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Cold chain tot


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Cold chain tot

  1. 1. Cold Chain – An Overview
  2. 2. Cold Chain is a system of transporting and storing vaccines at recommended temperature from the point of manufacture to the point of use Definition
  3. 3. Essential Elements of Cold Chain  PERSONNEL to organize and manage vaccine distribution  EQUIPMENT for storage and transport of vaccines.  Transport facilities  Maintenance of equipment  Monitoring
  4. 4. In general • All Vaccines tend to lose potency on exposure to heat above +80 C • Some Vaccines lose potency when exposed to freezing temperatures • The damage is irreversible
  5. 5. OPV Measles BCG Vaccines sensitive to heat
  6. 6. Hep- B DPT DT TT Vaccines sensitive to freezing
  7. 7. 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 case space is not available) •Thermometer: Place in the ILR-basket
  8. 8. Right way of keeping vaccines in ILR • Keep all vaccines in baskets • Place a thermometer in the center of the ILR. • Avoid placing vaccines at bottom of ILR. (never diluents, freeze sensitive) • Leave space between the vaccine 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 basket
  9. 9. Deep freezers (DF) • Capacity: 140 litres at PHC level • Ideal Temperature: -18 C to -20 C (In case of power failure - maintain temperature for 18-20 hrs) • Ice Pack Freezing Capacity: freezes 20 ice packs every 24 hours.
  10. 10. Cold Boxes • Type: Insulated boxes of 5 litre capacity • Usage: Stores & transports vaccine. Also stores frozen Ice Packs • Capacity: 1500 doses (mixed antigen) or 5000 doses (only OPV) with 24 ice packs. • Holdover Time:3 days (Keep thermometer inside) • Vaccine Layout: Direct contact of frozen Ice packs spoil the vaccine. Give carton spacers/surround vaccine by OPV vials. • Label Protection: Place vaccine in cartons or polythene bags.
  11. 11. Vaccine Carrier • Type: Insulated boxes used for carrying small quantities of vaccine. • Capacity: 16-20 vials • Holdover Time: Maintain +2 to+80 C for about 24 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)
  12. 12. Ice Packs Water Fill: • Do not fill 100%. • Leave 10 mm room for expansion as water freezes. • Close the cap tightly • Clean the outer surface dry before freezing
  13. 13. 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 use
  14. 14. Preparing icepacks for use: Conditioning A Conditioned ice-pack •On the session day, take the frozen ice-packs you need from the freezer and place on a table •Allow ice-packs to sweat (droplets of water) at room temperature •Shake the ice pack to listen to sound of water.
  15. 15. Maintenance of Equipment • Defrosting/Cleaning: Ice deposit 5mm & over in freezer or at the bottom of ILR results in rise in temperature. Periodic defrosting & cleaning ensures trouble free performance for a long period. • Cold boxes/Vaccine Carriers: Cold box hinges, lid knobs & chains are often damaged. Replace or repair locally. Minor insulation casing cracks/gaps can also be repaired with fresh PUF insulation • Ice Packs: Fill clean water for freezing & leave 10mm room for expansion as water freezes. Cap tightly to avoid leakage. Keep pack clean & dry.
  16. 16. Vaccine Distribution • Follow first-in-first - out rule (FIFO) • Also: first to expire - first out. (FEFO) • Vaccines are not stored at the sub-centre level and must be supplied on the day of use • Note manufacturer, batch no, VVM status • Use VVM stage-II vaccine near the cold chain point (do not distribute to remote areas)
  17. 17. Storage Temperature • Monitor temperature twice daily. • All vaccines at PHC are stored between +2 to+8 C
  18. 18. Shake test Shake the control and test samples • Hold the Control and the Test sample together in hand and vigorously shake the samples • Place both vials to rest on a flat surface, side-by-side observe them for 30 minutes. • Compare for rate of sedimentation USE TestControl Test Control Discard
  19. 19. Shake Test: Summary
  20. 20. Vaccine Vial Monitor 3 = bad: Don’t Utilize 4 = bad: Don’t Utilize The central square is equal to, or darker than the surrounding circle X X 1 = good: Utilize 2 = good: Utilize The central square is lighter than the surrounding circle
  21. 21. Potency • T series, Hep B and diluents should never be frozen. • BCG, OPV & Measles are sensitive to heat and light & 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 vaccine.