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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