6. Leaving the refrigerator/freezer door open overnight </li></ul>
  22. 22. <ul><li>5. Storing varicella vaccine in a dorm-style refrigerator </li></ul><ul><li>4. Recording temperatures once per day </li></ul><ul><li>3. Recording temperatures for only the refrigerator or freezer </li></ul><ul><li>2. Throwing away temperature logs at the end of every month or year </li></ul>Top Ten Vaccine Storage and Handling Errors
  23. 23. Top Ten Vaccine Storage and Handling Errors <ul><li>Documenting out of range </li></ul><ul><li>temperatures on vaccine </li></ul><ul><li>temperature logs and NOT </li></ul><ul><li>taking action! </li></ul>
  24. 24. When There is a Problem with your Refrigerator or Freezer <ul><li>Notify your supervisor- immediately! </li></ul><ul><li>Adjust the thermostat </li></ul><ul><li>Check the unit for problems </li></ul><ul><li>Document the date, time, temperature, problem, and what you did to correct </li></ul><ul><li>Recheck the temperature q2h </li></ul><ul><li>If still out of range, call for help </li></ul><ul><li>Move vaccine to alternate site </li></ul>
  25. 25. National Immunization Program <ul><li>Hotline 800.CDC.INFO </li></ul><ul><li>Email [email_address] </li></ul><ul><li>Website* </li></ul>*order S&H Toolkit CD from online publication system