Cold Chain

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EXPANDED PROGRAMME ON IMMUNIZATION

• Dr.Qazi Afsar Anwar
• Assistant Director EPI (Logistics) Khyber
  Pakhtunkhwa

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Cold Chain system of EPI

• System that ensures
• 1.Potency
• 2.Quality
• 3.Safety
• of Vaccines by maintaining the correct
  temperature from Manufacturer to
• Children/Women

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What is the cold chain?

• ? Vaccines are sensitive to heat and must be
  kept cold from
  the time they are manufactured until they are
  used.
• ? The equipment and people that keep vaccines
  cold during their journey are together called
  the cold chain.
• ? The cold chain is only as strong as its weakest
  link. We are all part of that chain.

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How long is the cold chain?

• ? Manufacturer to airport cold storage at
  airport
• ? Transport at the correct temperature from
  airport to storage in central, regional and
  district stores and in health centers
• ? Transported at the correct temperature to
  outreach sites
• ? Kept at correct temperature during immunization
  sessions

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COLD CHAIN SYSTEM PAKISTAN
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Cold Chain System Activitiesin Vaccine Facilities

• 1. Receipt
• 2. Storage
• 3. Delivery

Receipt
Delivery
Storage
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Loading Vaccine Refrigerators

• ? Put vaccines and diluents on the top and middle
  shelves of the main section
• ? OPV and measles vaccine on the top shelf
• ? BCG, Pentavalent and TT vaccines on the middle
  shelves
• ? Diluents next to the vaccines with which they
  were supplied
• ? Arrange the boxes of vaccine in stacks between
  which the air can move.

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• Choosing a Refrigerator and Freezer
• 1. Temperature Zone, the average temperature
  during the hottest/coldest months should be taken
  as criteria for the
• determination of the zones.
• There are three temperature zones for which cold
  chain refrigerators and freezers will be
  classified
• Hot zone, 0C to 43C
• Temperate zone, 0C to 32C
• Cold zone, -5C to 32C
• 2. Vaccine storage capacity, how much vaccines
  must be stored at 0-8C or -20C
• 3. Ice pack freezing capacity, how many icepacks
  should be frozen per 24 hours

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Conti..

• 4. Power source, electricity, kerosene or
  bottled gas. Is supply
• Continuous or not
• 5. Holdover time, How many hours will the
  vaccine remain below 10C
• Reliability, Repair facilities and spare parts
  are available
• 7. Price, Which refrigerator meets requirements
  at the lowest cost
• 8. Training, Are the users and those in charge of
  maintenance of equipment properly trained

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What to do when a vaccine refrigerator is out of
order If your vaccine refrigerator stops
working, first protect the vaccines and then
repair the refrigerator. Protecting the
vaccines Move the vaccines to another place
until the refrigerator is repaired. If you think
that the problem will last only a short time, you
may use a cold box or vaccine carrier lined with
conditioned ice-packs for temporary storage. For
a longer duration, use another refrigerator.
Always keep a freezer indicator with the
freeze-sensitive vaccines to monitor eventual
freezing.
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Restoring the refrigerator to working
order Check the power, gas or kerosene supply.
If there is no power, make other arrangements
(e.g. store the vaccine in a household
refrigerator) until power is restored. If there
is no gas or kerosene, get it as soon as
possible. If a lack of power, gas or kerosene is
not the problem, repair the refrigerator or
report to your repair technician or
supervisor. Record the breakdown on the daily
temperature recording chart. Note Concerning the
routine maintenance and the servicing of
refrigerators, WHO technical manuals exist for
each kind of refrigerator.
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All the vaccines should be stored in the basket
provided with the refrigerator1. Measles,BCG
and OPV in the bottom only2. Freeze-sensitive
vaccines (Penta, TT) in the top only.
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• Different Types of Refrigerators/Freezers

Chest freezer
Deep
Solar Powered
ILR Mk 074
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General rules about refrigerators

• ? Opening the refrigerator door raises the
  temperature.
• ? Before you open the door, plan what you are
  going to do.
• ? When you open the door, do what you have to do
  quickly and close the door as soon as possible.
• ? Try not to open the refrigerator door more than
  three times a day.

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Storage Principles

• ? Vaccines must not be kept
• In the door compartments of domestic
  refrigerators
• In the salad trays at the bottom of the
  refrigerator
• In contact with the evaporator plate
• ? Must not be confused with other heat sensitive
• pharmaceuticals
• ? Diluents must be stored at the same temperature
• at the point of use. This prevents damage to
  the potency of the vaccine

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Contingency Plans

• ? Each facility should have a contingency plan
  for power failures and these must be visible
  placed on the fridge
• ? It must be include an alternative storage
  area/place and it must be adequate

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Walk-in Type Cold Room
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Combination Walk-in Type Cold/Freezer Room
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Cold chain monitoringequipment thermometers

• ? Health centre staff use dial thermometers, as
  recommended by WHO to monitor the temperature of
• refrigerators, cold boxes and cooler boxes.
• ? Max-min thermometers are not recommended as
  training is required

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Type of Vaccine Thermometer
Dial type Thermometer
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Type of Vaccine Thermometer
Bar type Thermometer (read safety zone as 20 to
80 C not as 00 to 80)
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Maintaining cold boxes and vaccine
carriers Vaccine carriers and cold boxes must be
well dried after their use. If they are left wet
with their lids closed, they will become mouldy.
Mould may affect the seal of the cold boxes and
vaccine carriers. If possible, store cold boxes
and vaccine carriers with the lid open, when not
being used. Knocks and sunlight can cause cracks
in the walls and lids of cold boxes and vaccine
carriers. If this happens the vaccines inside
will be exposed to heat. If a cold box or vaccine
carrier wall has a small crack you may be able to
repair it with adhesive tape until you can get an
undamaged one.
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Packing a cooler box

• 1. Take all the frozen ice packs you need from
  the freezer and condition them.
• 2. Put ice packs against each of the four sides
  of the cold box or vaccine carrier.
• 3. Take all the vaccines and diluent you need
  from the main section of the refrigerator and
  close the door.
• 4. Put the vaccines and diluent in the middle of
  the cold box or carrier. Vials may be kept in
  their boxes or packed without them, depending on
  how many vials you need.

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Cold Chain Vaccine Management Training

• Cold box and Vaccine Carriers

Cold box
Vaccine carrier with vaccine vials in foam pad
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Keeping things cool in the field

• ? Keep the lid tightly on the vaccine carrier in
  transit.
• ? Keep cold boxes and vaccine carriers in the
  shade. Do not leave a cold box or vaccine carrier
  in a vehicle that is standing in the sun. Take it
  out of the vehicle and put it in the shade.

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Ice packs

• ? Ice packs are flat, square plastic bottles that
  can be filled with water and frozen. The required
  number in a particular cold box or vaccine
  carrier varies.
• ? Every health centre should have two sets of ice
  packs, one being frozen while the other is in
  use.
• ? Condition the ice packs before use

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• Ice packs

0.6 liters
0.4 liters
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Vaccines sensitive to
heatOPV Measles BCG TT Pe
ntavalent
Most sensitive
Least sensitive
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Vaccines sensitive to
coldPentavalent TT
Most sensitive
Least sensitive
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Recommended Storage Temperature for Vaccines
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What is a vaccine vial monitor?
A vaccine vial monitor (VVM) is a label
containing a heat-sensitive material which is
placed on a vaccine vial to register cumulative
heat exposure over time.
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VVM (Vaccine Vial Monitor)
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Reading a Vaccine Vial Monitor
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Cold Chain Monitor (CCM)
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Cont..
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PESHAWAR PROVINCIAL VACCINE STORE
Empty units
Non-operational ILRs stockpiled around the store
Refrigerated vans for collecting vaccines from NIH
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Some recommendations at each level after the
assessment
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Provision of Freeze tag for all freeze sensitive
vaccines
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2.Completing of cold chain monitor at federal,
provincial and district level
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3. Observe strictly vaccine ordering and stock
keeping
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4. Designate train cold chain staff at all
levels
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5. Observe Multi dose vial policy
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6. Perform Ice pack conditioning for freeze
sensitive vaccines
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7. Adapt an effective vaccine distribution system
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8. Monitor stock and expiry dates
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Vaccine and Cold Chain Monitoring Devices
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You are the guardian of yourvaccines