Cold Chain – An Overview
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Cold Chain is a system of
transporting and storing
vaccines at recommended
temperature from the point of
manufacture to the point of
use
Definition
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Essential Elements of Cold Chain
PERSONNEL to organize and
manage vaccine distribution
EQUIPMENT for storage and
transport of vaccines.
Transport facilities
Maintenance of equipment
Monitoring3www.drjayeshpatidar.blogspot.in
In general
• All Vaccines tend to lose potency
on exposure to heat above +80 C
• Some Vaccines lose potency when
exposed to freezing temperatures
• The damage is irreversible
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OPV
Measles
BCG
Vaccines sensitive to heat
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Hep- B
DPT
DT
TT
Vaccines sensitive to freezing
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Ice lined refridgerators (ILRs)
•Capacity: 140 litres at PHC level(1200 vials)
•Ideal Temperature: +2 C to 8 C
(Effective with electricity supply of 8/24 hrs)
•Safe Storage: Always in the basket section
(Always T series, Hepatitis-B and Diluents)
(OPV/Measles/BCG may be kept below basket in case space is not available)
•Thermometer: Place in the ILR-basket
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Right way of keeping vaccines
in ILR
• Keep all vaccines in baskets
• Place a thermometer in the center of the ILR.
• Avoid placing vaccines at bottom of ILR. (never diluents, freeze sensitive)
• Leave space between the vaccine boxes
• Same vaccines in same area.
• Diluent / freeze sensitive/ Closer expiry date vaccines on top
• Heat sensitive / Further expiry date vaccines in the bottom of basket
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Deep freezers (DF)
• Capacity: 140 litres at PHC level
• Ideal Temperature: -18 C to -20 C
(In case of power failure - maintain
temperature for 18-20 hrs)
• Ice Pack Freezing Capacity:
freezes 20 ice packs every 24 hours.
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Cold Boxes
• Type: Insulated boxes of 5 litre capacity
• Usage: Stores & transports vaccine. Also stores frozen Ice Packs
• Capacity: 1500 doses (mixed antigen) or 5000 doses (only OPV) with 24 ice packs.
• Holdover Time:3 days (Keep thermometer inside)
• Vaccine Layout: Direct contact of frozen Ice packs spoil the vaccine. Give carton spacers/surround vaccine by OPV vials.
• Label Protection: Place vaccine in cartons or polythene bags.
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Vaccine Carrier
• Type: Insulated boxes used for carrying small
quantities of vaccine.
• Capacity: 16-20 vials
• Holdover Time: Maintain +2 to+80 C for about
24 hours (one day)
• Ice packs: A maximum of 4 frozen packs
• Vaccine Layout: Keep vaccines in a plastic bag
(not in direct touch with the Ice packs)
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Ice Packs
Water Fill:
• Do not fill 100%.
• Leave 10 mm room for
expansion as water freezes.
• Close the cap tightly
• Clean the outer surface dry
before freezing
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Ice Pack Freezing
• Ice Packs to be frozen ROCK Solid
• Freezing is faster & uniform if gap /breathing space is left between ice packs
• Ice Packs are best frozen in Deep Freezers
• Condition before use
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Preparing icepacks for use: Conditioning
A Conditioned ice-pack
•On the session day,
take the frozen ice-packs
you need from the
freezer and place on a
table
•Allow ice-packs to
sweat (droplets of water)
at room temperature
•Shake the ice pack to
listen to sound of water.
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Maintenance of Equipment
• Defrosting/Cleaning: Ice deposit 5mm & over in freezer or at the bottom of ILR results in rise in temperature. Periodic defrosting & cleaning ensures trouble free performance for a long period.
• Cold boxes/Vaccine Carriers: Cold box hinges, lid knobs & chains are often damaged. Replace or repair locally. Minor insulation casing cracks/gaps can also be repaired with fresh PUF insulation
• Ice Packs: Fill clean water for freezing & leave 10mm room for expansion as water freezes. Cap tightly to avoid leakage. Keep pack clean & dry.
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Vaccine Distribution
• Follow first-in-first - out rule (FIFO)
• Also: first to expire - first out. (FEFO)
• Vaccines are not stored at the sub-centre level
and must be supplied on the day of use
• Note manufacturer, batch no, VVM status
• Use VVM stage-II vaccine near the cold chain
point (do not distribute to remote areas) 16www.drjayeshpatidar.blogspot.in
Storage Temperature
• Monitor temperature twice daily.
• All vaccines at PHC are stored
between +2 to+8 C
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Shake testShake the control and test samples
• Hold the Control and the Test sample together in hand and vigorously shake the samples
• Place both vials to rest on a flat surface, side-by-side observe them for 30 minutes.
• Compare for rate of sedimentation
USE
TestControl
Test Control
Discard18www.drjayeshpatidar.blogspot.in
Shake Test: Summary
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Vaccine Vial Monitor
3 = bad:
Don’t Utilize
4 = bad:
Don’t Utilize
The central square is equal to, or
darker than the surrounding circle
X
X
1 = good:
Utilize
2 = good:
Utilize
The central square is lighter
than the surrounding circle20www.drjayeshpatidar.blogspot.in
Potency
• T series, Hep B and diluents should never be frozen.
• BCG, OPV & Measles are sensitive to heat and light & lose potency fast.
• Potency lost due to heat exposure does not change the appearance of the vaccine.
• VVM is an effective tool in monitoring OPV potency.
• Damage to vaccine cannot be reversed by re-freezing.
• Discard frozen vaccine.
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