The Cold Chain

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The Cold Chain

  1. 1. INTRODUCTION
  2. 2. WORLD HEALTH ORGANIZATION (WHO)
  3. 3. COLD CHAIN Vaccines are sensitive to heat and freezing and must be kept at the correct temperature from the time they are manufactured until they are used. The system used for keeping and distributing vaccines in good condition is called the COLD CHAIN. The cold chain consists of a series of storage and transport links, all designed to keep vaccines within an acceptable range until it reaches the user.
  4. 4. COLD CHAIN MANAGEMENT Maintenance of the cold chain requires vaccines and diluents to be: collected from the manufacturer or an airport as soon as they are available; transported between 2ºC and 8ºC from the airport and from one store to another; stored at the correct temperature (see Figure 3A) in primary/central and intermediate vaccine stores and in health facilities; transported between 2ºC and 8ºC to outreach sites and during mobile sessions; kept between 2ºC and 8ºC range during immunization sessions; and kept between 2ºC and 8ºC during return to health facilities from outreach sites.
  5. 5. EVALUATION OF COLD CHAIN MONITORING IN KELANTAN, MALAYSIA K. Hanjeet, M. S. Lye, M. Sinniah, A. Schnur. Bull World Health Organ. 1996; 74(4): 391–397 • An analysis was carried out on a total of 883 cold chain monitor (CCM) cards, which had been attached to batches of poliomyelitis,measles, DPT (diphtheria, pertussis, tetanus) and hepatitis B vaccines, during their transport and storage from the central store in Kuala Lumpur to Kelantan • 234 freeze watches attached to hepatitis B vaccines were also analysed • observation were done at six levels between the central store and the periphery during distribution of the vaccines
  6. 6. • RESULT: 883 cold chain monitor (CCM) cards : at the final destination 13.4% of all cards remained white while a COLOUR CHANGE to blue was observed in 65% in window A, 16.6% in window B, and 4.4% in window C; none had turned blue in window D indicating that the vaccine had not been subjected to temperatures > or = 34 °C for 2 hours 234 freeze watches: ALL but 2 had turned purple, which indicates exposure of the hepatitis B vaccines to temperatures below 0°C
  7. 7. VACCINES Vaccines are delicate biological substances that can become less effective or destroyed if they are: · Frozen · Allowed to get too hot · Exposed to direct sunlight or fluorescent light
  8. 8. APA YANG MENYEBABKAN VAKSIN ROSAK?  Tiada penjagaan yang betul  Semua vaksin hilang potensinya selepas tarikh vaksin luput walaupun diberi penjagaan yang begitu rapi  Faktor-faktor lain : i. Panas cahaya matahari boleh merosakkan kesemua vaksin terutama polio, campak & BCG ii. Pembekuan atau terlalu sejuk akan mengakibatkan DPT dan tetanus toxoid rosak iii. Bahan kimia e.g disinfeksi,antiseptik,alkohol (spirits) dan sabun (detergents ) - suhu yg tidak mengikut kehendak vaksin yang telah ditetapkan
  9. 9. APA YANG MENYEBABKAN VAKSIN ROSAK?  Stabiliti juga terganggu jika aseptik teknik tidak digunakan dgn betul (terutamanya sediaan multi dos TT)  Sediaan multidos dinasihatkan digunakan selepas sebulan dibuka
  10. 10. SEMASA DIANGKUT…..  Vaccine – perlu diangkut dalam bekas berpenebat  Guna – ‘freeze-watch’ dan vaccine monitor  Jenis bekas – cold-box, flask Ais kering (dry ice) tidak boleh digunakan semasa mengangkut vaksin Hepatitis B
  11. 11. VACCINE COLD CHAIN MONITOR
  12. 12. PENTING! o Sekiranya tetingkap 1,2,3 & 4 adalah berwarna PUTIH, gunakan vaksin seperti biasa o Jika tetingkap 1 hingga 3 berwarna MERAH sepenuhnya, tetapi tetingkap 4 masih berwarna PUTIH, bermakna vaksin telah terdedah kepada suhu melebihi 10°C o Jika tetingkap 4 adalah MERAH, ini bermakna terdapat gangguan pada ‘cold chain’ di mana suhu melebihi 34°C untuk tempoh sekurang- kurangnya 2 jam.
  13. 13. FREEZE WATCH
  14. 14. COLD BOX
  15. 15. SEMASA DISIMPAN…..  Asingkan jenis-jenis vaksin dengan jelas  Biarkan ruangan 1-2 cm antara barisan vaksin/ubat untuk memudahkan pergerakan udara  JANGAN letakkan vaksin di rak paling bawah kerana suhunya lebih tinggi  JANGAN letakkan sebarang makanan @ minuman – menyebabkan peti sejuk menjadi panas  JANGAN letakkan sebarang vaksin di rak-rak pintu  JANGAN simpan vaksin yang melebihi tarikh luput  Rekod bacaan suhu 2 kali sehari – pagi dan petang
  16. 16. FREEZING COMPARTMENTS TOP MIDDLE LOWER MAINCOMPARTMENTS OPV VIALS ICE CUBED BCG MEASLES DPT/DT/TT THYPHOID HEPATITIS A HEPATITIS B VARICELLA DILUENT NOTHING IN DOOR DUAL THERMOMETER (TOP SHELF)
  17. 17. DOMESTIC REFRIGERATOR
  18. 18. SEMASA IMUNISASI….. • JANGAN beri imunisasi dibawah sinaran matahari • Jalankan pelalian di tempat yang teduh
  19. 19. At a later time, inner square still lighter than outer circle. If the expiry date has not passed, USE the vaccine At a later time, inner square still lighter than outer circle. If the expiry date has not passed, USE the vaccine DISCARD POINT: Inner square matches colour of outer circle. DO NOT use vaccine DISCARD POINT: Inner square matches colour of outer circle. DO NOT use vaccine BEYOND THE DISCARD POINT: Inner square darker than outer ring. DO NOT use the vaccine. BEYOND THE DISCARD POINT: Inner square darker than outer ring. DO NOT use the vaccine. √ X X Inner square lighter than outer circle. If the expiry date has not passed, USE the vaccine Inner square lighter than outer circle. If the expiry date has not passed, USE the vaccine THE VACCINE VIAL MONITOR √
  20. 20. ALGORITHM TO ASSESS PROBLEMS IN TEMPERATURE READINGS refrigerator temperature reading is less than +2ºC or greater than +8ºC
  21. 21. First Nations Inuit Health Branch, Health Canada and CDC Vaccine Storage and Handling Toolkit (2005), Resources Section, National Vaccine Storage and Handling Guidelines for Immunization Providers, Appendices
  22. 22. First Nations Inuit Health Branch, Health Canada and CDC Vaccine Storage and Handling Toolkit (2005), Resources Section, National Vaccine Storage and Handling Guidelines for Immunization Providers, Appendices
  23. 23. ESSENTIAL ACTIONS • Take inventory of potentially compromised immunizing agents and biologics. • Isolate potentially elected product into a separate container (paper bag) marked “DO NOT USE” and store in a functioning refrigerator. • Do not return product to malfunctioning fridge until the unit has been serviced and demonstrated to maintain +2ºC to +8ºC storage temperatures for at least 2 days. • Do not use potentially compromised vaccine until clear instructions related to their use have been received by the manufacturers or from stability data in the product monographs.
  24. 24. BACAAN SUHU • Suhu semasa dibaca pada paras raksa ketika membaca. • Suhu yang tertinggi semenjak bacaan lalu (suhu maksima) yang dibaca pada indikator di bahagian maksima pada termometer. • Bacaan semasa pada bahagian minima dan bahagian maksima adalah sama.
  25. 25. BahagianBahagian atas kiriatas kiri (minimum)(minimum) dari sifardari sifar  -ve-ve BahagianBahagian bawahbawah (maksimum)(maksimum) dari sifardari sifar  -ve-ve BahagianBahagian bawah kiribawah kiri (minimum)(minimum) dari sifardari sifar  +ve+ve Bahagian atasBahagian atas kanankanan (maksimum)(maksimum) dari sifardari sifar  +ve+ve
  26. 26. MINIMUM MAKSIMUM BACAAN MAKSIMUM BACAAN MINIMUM BACAAN SEMASA RESET
  27. 27. TUBERCULIN PPD (PURIFIED PROTEIN DERIVATIVE) FOR MANTOUX TESTING Tuberculin is a protein extract from Mycobacterium tuberculosis, the bacteria that causes tuberculosis. It is injected just beneath the surface of the skin of the forearm to test if a person has previously been infected with M. tuberculosis or not. TUBERCULIN PPD RT23 SSI
  28. 28. TERIMA KASIH

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