Cold chain is defined as the series of actions and equipment applied to maintain a product within a specified low-temperature range from harvest/production to consumption.

1. COLD CHAIN
DR.ANJALATCHI MUTHUKUMARAN
VICE PRINCIPAL
ERA COLLEGE OF NURSING
ERA UNIVERSITY

2. INTRODUCTION
 Cold chain is the system used for storing vaccine in good
condition. It is otherwise called a vaccine supply chain or
immunization supply chain. It is a series of links that are
designed to keep vaccines with WHO-recommended Temperature
Ranges from the point of manufacture to the point of
immunization. The cold chain system is necessary because
vaccine failure may occur due to failure to store and transport
under the strict temperature.
 The term supply chain management was first coined by Keith
Oliver.

3. DEFINITION
The “Cold Chain” is a system
of storage and transport of
vaccine at low temperature
from the manufacturer to actual
vaccination site

5. COLD CHAIN
• System of storage & transport of vaccines at low temp. from
the manufacturer to the actual vaccination site.
Manufacturer
Airpor
t State/Region
District
store Health centre
Outreach
Subcentre

6. IMPORTANCE OF COLD
CHAIN
 Obtaining the vaccine from
manufacturers.
 Storing and transporting the vaccine
 Maintaining the supply of vaccine
 Having information about essential
equipments ,supply of electricity etc
 Keeping the vaccine at low temperature
 Protecting the vaccine from sunlight
exposure

7. TRANSPORT AND STORAGE
For successful Cold chain system, three elements are essential:
 Personnel: To manage vaccine storage and Distribution.
 Equipments: To store and Transport vaccine and to monitor
temperature.
 Procedures: To ensure the vaccines are stored and transport at
appropriate temperature.
 All the vaccine must be stored, transported and distributed at
the recommend temperature by the manufacturer in the
literature accompanying the vaccine , otherwise they may
become denatured and totally in effective with loss of potency

8. CONT….
 Among all vaccine , polio is the most heat sensitive,
requiring storage at 20.C
 Polio and measles vaccines must be stored in the
freezer comportment
 TPD, DT, TT, BCG Typhoid and diluents of vaccines
must be stored in the cold part and never allow to
freeze
 Vaccine must be protected from sunlight and contact
of antiseptic

9. COLD CHAIN
EQUIPMENTS
 Walk in cold room : they are
located at regional level , meant to
store vaccines up to three months
and serve 4-5 district.

10. Walk-in-Freezers
(WIF)
 Installed in all of the states and larger divisional head
quarters.
 They maintain a temperature around -20°C.
 bulk storage of OPV, and also to prepare frozen ice packs
at state stores.
Available in
sizes of 16.5 Cum.
and 32 Cum.

11. Deep Freezers: supplied to all districts and PHC to store vaccines
the cabinet temperature is maintained between 15.C -25.C in case of
power failure , these freezers can maintain the cabinet temperature
for 18-22 hours. Deep
Freezer are used polio and measles vaccines. 300ltr - 140ltr
for making ice packs and for storing capacity available in
deep freezer.

12. CONT…
Ice lined refrigerator: -
 ILR are kept at the PHC and district level. The cabinet temperature is maintain at
+2.C to +8.C at the PHC level, ILR are used for storing all UIP Vaccines.
 The bottom of ILR is the coldest part. DPT, DT, TT and diluents should not be kept
directly on the floor of the ILR as they can freeze and get denatured. These vaccines
should be kept in the basket provided within the ILR.
 Temperature of the ILR should be recorded twice a day with the dial thermometer
which should be kept inside the ILR, even if there is an in built thermometer.

14. CONT…
There are some DOs and DONTs for the use of ILR
freezer.
 DOs: keep the equipment in cool room away from
direct sunlight and at least 10cms away from the
walls. The vaccine should be kept inside the ILR
neatly with the space in between for air circulation.
The ILR should be kept locked and open only when
necessary.
 DONTs: do not kept any object on the deep freezer or
ILR. Never store any other Drugs. Drinking water,
foods or date expired vaccines or more then 1 month
requirement at PHCs level and don’t open these
equipment unless required.

15. CONT..
Cold Boxes:
 cold boxes are available at all peripheral health
centers. They are used for transporting vaccines and
also for storing vaccines during failure of electric
supply. Fully frozen ice packs are placed at the
bottom and sides of the cold box before placing the
vaccines in it. The vaccines should be first packed in
cartoons or polythene bags then to be kept inside the
cold box. DPT, DT, TT vaccines and diluents should
not be kept in direct contract with the frozen ice
packs.

16. COLD BOXES

17. CONT…
Vaccines carrier :
 vaccines carrier are used to carry 16 to 20
vials of vaccines to out Reach sites to the Sub
centers, village vaccination clinics or camp.
Four fully frozen ice packs are placed for
lining the sides of the carriers DPT, DT,TT
and diluents should not be placed in direct
contract of frozen ice packs. The carrier must
be closed tightly. 4 ice packs cantains in the
vaccine carriers.

18. VACCINE CARRIER

19. CONT..
Day Carriers:
 Day carriers are used for nearby areas and only for
few hours period with two fully frozen ice packs. It is
used to carry small quantities of Vaccines, e.g. 6 to 8
vials only.

20. CONT…
Ice Packs:
 Ice packs are used for cold boxes and vaccines
Carriers. it is prepared in the deep freezer. Ice
Pack Contain water, filed up to the level
market on the side. No salt is added to it leak
ice pack should not be used.

21. CORRECT STORAGE
AND USE OF DILUENTS
 Only use the diluents supplied and
packaged by the manufacturer with the
vaccine since the diluents is specially
designed for the needs of that vaccine, with
respect to volume, PH level and chemical
properties.
 Store the diluents between +20C to +80C in
the ILR. If there are store the diluents
between +20C to +80C in the ILR.

22. CONT…
 If there are constants of space, than store diluents
outside the cold chain. However, remember to cool
diluents for at least 24 hours before use to ensure that
vaccine and diluents are at 20C to 8oC when being
reconstituted. Otherwise, it can lead to thermal shock
i.e the death of some or all the essential live
organisms in the vaccine.
 Store the Diluents and droppers with the vaccines in
the vaccine carriers during transportation .Diluents
should not come in direct contact with the ice pack.

23. MONITOR AND CONTROL OF
TEMPERATURE:-
Should be a Routine Activity.
At the start and end of each working day
Monitoring devices include:
 Thermometers.
 Temperature record sheets.
 Refrigerator and freezer thermostat.
 Cold chain monitoring card (CCM)
 Vaccine vial monitoring(VVM)
 Freeze watch indicator.

24. CONT…
 Thermometer: every piece of cold chain should be fitted with a thermometer.
 Different types may be used, commonly mercury thermometer. i.e Dial
thermometer ,Stem thermometer
 Temperature record sheets: Record temperature of refrigerator or freezer.
 Twice Daily: in the morning and afternoon. Any malfunction then should be
reported.
 Refrigerator or Freeze thermostat: Used to control storage Temperature.
 Thermostat is set to suitable temperature.

28. VACCINE VIAL MONITOR(VVM)
A VVM is a label containing a heat – sensitive material
which is Placed on a vaccine vial to register
cumulative heat exposure over time .
 Reading the stage of the VVM:-
 Stage 2: The inner square is lighter then the outer
Circle. if the expiry date has not been passed :use the
vaccine
 Stage 2: The inner square is still lighter than the
outer Circle. if the expiry date has not been passed
:use the vaccine

29. CONT…
Discard Point :
 Stage 3: The color of the inner square matches that of
the outer circle : Don’t use the vaccine
Beyond the discard point
 Stage 4: The color of the inner square is darker than
the outer Circle. Don’t use the Vaccine.
 The VVM does not directly measure vaccine potency
but gives information about the main factor that
affects potency i.e Heat exposure over a period of
time.

30. USABLE A N D UNUSABLE STAGES OF
VVM

32. THANK
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