The Cold Chain and Vaccine storage

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Objectives
Understand the correct procedures for handling and storage of vaccines including Knowledge of the cold chain and vaccine delivery service Monitoring the cold chain within your own practice Understanding how to dispose of out of date, unused vaccines etc.
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The cold chain

The cold chain is the system of transporting and storing vaccines within the safe temperature range of 2C to 8C.

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Why is the cold chain important?

Risks to vaccines of exposure to extremes in temperature Compliance with vaccine manufacturer Assurance/confidence in potent product Ensuring maximum benefit from immunisation
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National Cold Chain Delivery Service

Commenced 1st January 2005 Initial contract with Cahill May Roberts Currently United Drug Distributors Main storage site in Tallaght Satellite sites in Limerick and Ballina

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Monthly deliveries 2006/2007

3000

Flu Season
2500

Number of delivries

2000

1500

1000

500 Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec 2006 Year Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

2007

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Vaccines supplied
Vaccines
Primary Childhood vaccines Adult vaccines HSE vaccines Restricted vaccines 5 in 1/ Men C/ MMR/ Hib/ 4 in 1 Td Influenza/ Pneumococcal polysaccharide vaccine BCG / Tuberculin/ 4 in 1 Hepatitis A/ Hepatitis B/ Hepatitis A +B IPV Pneumococcal Conjugate Vaccine (PCV) Td/IPV

Current list of available vaccines from United drug in newsletter on immunisation website

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Who can order vaccines?

GPs who hold an immunisation contract Community Health Doctors who run the school immunisation service, BCG clinics Hospitals who require vaccines Vaccines are delivered monthly directly to the GP surgery, HSE health centre or hospital pharmacies

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How much vaccine should be ordered?

The quantity of vaccine order can be determined by
Quantity used since last delivery Storage volume within the refrigerator Vaccines currently in the refrigerator Seasonal variation e.g. influenza vaccine Disease outbreaks

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Recommended procedure on receipt of vaccine

Requires a named, trained and designated person and deputy Check vaccine deliveries against the order for any damage or discrepancies Place vaccines in the vaccine refrigerator immediately

Do not leave at room temperature

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Vaccine Storage
Never use out of date vaccines Always keep the temperature between 2-80C Store vaccines in their original packaging Store vaccines on shelves, not touching the sides of the fridge Record fridge temperature daily Use a switchless socket Do not unplug the fridge

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Recommended procedure following a break in the Cold Chain

Usually occurs due to a problem with the vaccine fridge. E.g.
electricity power cut switch turned off Fridge door left open.

If this happens
Make sure that the refrigerator door is closed Check the temperature and find out how long the refrigerator breakdown has been Contact the Chief Pharmacist, National Immunisation Office for further advice. (087 9915452 or 01 8676108)

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Recommended procedure following a break in the Cold Chain (2)

Any vaccine not stored between 20-80C is no longer a licensed product Do not use these vaccines and return to the National Cold Chain Delivery Service

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Vaccine disposal within a session

Use all opened vaccines within the recommended period, according to the manufacturer's instructions Any opened vaccine, spent or partly spent vials must be disposed of safely in a sharps box for incineration Dispose of open multidose vials at the end of the session Dispose of sharps boxes when two-thirds full
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Vaccine disposal
Unused unopened vaccines which have expired or have been kept outside 2-80C should be returned to the HSE National Cold Chain Delivery Service

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Useful resources
Australian Government Department of Health and Ageing National Vaccine Storage Guidelines 2005, Strive for 5 http://www.health.gov.au/internet/immunise/publishing.nsf/Content/provider-store Centre for Disease Control. Vaccine management, Handling and Storage details for vaccines. http://www.cdc.gov/vaccines/programs/vfc/downloads/vacc_mgmt_guide_utah.pdf. Department of Health UK. November 2006. Immunisation against infectious disease. http://www.dh.gov.uk/en/Policyandguidance/Healthandsocialcaretopics/Greenbook/D H_4097254 Irish Pharmaceutical Healthcare Association Medical Compendium. http://www.medicines.ie. Irish Medicines Board. http://www.imb.ie. National Immunisation Office Ireland. Health Service Executive. http://www.immunisation.ie. Public Health Agency Canada. National Vaccine Storage and Handling Guidelines for immunisation providers 2007. http://www.phac-aspc.gc.ca/publicat/2007/nvshglpldemv/index-eng.php. Royal College of Physicians of Ireland. Immunisation Guidelines for Ireland. Available at www.hpsc.ie

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