Cold Chain

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Cold Chain

• PSP Sept. 2007

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Objectives

• In addition to the DVD, to provide practical
  information about
• Vaccine management
• Cold chain surveillance per level
• Temperature monitors for vaccines and cold chain
  
• Possible flexibility of the cold chain
• Vaccine Vial Monitor
• Open Vial Policy
• Setting up an immunisation session
• Safety policy
• Bundle policy

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Vaccines management (1)

• Vaccines should be managed the same way as drugs
  (being able to trace vaccines)
• Register in stock card (name and doses/vial)
• Register Batch numbers expiry dates
• Vaccines must be kept at the correct temperature
  from manufacture until they are used
• Other elements to check
• Some cannot be frozen
• Some are sensitive to light
• Some need to be reconstituted ? once
  reconstituted, use within 6 hours

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Vaccines management (2)
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Vaccines management (3)

• ! Important !
• All vaccines lose potency gradually, even at
  correct storage temperatures observe expiry
  dates
• Any loss of vaccine potency is irreversible
• Damage due to successive exposures to heat or
  light is cumulative

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The cold chain (1)

• Vaccines must be kept at the correct temperature
  from the time they are manufactured until they
  are used
• The cold chain consists of a series of storage
  and transport links
• Cold chain monitoring equipment is needed to keep
  track of the temperature to which vaccines are
  exposed during transportation and storage

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The cold chain (2)
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Monitoring vaccine T

• For international transport
• Temperature data loggers
• 3M cards
• Vaccine vial monitors
• 2 x
• For MSF storages
• Freeze tag
• Thermometers T chart x 2 day
• Stopwatch card
• Vaccine vial monitors
• For cold boxes / vaccines carriers
• Thermometers
• Vaccine vial monitors

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International transport

• Temperature data logger (Spy Temp). Non reusable.
  
• For transport carried out by MSF. Records
  precise information on possible breaks in the
  cold chain
• Together with a 3M card. (temperature, moment
  duration).
• Records exposure lt2or gt 8
• Record length 10 days
• Record interval 15 min
• Instructions for use on the back of the device

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3M Cards (1)
For international transport, storage
Date in Index Location
Date out Index

• 1/1/93 - Central Store 1/3/93
  --
• 1/3/93 - Regional Store 1/4/93
  --

3M
10c
INDEX/INDICE
D
A
B
C
D
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3M Cards (2)
Date in Index Location
Date out Index

• 1/1/93 - Central Store 1/3/93 --
• 1/3/93 - Regional Store 1/4/93 --
• 2/4/93 A District Store

3M
10c
INDEX/INDICE
D
A
B
C
D
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3M Cards (3)
Date in Index Location
Date out Index

• 1/1/93 - Central Store 1/3/93 --
• 1/3/93 - Regional Store 1/4/93 --
• 2/4/93 A District Store 2/5/93 A
• 4/5/93 BD Health Centre

3M
10c
INDEX/INDICE
D
A
B
C
D
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3M Cards (4)

• Example in the ITC catalogue
• Measles, 10 doses Code O
• Meaning
• cold chain
• O if windows A, B, C, D are white ? OK
• if windows A, B, C and / or D blue ? Do not use
• Polio oral, 20 doses Code A
• A if windows A, B, C, D are white ? OK
• if windows A blue ? OK
• if windows B, C and / or D blue ? Do not use

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Freeze Tag
Freezing indicator Dont use the Freeze
Watch Now use only Freeze Tag
0C 1H
0C 1H
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MSF storage cold boxes,
Thermometers Examples in the ITC
catalogue THERMOMETER, ALCOHOL (Moëller 104614),
- 40º to 50º C Thermometer Mini-Maxi
(Moëller 102472), - 50 to 50 C This one is
to be used in MSF storage only, fragile
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Vaccine Vial Monitor (VVM)
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Vaccine Vial Monitor (VVM)

• Chemical Time Temperature indicators
• Indicates over-exposure to Heat over Time
• Gradual and Irreversible colour change

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The VVM says USE the vaccine!
Inner square lighter than the outer circle
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The VVM says USE the vaccine!
Inner square lighter than the outer circle
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The VVM saysDO NOT USE the vaccine!
Inner square same as the outer circle
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The VVM saysDO NOT USE the vaccine!
Inner square darker than the outer circle
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Flexibility in cold chain

• Open Vial Policy Change in global EPI policy !

Vials of OPV, DPT, TT, dT, Hep B and Hib may be
used if the following conditions are respected

• Expiry date not passed
• Vaccines stored under appropriate cold chain
  conditions
• Vaccine vial septum has not been submerged in
  water
• Aseptic technique respected
• VVM, if attached, has not reached the discard
  point
• Opened vials can only be used for 4 weeks
• Opened vials cannot leave the health facility

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Open Vial Policy
But , if sterile procedures have not been fully
respected or there is a suspicion of
contamination, etc.
DISCARD THE VIAL !!
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Open Vial Policy
Opened vials of measles, meningitis, yellow fever
and BCG vaccines MUST be discarded at the end of
each immunization session
Reconstituted vaccine
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Setting up an immunisation session

• Before starting the immunisation session you need
  to check if vaccines are safe for use
• Name of the vaccine / solvent
• Expiry date
• Control VVM
• Control appearance of vaccine
• Labelling,
• Colour,
• Transparency of the preparation

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Possible confusion
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Solvent No solvent

• Always use the solvent dedicated for a specific
  antigen
• If no solvent
• Contact the HQ / the manufacturer to know how to
  replace it
• If no possibility to be supplied by the
  manufacturer, solvent can be replaced by water
  for injection or NaCl
• Always read the instructions
• Respect the quantity to be add for dilutions

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Bundle Policy

• Auto-disable syringes, good quality vaccines and
  safety boxes should be supplied as a bundle for
  vaccination campaigns

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Safety Policy

• Auto disable syringe is the equipment of choice
  for administering vaccines, both in routine
  activities and in mass campaigns
• Safety boxes (puncture-proof containers) for
  collection and disposal of used syringes, auto
  disable syringes and needles.
• Mass campaign use 15 litres containers.
• Safe disposal and storage
• Training of health care workers in injection
  safety
• Empty vials to be kept apart, crushed and
  disposed of properly

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Thank you
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MSF Storage
For products that can not be frozen Dont
hesitate to stick it to the ice-lined fridge