Cold Chain Management - PAHOThe cold chain • The cold chain is the system used for keeping and...

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Cold Chain Management Cold Chain Management

Transcript of Cold Chain Management - PAHOThe cold chain • The cold chain is the system used for keeping and...

Page 1: Cold Chain Management - PAHOThe cold chain • The cold chain is the system used for keeping and distributing vaccines and other Biologicalsin good conditions. • It consists of a

Cold Chain ManagementCold Chain Management

Page 2: Cold Chain Management - PAHOThe cold chain • The cold chain is the system used for keeping and distributing vaccines and other Biologicalsin good conditions. • It consists of a

IntroductionIntroduction•• The cold chainThe cold chain

–– DefinitionDefinition–– Cold chain equipmentCold chain equipment–– Monitoring a cold chainMonitoring a cold chain–– How to freeze icepacksHow to freeze icepacks–– Maintenance of the cold chainMaintenance of the cold chain

Page 3: Cold Chain Management - PAHOThe cold chain • The cold chain is the system used for keeping and distributing vaccines and other Biologicalsin good conditions. • It consists of a

The cold chainThe cold chain•• The cold chain is the system used for keeping The cold chain is the system used for keeping

and distributing vaccines and other and distributing vaccines and other Biologicalsin good conditions.Biologicalsin good conditions.

•• It consists of a series of storage and transport It consists of a series of storage and transport links, all designed to keep vaccines within an links, all designed to keep vaccines within an acceptable range until it reaches the user.acceptable range until it reaches the user.

•• Vaccines are sensitive to heat and freezing and Vaccines are sensitive to heat and freezing and must be kept at the correct temperature from must be kept at the correct temperature from the time they are manufactured until they are the time they are manufactured until they are used.used.

Page 4: Cold Chain Management - PAHOThe cold chain • The cold chain is the system used for keeping and distributing vaccines and other Biologicalsin good conditions. • It consists of a

The cold chain (cont)The cold chain (cont)

Page 5: Cold Chain Management - PAHOThe cold chain • The cold chain is the system used for keeping and distributing vaccines and other Biologicalsin good conditions. • It consists of a

The cold chain equipmentThe cold chain equipmentDifferent levels within the health care system Different levels within the health care system

need different equipment for transporting and need different equipment for transporting and storing vaccines and diluents at the correct storing vaccines and diluents at the correct temperaturetemperature

•• Primary vaccine stores: Primary vaccine stores: need cold or freezers need cold or freezers rooms, freezers, refrigerators, cold boxes and rooms, freezers, refrigerators, cold boxes and sometimes refrigerator trucks for sometimes refrigerator trucks for transportationtransportation

•• Intermediate vaccine stores: Intermediate vaccine stores: depending on their depending on their size and capacity need cold and freezer rooms, size and capacity need cold and freezer rooms, and/or freezers , refrigerators and cold boxesand/or freezers , refrigerators and cold boxes

Page 6: Cold Chain Management - PAHOThe cold chain • The cold chain is the system used for keeping and distributing vaccines and other Biologicalsin good conditions. • It consists of a

The cold chain equipment (cont)The cold chain equipment (cont)•• Health facilities: Health facilities: need refrigerators with need refrigerators with

freezing compartments, cold boxes and vaccine freezing compartments, cold boxes and vaccine carrierscarriers

Selecting a refrigerator and / or a FreezerSelecting a refrigerator and / or a Freezer•• Compression Models:Compression Models:

–– Powered by electricityPowered by electricity–– Cooling capacities 4 times better than Cooling capacities 4 times better than

absorption modesabsorption modes–– Most reliableMost reliable–– Safest and easiest to maintainSafest and easiest to maintain–– If electricity available = best choiceIf electricity available = best choice

Page 7: Cold Chain Management - PAHOThe cold chain • The cold chain is the system used for keeping and distributing vaccines and other Biologicalsin good conditions. • It consists of a

Cold chain equipment (cont)Cold chain equipment (cont)–– Where electricity or fuel supply is not Where electricity or fuel supply is not

reliable, icereliable, ice--lined refrigerators can maintain lined refrigerators can maintain appropriate temperature for 16 hours appropriate temperature for 16 hours without power if they operate with power without power if they operate with power continuously for at least 8 hours a daycontinuously for at least 8 hours a day

•• Absorption modelsAbsorption models–– Working on gas or keroseneWorking on gas or kerosene–– Less performingLess performing–– Need constant attention, more maintenance Need constant attention, more maintenance

is neededis needed–– If available, prefer the gas model If available, prefer the gas model

Page 8: Cold Chain Management - PAHOThe cold chain • The cold chain is the system used for keeping and distributing vaccines and other Biologicalsin good conditions. • It consists of a

Cold Chain equipment (cont)Cold Chain equipment (cont)•• Solar models: Solar models:

–– Batteries maintenanceBatteries maintenance–– Less performingLess performing–– Small capacitiesSmall capacities–– Not ideal for campaignsNot ideal for campaigns–– But: New technologies under developmentBut: New technologies under development

Page 9: Cold Chain Management - PAHOThe cold chain • The cold chain is the system used for keeping and distributing vaccines and other Biologicalsin good conditions. • It consists of a

RefrigeratorsRefrigerators--FreezersFreezers-- capacitiescapacitiesBrand Model Negative Volume

(liters)Positive Volume (liters)

Sibir V110 17

Sibir V170 36 55

Vestfrost MF114 72

Vestfrost MF214 192

Vestfrost MF304 172

Vestfrost MF314 264

Vestfrost MK074 20

Vestfrost MK144 45

Vestfrost MK204 63

Vestfrost MK304 100

Electrolux TFW791 50

Electrolux TFW800 144

Page 10: Cold Chain Management - PAHOThe cold chain • The cold chain is the system used for keeping and distributing vaccines and other Biologicalsin good conditions. • It consists of a

Cold BoxesCold Boxes•• Isotherm container which is lined with frozen Isotherm container which is lined with frozen

icepacks to keep large quantities of vaccines icepacks to keep large quantities of vaccines between 2between 2°°C C --88°°C for several daysC for several days

•• The most common is ELECTROLUX RCW25The most common is ELECTROLUX RCW25–– Vaccine storage capacity: 20.7 liters (=7000 Vaccine storage capacity: 20.7 liters (=7000

doses of measles vaccine)doses of measles vaccine)–– Cold life without opening at 43Cold life without opening at 43°°C: 129 C: 129

hourshours•• Can be used for vaccine storage at peripheral Can be used for vaccine storage at peripheral

level when no refrigerator on the condition of level when no refrigerator on the condition of renewing regularly the icepacksrenewing regularly the icepacks

Page 11: Cold Chain Management - PAHOThe cold chain • The cold chain is the system used for keeping and distributing vaccines and other Biologicalsin good conditions. • It consists of a

Vaccine carriersVaccine carriers•• Isotherm container which is lined with frozen Isotherm container which is lined with frozen

icepacks to keep small quantities of vaccines icepacks to keep small quantities of vaccines between 2between 2°°CC--88°°C for 24 to 72 hoursC for 24 to 72 hours

•• Used for vaccination sessions and short Used for vaccination sessions and short journeysjourneys

•• Cold life without opening at 43Cold life without opening at 43°°C external C external temperature varies from 24 to 32 hours temperature varies from 24 to 32 hours depending the modeldepending the model

Page 12: Cold Chain Management - PAHOThe cold chain • The cold chain is the system used for keeping and distributing vaccines and other Biologicalsin good conditions. • It consists of a

Cold chain monitoring equipmentCold chain monitoring equipment•• The purpose of cold chain monitoring The purpose of cold chain monitoring

equipment is to keep track of the temperature equipment is to keep track of the temperature to which vaccines and diluents are exposed to which vaccines and diluents are exposed during transportation and storageduring transportation and storage

•• The different monitors are:The different monitors are:–– Vaccine vial monitorsVaccine vial monitors–– Vaccine cold chain monitor cardVaccine cold chain monitor card–– ThermometersThermometers–– Freeze indicatorsFreeze indicators

Page 13: Cold Chain Management - PAHOThe cold chain • The cold chain is the system used for keeping and distributing vaccines and other Biologicalsin good conditions. • It consists of a

Vaccine Vials Monitors (VVM)Vaccine Vials Monitors (VVM)•• VVM on vial label or capVVM on vial label or cap

Page 14: Cold Chain Management - PAHOThe cold chain • The cold chain is the system used for keeping and distributing vaccines and other Biologicalsin good conditions. • It consists of a

VVM (cont)VVM (cont)

•• Use only vials with inner squares that are Use only vials with inner squares that are lighter in color than the outside circlelighter in color than the outside circle

•• Vials with VVMs in which the inner square has Vials with VVMs in which the inner square has begun to darken but is still lighter than the begun to darken but is still lighter than the outer circle should be used before the vials with outer circle should be used before the vials with a lighter inner square a lighter inner square

!!! VVM do not measure exposure to freezing !!! VVM do not measure exposure to freezing temperatures (for freeze sensitive vaccines)temperatures (for freeze sensitive vaccines)

Page 15: Cold Chain Management - PAHOThe cold chain • The cold chain is the system used for keeping and distributing vaccines and other Biologicalsin good conditions. • It consists of a

VVM (cont)VVM (cont)•• How to read a vaccine vial monitor (VVM)How to read a vaccine vial monitor (VVM)

Page 16: Cold Chain Management - PAHOThe cold chain • The cold chain is the system used for keeping and distributing vaccines and other Biologicalsin good conditions. • It consists of a

Vaccine Cold Chain Monitor CardVaccine Cold Chain Monitor Card•• A vaccine cold chain monitor is a card with an A vaccine cold chain monitor is a card with an

indicator strip that changes color when the indicator strip that changes color when the vaccines are exposed to temperatures too high. vaccines are exposed to temperatures too high.

•• The vaccine cold chain card is used to estimate The vaccine cold chain card is used to estimate the length of time that vaccine has been the length of time that vaccine has been exposed to high temperaturesexposed to high temperatures

•• Manufacturers pack these monitors with Manufacturers pack these monitors with vaccines supplied by WHO and UNICEFvaccines supplied by WHO and UNICEF

•• Usually used for large shipments of vaccinesUsually used for large shipments of vaccines•• Same card should remain with same batchSame card should remain with same batch•• Change of color is cumulativeChange of color is cumulative

Page 17: Cold Chain Management - PAHOThe cold chain • The cold chain is the system used for keeping and distributing vaccines and other Biologicalsin good conditions. • It consists of a

Monitor card (cont) Monitor card (cont)

Page 18: Cold Chain Management - PAHOThe cold chain • The cold chain is the system used for keeping and distributing vaccines and other Biologicalsin good conditions. • It consists of a

ThermometersThermometers•• Used to monitor temperatures of refrigerators Used to monitor temperatures of refrigerators

and /or cold boxesand /or cold boxes•• Dial thermometers tend to loose their accuracy Dial thermometers tend to loose their accuracy

over time. They can be re calibrated over time. They can be re calibrated •• (facility screw to be adjusted)(facility screw to be adjusted)

Page 19: Cold Chain Management - PAHOThe cold chain • The cold chain is the system used for keeping and distributing vaccines and other Biologicalsin good conditions. • It consists of a

Freeze indicatorsFreeze indicators•• Freeze watchFreeze watch

•• Irreversible temperature indicator which shows Irreversible temperature indicator which shows if a product, such as vaccine, has been exposed if a product, such as vaccine, has been exposed to freezing temperatures . If exposed to to freezing temperatures . If exposed to temperatures below 0temperatures below 0°°C for more than 1 hour C for more than 1 hour the vial releases the colored liquidthe vial releases the colored liquid

Page 20: Cold Chain Management - PAHOThe cold chain • The cold chain is the system used for keeping and distributing vaccines and other Biologicalsin good conditions. • It consists of a

Freeze indicators (cont)Freeze indicators (cont)•• Freeze Tag : electronic temperature measuring Freeze Tag : electronic temperature measuring

circuit with LCD display. If indicator exposed circuit with LCD display. If indicator exposed to temperatures below 0to temperatures below 0°°C for more than 1 C for more than 1 hour the display changes to hour the display changes to ““alarmalarm””

•• See the shake test below See the shake test below

Page 21: Cold Chain Management - PAHOThe cold chain • The cold chain is the system used for keeping and distributing vaccines and other Biologicalsin good conditions. • It consists of a

How to freeze Ice PacksHow to freeze Ice Packs•• IceIce--packs are flat, square plastic bottles that are packs are flat, square plastic bottles that are

filled with water and frozen. filled with water and frozen. •• They are used to keep vaccines cool inside the They are used to keep vaccines cool inside the

vaccine carrier or cold box.vaccine carrier or cold box.

Page 22: Cold Chain Management - PAHOThe cold chain • The cold chain is the system used for keeping and distributing vaccines and other Biologicalsin good conditions. • It consists of a

How to freeze IceHow to freeze Ice--Packs (cont)Packs (cont)

•• The proper freezing and use of iceThe proper freezing and use of ice--packs is essential packs is essential for good quality of the vaccinesfor good quality of the vaccines

•• Make sure that the size and number of iceMake sure that the size and number of ice--packs packs correspond to the cold boxes and vaccines carrierscorrespond to the cold boxes and vaccines carriers

•• To freeze an IceTo freeze an Ice--PackPack–– Fill with water leaving a little air space at the topFill with water leaving a little air space at the top–– Hold each iceHold each ice--pack upside down and squeeze it to pack upside down and squeeze it to

make sure it does not leakmake sure it does not leak–– Put IcePut Ice--packs upright on their sides in the freezerpacks upright on their sides in the freezer–– Let the air circulate in between the iceLet the air circulate in between the ice--packspacks

Page 23: Cold Chain Management - PAHOThe cold chain • The cold chain is the system used for keeping and distributing vaccines and other Biologicalsin good conditions. • It consists of a

Freezing IceFreezing Ice--packspacks•• It take time (24 hours) to freeze an IceIt take time (24 hours) to freeze an Ice--packpack•• Gas refrigerators or iceGas refrigerators or ice--lined refrigerators with lined refrigerators with

a freezing compartment can freeze up to 6 large a freezing compartment can freeze up to 6 large (0,6 liter) or 12small ice(0,6 liter) or 12small ice--packs per day. More packs per day. More packs will take longer to freezepacks will take longer to freeze

•• TIP: good to keep unfrozen icepacks in the TIP: good to keep unfrozen icepacks in the bottom of the refrigerator compartment, it will bottom of the refrigerator compartment, it will keep this section cold in case of power failure keep this section cold in case of power failure and when you put them in the freezer they will and when you put them in the freezer they will freeze more quickly as the water inside is cold freeze more quickly as the water inside is cold

Page 24: Cold Chain Management - PAHOThe cold chain • The cold chain is the system used for keeping and distributing vaccines and other Biologicalsin good conditions. • It consists of a

Freezing iceFreezing ice--packs (cont)packs (cont)

Brand Model Freezing capacity

Number small ice-packs (0,3 liter)

Storage capacity (in liters)

Vestfrost MF114 17,5 kg/24H 58 72Vestfrost MF214 22,3 kg/24H 74 192Vestfrost MF314 32,4 kg/24H 108 246Sibir V170 1,2 kg/24H 3 36

Page 25: Cold Chain Management - PAHOThe cold chain • The cold chain is the system used for keeping and distributing vaccines and other Biologicalsin good conditions. • It consists of a

Freezing IceFreezing Ice--packspacks

•• Never fill a Freezer completely with unfrozen Never fill a Freezer completely with unfrozen IceIce--Packs at one time, it will take too long to Packs at one time, it will take too long to freeze and the compressor will suffer.freeze and the compressor will suffer.

•• The best option is to put one row every 24 The best option is to put one row every 24 hours and to leave some space in order to keep hours and to leave some space in order to keep a good ventilationa good ventilation

•• Start freezing iceStart freezing ice--packs as soon as possiblepacks as soon as possible

Page 26: Cold Chain Management - PAHOThe cold chain • The cold chain is the system used for keeping and distributing vaccines and other Biologicalsin good conditions. • It consists of a

How to maintain cold chain equipmentHow to maintain cold chain equipment•• Vaccine refrigerators:Vaccine refrigerators:

–– A refrigerator works well only if it is properly A refrigerator works well only if it is properly installed, cleaned and defrosted regularly.installed, cleaned and defrosted regularly.

–– Thick ice in the freezer compartment does not Thick ice in the freezer compartment does not keep the refrigerator cool, it makes the keep the refrigerator cool, it makes the refrigerator work harder and use more power, refrigerator work harder and use more power, gas or kerosene. gas or kerosene.

–– You should DEFROST the refrigerator when the You should DEFROST the refrigerator when the ice becomes more than 0,5 cm thick or once a ice becomes more than 0,5 cm thick or once a month. month.

Page 27: Cold Chain Management - PAHOThe cold chain • The cold chain is the system used for keeping and distributing vaccines and other Biologicalsin good conditions. • It consists of a

How to defrost and clean a How to defrost and clean a refrigeratorrefrigerator

•• Take out all the most heat sensitive vaccines (OPV, Take out all the most heat sensitive vaccines (OPV, measles, BCG, yellow fever) and transfer them to a measles, BCG, yellow fever) and transfer them to a cold box lined with cold box lined with frozen frozen iceice--packspacks

•• Take out all the freeze sensitive vaccines (DTP, DT, Take out all the freeze sensitive vaccines (DTP, DT, Td, hepatitis B, ) and diluents, and transfer them to Td, hepatitis B, ) and diluents, and transfer them to a cold box lined with a cold box lined with conditioned conditioned iceice--packspacks

•• Turn off the power supply to the refrigeratorTurn off the power supply to the refrigerator•• Leave de door open and wait for the ice to meltLeave de door open and wait for the ice to melt•• Clean the inside and the door seal with a clean wet Clean the inside and the door seal with a clean wet

cloth and turn the refrigerator on again.cloth and turn the refrigerator on again.

Page 28: Cold Chain Management - PAHOThe cold chain • The cold chain is the system used for keeping and distributing vaccines and other Biologicalsin good conditions. • It consists of a

How to defrost and clean a How to defrost and clean a refrigeratorrefrigerator

•• When the inside temperature in the main section When the inside temperature in the main section falls to 2falls to 2°°CC-- 88°°C return the vaccines, diluents C return the vaccines, diluents and ice packs in appropriate places.and ice packs in appropriate places.

•• TIP: If you need to defrost your refrigerator more TIP: If you need to defrost your refrigerator more than once a month, it could be because:than once a month, it could be because:–– Opening it too much (more 3 x/day)Opening it too much (more 3 x/day)–– The door not closing properlyThe door not closing properly–– the seal of the door needs to be replacedthe seal of the door needs to be replaced–– If breakdown of refrigerator: THINK TO If breakdown of refrigerator: THINK TO

PROTECT VACCINES FIRST !!! PROTECT VACCINES FIRST !!!

Page 29: Cold Chain Management - PAHOThe cold chain • The cold chain is the system used for keeping and distributing vaccines and other Biologicalsin good conditions. • It consists of a

Maintaining cold boxes and vac. carriersMaintaining cold boxes and vac. carriers

•• Must be dried after their useMust be dried after their use•• If left wet with closed lids, they become moldy If left wet with closed lids, they become moldy

and the seal will be affectedand the seal will be affected•• Store them with the lid open when not used, if Store them with the lid open when not used, if

possiblepossible•• DonDon’’t store them outside under the sunlight, it t store them outside under the sunlight, it

can cause cracks and reduce the efficiency of can cause cracks and reduce the efficiency of the cold box the cold box

Page 30: Cold Chain Management - PAHOThe cold chain • The cold chain is the system used for keeping and distributing vaccines and other Biologicalsin good conditions. • It consists of a

The Shake testThe Shake test•• Used to know if freeze sensitive vaccines have Used to know if freeze sensitive vaccines have

been subjected to freezing temperatures that been subjected to freezing temperatures that have damaged them.have damaged them.

•• After freezing, the vaccine no longer After freezing, the vaccine no longer appearance of HOMOGENOUS cloudy liquid appearance of HOMOGENOUS cloudy liquid but tend to form flakes which settle at the but tend to form flakes which settle at the bottom of the vial after shakingbottom of the vial after shaking

•• Sedimentation is faster in a vial which has been Sedimentation is faster in a vial which has been frozen than in a vial (from same manufactured) frozen than in a vial (from same manufactured) which has not been frozen. which has not been frozen.

Page 31: Cold Chain Management - PAHOThe cold chain • The cold chain is the system used for keeping and distributing vaccines and other Biologicalsin good conditions. • It consists of a

The Shake testThe Shake test•• How to do the SHAKE test:How to do the SHAKE test:

–– 1. Prepare a frozen control sample1. Prepare a frozen control sample•• Take sample same batch same manufacturerTake sample same batch same manufacturer•• Make it freeze, min 10 hours at Make it freeze, min 10 hours at --1010°°CC•• Then let it thawThen let it thaw•• This will be the This will be the CONTROL SAMPLECONTROL SAMPLE•• Mark the vial clearlyMark the vial clearly

–– 2. Choose a test sample2. Choose a test sample•• Take a vial from the batch you suspect has been Take a vial from the batch you suspect has been

frozen this will be the frozen this will be the TEST SAMPLETEST SAMPLE

Page 32: Cold Chain Management - PAHOThe cold chain • The cold chain is the system used for keeping and distributing vaccines and other Biologicalsin good conditions. • It consists of a

The Shake testThe Shake test•• 3. Shake the CONTROL and TEST samples3. Shake the CONTROL and TEST samples

–– Shake them in the same hand for 10Shake them in the same hand for 10--15 seconds15 seconds•• 4. Allow to rest 4. Allow to rest •• 5. Compare the vials5. Compare the vials

–– View both vials against the light to compare the View both vials against the light to compare the SEDIMENTATION rateSEDIMENTATION rate

•• If test sample shows MUCH LESS sedimentation than If test sample shows MUCH LESS sedimentation than the control then it has not been frozen and OKthe control then it has not been frozen and OK

•• If same sedimentation NOT TO BE USED, then all the If same sedimentation NOT TO BE USED, then all the vials need to be tested vials need to be tested

Page 33: Cold Chain Management - PAHOThe cold chain • The cold chain is the system used for keeping and distributing vaccines and other Biologicalsin good conditions. • It consists of a

The Shake testThe Shake test

Page 34: Cold Chain Management - PAHOThe cold chain • The cold chain is the system used for keeping and distributing vaccines and other Biologicalsin good conditions. • It consists of a

Heat sensitivityHeat sensitivity

Page 35: Cold Chain Management - PAHOThe cold chain • The cold chain is the system used for keeping and distributing vaccines and other Biologicalsin good conditions. • It consists of a

Freeze sensitivityFreeze sensitivity

Page 36: Cold Chain Management - PAHOThe cold chain • The cold chain is the system used for keeping and distributing vaccines and other Biologicalsin good conditions. • It consists of a

Light sensitivityLight sensitivity•• Some vaccines are very sensitive to strong light and Some vaccines are very sensitive to strong light and

their exposure to ultraviolet light causes loss of their exposure to ultraviolet light causes loss of potency. potency.

•• These vaccines need ALWAYS to be protected from These vaccines need ALWAYS to be protected from sunlightsunlight–– BCG, measles, MR, MMR and rubellaBCG, measles, MR, MMR and rubella

IT IS VERY IMPORTANT: IT IS VERY IMPORTANT: Measles efficiency of the vaccines = 85%Measles efficiency of the vaccines = 85%This is why you need >95% coverage to stop the This is why you need >95% coverage to stop the

spread. If coverage 75%, children protected only spread. If coverage 75%, children protected only 63%. If efficiency only 65 % and coverage 95%, 63%. If efficiency only 65 % and coverage 95%, children protected 61 %, not enough children protected 61 %, not enough

Page 37: Cold Chain Management - PAHOThe cold chain • The cold chain is the system used for keeping and distributing vaccines and other Biologicalsin good conditions. • It consists of a