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Cold chain
- 1. Cold Chain System DRBUSHRA JABEEN MD COMMUNITY MEDICINE 1
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- 3. 1. Introduction 2. ColdChain Equipments 3. Placement Of Vaccine Vials 4. Potency Of Vaccine 5. Maintenance In Practice 6. Summary 3
- 4. “ ” Vaccine-potency once lostcannot be restored. Cold Chain is a system of storing and transporting vaccine at the recommended temperature range from the point of manufacture to point of use. INTRODUCTION Manufacturer Distributor Vaccine depots Health care provider Vaccine recipient 4
- 5. Cold chain networkin the country has been the backbone to ensure the delivery of vaccine (6 rights) • In right quantity • In right quality • In right time • In right temperature • In right place • To right beneficiary INTRODUCTION 5
- 6. Key Elements Personnel Tomanage vaccine storage and distribution. Equipment To store and transport vaccine and monitor temperature. Procedures To ensure correct utilization of equipment and ensure vaccines are stored and transported safely. 6
- 7. 2 to 8c Vaccineflow 7
- 8. Cold chain Equipment StorageTransportation Associated equipment Temperature monitoring device Electrical Solar Non - Electrical • WIF • WIC • DF • ILR Solar refrigerat -or • Cold box • Vaccine Carrier • Refrigerated van • Insulated van • cold box • Vaccine carrier • Ice packs • Stabilizer • Generator • Inverter • Thermometer • Electronic data logger • Freeze indicator • Real time temp • Monitoring device 8
- 9. Pre-fabricated modularpolyurethane foam insulated panel assembled cold room Two identical refrigerator units Standby generator set. National, State and Regional/Divisional Stores. -150C to -250C. Bulk storage of OPV Vaccine Preparation of frozen Ice Packs for vaccine transportation Walk-in-Freezers (WIF) Cold Chain Equipment 9
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- 11. Walk-in-Coolers (WIC) Pre-fabricatedmodular Polyurethane insulated panel assembled cold room. Two identical cooling units with standby generator. Maintain temperature of +2°C to +8°C. Used for storage of large quantities of UIP vaccines Installed at state & regional vaccine store. Components: Graphic chart temperature recorder Alarm systems Voltage Stabilizer Cold Chain Equipment 11
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- 13. Deep Freezer Operateson vapour compression system (220 volts A.C) -150 C to -250 C. Used for storing of OPV (district level and above only) Frozen ice packs kept permanently for increasing hold over time. Large deep freezers at district headquarters have been supplied for: • Storage of OPV • Preparation of ice packs Small deep freezers at PHC headquarters have been supplied for: • Preparation of ice packs only Cold Chain Equipment 13
- 14. Hold over time Timetaken by the equipment to raise the inside cabinet temperature from its temperature at the time of power cut, to maximum temperature limit of its recommended range. Depends on : Ambient temperature Frequency of opening the lid Quantity of vaccines kept inside Condition of ice pack lining. 14
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- 16. Ice Lined Refrigerator(ILR) Cold Chain Equipment 16
- 17. Domestic Refrigerators Continuouspower supply is ensured & dedicated for storage of vaccines. 20C to 80C Do not store other supplies such as drugs, ointment, serum, samples, food articles, drinks etc. Do not put vaccines on the door shelves. Cold Chain Equipment 17
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- 19. Cold Box Biginsulated boxes 5 & 8 litres - 1500 & 2400 doses 20-22 litres - 6000 – 6600 doses Mainly used for transportation The vaccines should be placed in cartons or polythene bags and then place in the cold box. The vials of DPT, DT, TT and Hep B vaccines should never be placed in direct contact with the ice packs Store vaccines for transfer up to five days Cold Chain Equipment 19
- 20. Packing a coldbox 20
- 21. Vaccine Carriers 16-20 vials Fourice packs To carry vaccine from PHC to outreach sessions. Cold Chain Equipment 21
- 22. Ice Packs andtheir use Used for ice lining inside the cold box and vaccine carrier. Start freezing ice packs several days before you need them. Salt should never be added to the water Ice-packs need not be refilled every time they are used. 22
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- 24. Conditioning of IcePacks 24
- 25. Ice - Pack ColdChain Equipment 25
- 26. Placement of vaccineswhen at the RI site 26
- 27. Vaccines lose theirpotency due to exposure to : Safeguarding Vaccines 27
- 28. Sensitivity of vaccinesto Heat, Light And Freezing 28
- 29. Temperature Monitoring Alcohol stem thermometer Electronicdata logger Fridge indicator Freeze indicator 29
- 30. How to checkvaccines for correct maintenance of cold chain? Checking vaccines for heat damage? VVM showing colour change sequence and interpretation 30
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- 32. Checking vaccines forcold damage (freezing) Shake Test Passed - Vaccine usable Shake Test Failed - Do not use Vaccine 32
- 33. Transportation inbulk quantity. From GMSD to SVS. Provide temperature range for specific vaccine 33
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- 36. REVERSE COLD CHAIN It is used in AFP (Acute Flaccid Paralysis) surveillance. Transportation of stool sample from a suspected polio case for diagnosis from periphery to central laboratory. Specific RED vaccine carrier is used for reverse cold chain. Temperature 2°C to 8°C. 36
- 37. Summary Vaccine transportationfrom site of manufacture to field level. Equipment's used for :- Storage, Transportation, Supportive Equipment and maintenance of vaccine. Different position for different types of vaccines Checking for potency of vaccine before use Vaccine vial monitor 37
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- 39. Further reading ParkK. Park’s Text Book Of Preventive And Social Medicine. 25th Ed. Jabalpur: Banarsidas Bhanot Publishers; 2019. A H Suryakantha. Textbook of community medicine with recent advances; 5th edition; 2019. Immunization Handbook for Medical Officers, Ministry of Health and Family Welfare; 3rd edition; 2016. 39
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Editor's Notes
- #8 The cold chain system and vaccine flow in the country is schematically represented below.
- #12 In India, under UIP usually WIC with capacity of 16.5, 32 and 40 Cubic meter are in use.
- #14 All routine immunization vaccines including OPV/Measles should be stored only in ILR at PHC/CHC level for maximum period of one month.
- #25 Keep at room temperature for a period of time to allow temperature at core of icepack to rise to 0 C Droplets of water appears and listen for sound of water.
- #28 The physical appearance of the vaccine may remain unchanged even after it is damaged which is permanent. Evidence suggests that freezing could occur at any level and the vaccine handlers should take precautionary steps to prevent vaccine freezing and discard vaccines that are damaged due to freezing
- #30 Alcohol stem thermometer, Electronic data logger (30DTR – 30 days temperature recorder), Fridge indicator, Freeze indicator,Temperature logbook, VVM.
- #31 Vaccines need to be checked both for damage from excessive heat as well as from freezing. However, the physical appearance of a vaccine may remain unchanged even after it is damaged.