Date post: | 10-Feb-2017 |
Category: |
Health & Medicine |
Upload: | preetika-maurya |
View: | 148 times |
Download: | 4 times |
Cold Chain
Definition
“Cold Chain is a system of keeping Vaccines at their recommended temperature from the
point of manufacturing to the point of vaccination of the beneficiary”
Cold Chain
Importance of cold chain
• Vaccines are sensitive biological products which may become less effective, or even destroyed, when exposed to temperatures outside the recommended range.
• Cold-sensitive vaccines experience an immediate loss of potency following freezing.
• Vaccines exposed to temperatures above the recommended temperature range experience some loss of potency with each episode of exposure.
• Repetitive exposure to heat episodes results in a cumulative loss of potency that is not reversible.
The Effective Cold ChainThree main elements combine to ensure proper
vaccine transport, storage, and handling.• Trained personnel• Transport and storage equipment• Efficient management procedures
Equipment
People
Procedures
OPV
Measles, MR, MMR
DPT, DPT+HepB, DPT+Hib, DPT+HepB+Hib , Yellow fever V
BCG
DT, Hib
TT , Td, hep B, JE
Vaccines vulnerable to heat
Vaccines vulnerable to freezing
hep B
Hib liquid
DPT, DPT+HepB, DPT+Hib, DPT+HepB+Hib
DT,
Td
TT
Light sensitive vaccines• BCG• Measles• MR• MMR
Vaccine Heat Light Freezing Temperature at PHC
OPV(live attenuated)
Sensitive Sensitive Okay to freeze +2˚C to +8˚C(-15˚C to -25˚C at
state, regional and district stores)
BCG(live attenuated)
Sensitive Sensitive Okay to freeze (before reconstitution)
+2˚C to +8˚C
Measles(live attenuated)
Sensitive Sensitive Okay to freeze (before reconstitution)
+2˚C to +8˚C(-15˚C to -25˚C at
state, regional and district stores)
DPT(toxoid, killed)
Relatively heat stable
Freezes at -3˚C. Discard if frozen.
+2˚C to +8˚C
Hep B(recombinant)
Relatively heat stable
Freezes at- .5˚C. Discard if frozen.
+2˚C to +8˚C
TT(toxoid)
Relatively heat stable
Freezes at -3˚C. Discard if frozen.
+2˚C to +8˚C
Summary of vaccine vulnerability
Walk in cooler and freezer• They are located at the regional/ Divisional level.• Store vaccines up to 3 months and 4-5 districts.
Walk-in Freezer(-15o to -25o C)
Walk-in Cooler(+2o C to +8o C)
Size: 300 ltr / 140 ltr
Level: District (300 ltr) / PHC, CHC(140 ltr)
Temperature: -15o to -25o C
Utilization: 1. Preparation of ice packs (at the
PHC, CHC)
Holdover time: 18- 22 hours In case of power cut.
Storage capacity: 300 ltr: 150, 000 to 200, 000 doses 140 ltr : Approx. 20-25 Ice Packs
with 8 hour of continuous supply
Deep freezers
Size: 300 ltr / 140 ltr
Level: District (300 ltr) / PHC (140 ltr)
Temperature: +2˚C to +8˚C
Utilization: At PHC for storing all vaccine for 1 month
Holdover time: 24 hrs after 8 hrs continuous power supply
Storage capacity: 300 ltr: 60,000 doses of mixed antigen & 20,000 doses of OPV140 ltr : 25,000 doses of mixed antigen & 18,000 doses of OPV*
Ice line refrigerators (ILR)
Arrange the vaccine In the order Top to bottom in ILR
Dos (for ILR and Deep freezer)
• Keep the equipment in cool room away from direct sun light.
• Keep the equipment labeled• Fix the equipment through the voltage stabilizer• Keep the vaccine nearly with space between the
stacks for circulation of air.• Keep the equipment locked and open only when
necessory.• Defrost periodically.• Supervise the temperature records
Donot (for ILR and Deep freezer)
• Donot keep any object on these equipment • Donot store any drug• Donot keep food and drinking water in them• Donot keep moor then one month requirments at
PHC level.• Donot keep expiry date vaccine.
Size: 20 ltr and 5 ltr
Level: all peripheral level
Temperature: +2˚C to +8˚C
Utilization: All vaccines can be stored for transportation or in case of power failure
Storage capacity: 20 ltr: 52 Ice Packs & 6000 doses of mixed antigens 5 ltr: 20 Ice Packs & 1500 doses of mixed antigens
Cold boxes
• Before the vaccines are placed in the cold boxes, fully frozen ice packs are placed at the bottom and sides.
• The vaccine are kept in the cartons and polythene bags.
• The vials of DPT, DT, TT vaccines and diluents should not placed in direct contact with frozen ice packs.
Size: 1.7 ltr
Level: PHC/ Sub Centre
Temperature: +2˚C to +8˚C
Utilization: All vaccines can be carried in small quantity for vaccination sessions
Holdover time: 12 hours Storage capacity: 4 Ice Packs &15-20 vials of mixed antigens
Vaccine carriers
Size: 763 X 90 X 33 mm
Ice capacity: 360 ml
Weight: 80 gm
Level: District / PHC/ Sub Centre
Temperature: +2˚C to +8˚C
Utilization: line the walls of vaccine carrier/cold box/day boxes
Time to Freeze: 48 hours in DF at - 20˚C
Ice packs
• Fill icepacks with water to mark• Fit the sealing plug and screw on the lid
tightly• Hold each ice-pack upside down and
squeeze it to make sure it does not leak.• Place the icepacks in the deep freezer.• Ice-packs need not be refilled every time
they are used. The same water can be used repeatedly.
• Do not use saline water for filling
Preparing icepacks for use
• On the session day, take the frozen ice-packs you need from the freezer and place on a table
• Allow ice-packs to sweat at room temperature for 15 minutes
• Shake the ice pack to listen to melted for water.
• This will prevent freeze-sensitive vaccines from freezing.
A Conditioned an ice-pack
Conditioning of ice packs
Verify Daily the Temperature of the Cold Chain Storage at the
Health Centers and Out PostsHealth Centers and Out Posts
+2°C to + 8°C
DPT,DT & Tetanus Toxoid
OPV (Polio), BCG, Measles,
0°C
-15°C to -25°C
Ice Packs in deep Freezers
Full ILR can not maintain potency of vaccine
Do not open lid of ILR too often
Discard frozen DPT, DT and TT vials
Ice Packs in Deep Freezer- Side View
Freezing Ice packs in deep freezer
Over filling Deep freezer damages equipment
Never put vaccines in direct touch with ice packs
Maintenance of Equipment• Breakdown/Repairs:
• Early reporting & timely repairs is good cold chain management.
• Handy spares reduces down time & speeds repair. • Condemned units to be removed/ replaced by standby
units.
• Contingency/Emergency Plan: • Identify alternate storage points incase of equipment
failure.• Funds approval, manpower & mobility to be geared up in
advance.
Vaccine Basics.............• Follow “First-in-First - out rule” (FIFO)
• Also “First to expire - First out” (FEFO)
• T series, Hep B and Hib and diluents should never be frozen.
• BCG, OPV & Measles (light) are sensitive to heat & 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 T series vaccine & Hepatitis B Vaccines.
Vaccine Vial Monitor - Interpretation
Thanks
• Aj ka din wo din hai jab ma papa ko ek doosre ko pehli baar dekhe 25 saal
poore ho gaye• In saalo me, papa jada time ghar pe nahi the, aur mummy se jitni ladaiya ki
hai, shayad ab zindagi me kisi se nahi hongi…• Ma ne humesha meri choti badi galti ko sudhara hai• Poora ghar akele chalana, aur 2 ladkiyo ko bada karna, shayad isiliye, unka
pyar daant k form me hi bahar aata tha, aur tb ye baat mere smjh me nahi aati thi
• Unhe hmesha is baat ki chinta rehti hai ki unke bachho se koi galti na ho jaye, kisi ko bhi kabhi koi kami nikalne ka mauka na mile
• Papa ne hume humesha support kiya hai, ki jo karne ka mann kare. Karo. Papa humesha tumhare sath hain
• Dono ne aj tk meri koi bhi farmaish adhoori nahi chodi, ab to ye bolna padta hai, ki bachho k muh se nikli baat poori nahi karte, bachhe bigad jate hain