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1. By – SURESH KUMAR ( Nursing Tutor )
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2. COLD CHAIN
“cold chain” is a system to maintain
vaccine quality from the time of
manufacture until the point of
administration by ensuring that
vaccines are stored and transported
within the recommended
temperature ranges.

3. COLD CHAIN
The system used for storing vaccines in good
condition is called the cold chain. It is sometimes
referred to as the vaccine supply chain, or the
immunization supply chain. The cold chain consists of
a series of links that are designed to keep vaccines
within the recommended temperature ranges, from
the point of manufacture to the point of
administration

4. COLD CHAIN

5. Why cold chain?
Excessive heat or cold exposure damages vaccine,
resulting in loss of potency. Once potency is lost, it
can never be restored. Furthermore, each time
vaccine is exposed to heat or cold, the loss of potency
increases and eventually, if the cold chain is not
correctly maintained, all potency will be lost, and the
vaccine becomes useless.

7. Essential elements:
Cold chain
Personnel to manage vaccine distribution
Equipment for vaccine storage & transport
Maintenance of equipment
Monitoring

8. Personnel to manage
vaccine distribution
There should be a designated and trained
personnel (cold chain handler) in handling cold
chain and distribution of vaccines at all levels
including center, state, district and all health
facilities of cold chain equipment and vaccine
distribution .

9. Equipment for vaccine
storage & transport
Cold chain equipments includes-
Walk in coolers
Deep freezer
Ice-Lined Refrigerator (ILR)
Cold Box
Refrigerator
Vaccine carrier
Ice pack

10. Walk-in coolers
These are big equipments of cold
chain system like a room. These
are used at regional level vaccine
storage system. Temperature
range 0-25 degree can be
maintained in these coolers. These
are also known as walk in cold
rooms.

11. Deep freezer
Deep freezer is used at district
and CHC level. A temperature
range of -20 to 25 degree can
be maintained in deep
freezers. It is used to store
polio vaccine and to freeze ice
packs.

12. Ice lined refrigerator
Ice lined refrigerator (ILR) is
used at approximately all the
vaccine storage facilities. A
temperature range of 2-8
degree in maintained in ILR.

13. Cold Box
It is a thermo-insulator box
which is used to transport
vaccines. freezed ice packs are
placed at bottom, sides and top
of vaccines to be transported
inside the cod box.

14. Refrigerator
It is a simple refrigerator and
used at PHC or sub-center level
to maintain cold chain for
vaccines. WHO recommended
refrigerator is slightly different
form domestic refrigerator.

15. Vaccine carrier
It is also a thermo-insulator box
having strips to carry at the
point of vaccination. 4 ice packs
are kept inside to maintain
recommended temperature to
vaccines.

16. Ice packs
It is plastic box which is filled
with water and freezed in deep
freezer. After freezing these are
used in cold boxes and vaccine
carriers to keep vaccines cold.

17. Maintenance of cold
chain equipments
All cold chain equipments should be well
maintained. They should have dedicated switch
board for electrical supply.Cold chain handler
should take care to defrost the electrical
equipments (deep fridge, ILR and refrigerator )
regularly as and when needed. Do not let ice
deposition more than 0.5 cm thick

18. Defrosting of cold
chain equipments
Remove all the vaccines and transfer them to another
refrigerator or to a cold box or vaccine carrier lined with
conditioned ice packs.
Switch off the electrical supply for the ILR/refrigerator.
Leave the door open and wait for the ice to melt. Never try
to remove the ice with a knife or ice pick; this can
permanently damage the ILR/refrigerator. A pan of boiling
water can be placed inside and the door closed.

19. Defrosting of cold
chain equipments
Clean the inside of the ILR/refrigerator and door
seal with a clean damp cloth.
Re-start the ILR/refrigerator. Do not adjust the
thermostat.
When the temperature in the main section falls to
+8 °C or lower (but not less than +2 °C), arrange the
vaccines, diluents and water packs in their
appropriate places.

20. Conditioning of Ice Packs
Frozen ice packs, taken directly from the freezer, are not
suitable for immediate use. If they are not correctly
conditioned it is very likely that freeze-sensitive vaccines will
be frozen and destroyed.
Lay the frozen ice packs on a work surface in a single layer
leaving gaps of about 5 cm between packs.
Wait until all packs are properly conditioned – there must
be liquid water inside every pack and the ice-cores should
move inside the packs when shaken

22. Packing vaccines in
cold boxes and vaccine carriers
Arrange the conditioned ice packs or cool water
packs in the cold boxes and/or vaccine carriers
exactly as shown on the manufacturer’s instructions
on the inside of the lid.
Put the vaccines and diluents in a plastic bag in the
middle of the cold box or carrier to protect them
from damage due to condensation.

23. Packing vaccines in
cold boxes and vaccine carriers
If conditioned ice packs are used, put an
electronic freeze indicator with the vaccines.
For vaccine carriers, place the foam pad in the
top of the container.
Close the cold box or vaccine carrier lid tightly.

24. Arranging cold Box arranging vaccine carrier

25. Monitoring
Monitoring of temperature is very important in cold
chain management. A temperature monitoring
chart should be maintained at every cold chain
facility by cold chain handler. Temperatrue should
be monitored and recorded at leaset two times a
day

27. Temperature monitoring
devices.

28. By – SURESH KUMAR ( Nursing Tutor )
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