COLD CHAIN PPT.pptx

Cold chain is defined as the series of actions and equipment applied to maintain a product within a specified low-temperature range from harvest/production to consumption.

1. COLD CHAIN DR.ANJALATCHI MUTHUKUMARAN VICE PRINCIPAL ERA COLLEGE OF NURSING ERA UNIVERSITY

2. INTRODUCTION Cold chain is the system used for storing vaccine in good condition. It is otherwise called a vaccine supply chain or immunization supply chain . It is a series of links that are designed to keep vaccines with WHO-recommended Temperature Ranges from the point of manufacture to the point of immunization. The cold chain system is necessary because vaccine failure may occur due to failure to store and transport under the strict temperature. The term supply chain management was first coined by Keith Oliver.

3. DEFINITION The “Cold Chain” is a system of storage and transport of vaccine at low temperature from the manufacturer to actual vaccination site

4. COLD CHAIN System of storage & transport of vaccines at low temp. from the manufacturer to the actual vaccination site. M a n u f a c tu r e r A i r p o r t State/Region District store Health centre Outreach S u b c e n t r e

5. IMPORTANCE OF COLD CHAIN Obtaining the vaccine from manufacturers. Storing and transporting the vaccine Maintaining the supply of vaccine Having information about essential equipments ,supply of electricity etc Keeping the vaccine at low temperature Protecting the vaccine from sunlight exposure Maintaining the potency of vaccine.

6. TRANSPORT AND STORAGE For successful Cold chain system, three elements are essential: Personnel: To manage vaccine storage and Distribution . Equipments: To store and Transport vaccine and to monitor temperature . Procedures: To ensure the vaccines are stored and transport at appropriate temperature. All the vaccine must be stored, transported and distributed at the recommend temperature by the manufacturer in the literature accompanying the vaccine , otherwise they may become denatured and totally in effective with loss of potency

7. CONT …. Among all vaccine , polio is the most heat sensitive, requiring storage at 20.C Polio and measles vaccines must be stored in the freezer comportment TPD, DT, TT, BCG Typhoid and diluents of vaccines must be stored in the cold part and never allow to freeze Vaccine must be protected from sunlight and contact of antiseptic

8. COLD CHAIN EQUIPMENTS Walk in cold room : they are located at regional level , meant to store vaccines up to three months and serve 4-5 district.

9. Walk-in-Freezers (WIF) Installed in all of the states and larger divisional head quarters. They maintain a temperature around -20°C. bulk storage of OPV, and also to prepare frozen ice packs at state stores. Available in sizes of 16.5 Cum. and 32 Cum.

10. Deep Freezers: supplied to all districts and PHC to store vaccines the cabinet temperature is maintained between 15.C -25.C in case of power failure , these freezers can maintain the cabinet temperature for 18-22 hours. Deep Freezer are used polio and measles vaccines. 300ltr - 140ltr for making ice packs and for storing capacity available in deep freezer.

11. CONT … Ice lined refrigerator : - ILR are kept at the PHC and district level. The cabinet temperature is maintain at +2.C to +8.C at the PHC level, ILR are used for storing all UIP Vaccines. The bottom of ILR is the coldest part. DPT, DT, TT and diluents should not be kept directly on the floor of the ILR as they can freeze and get denatured. These vaccines should be kept in the basket provided within the ILR. Temperature of the ILR should be recorded twice a day with the dial thermometer which should be kept inside the ILR, even if there is an in built thermometer.

12. CONT … There are some DOs and DONTs for the use of ILR freezer. DOs: keep the equipment in cool room away from direct sunlight and at least 10cms away from the walls. The vaccine should be kept inside the ILR neatly with the space in between for air circulation. The ILR should be kept locked and open only when necessary. DONT s: do not kept any object on the deep freezer or ILR. Never store any other Drugs. Drinking water, foods or date expired vaccines or more then 1 month requirement at PHCs level and don’t open these equipment unless required.

13. CONT.. Cold Boxes : cold boxes are available at all peripheral health centers. They are used for transporting vaccines and also for storing vaccines during failure of electric supply. Fully frozen ice packs are placed at the bottom and sides of the cold box before placing the vaccines in it. The vaccines should be first packed in cartoons or polythene bags then to be kept inside the cold box. DPT, DT, TT vaccines and diluents should not be kept in direct contract with the frozen ice packs.

14. COLD BOXES

15. CONT… Vaccines carrier : vaccines carrier are used to carry 16 to 20 vials of vaccines to out Reach sites to the Sub centers, village vaccination clinics or camp. Four fully frozen ice packs are placed for lining the sides of the carriers DPT, DT,TT and diluents should not be placed in direct contract of frozen ice packs. The carrier must be closed tightly. 4 ice packs cantains in the vaccine carriers.

16. VACCINE CARRIER

17. CONT .. Day Carriers: Day carriers are used for nearby areas and only for few hours period with two fully frozen ice packs. It is used to carry small quantities of Vaccines, e.g. 6 to 8 vials only .

18. CONT… Ice Packs : I ce packs are used for cold boxes and vaccines Carriers. it is prepared in the deep freezer. Ice Pack Contain water, filed up to the level market on the side. No salt is added to it leak ice pack should not be used.

19. CORRECT STORAGE AND USE OF DILUENTS Only use the diluents supplied and packaged by the manufacturer with the vaccine since the diluents is specially designed for the needs of that vaccine, with respect to volume, PH level and chemical properties . Store the diluents between +2 C to +8 C in the ILR. If there are store the diluents between +2 C to +8 C in the ILR.

20. CONT… If there are constants of space, than store diluents outside the cold chain. However, remember to cool diluents for at least 24 hours before use to ensure that vaccine and diluents are at 2 C to 8 o C when being reconstituted. Otherwise, it can lead to thermal shock i.e the death of some or all the essential live organisms in the vaccine. Store the Diluents and droppers with the vaccines in the vaccine carriers during transportation .Diluents should not come in direct contact with the ice pack.

21. MONITOR AND CONTROL OF TEMPERATURE:- Should be a Routine Activity. At the start and end of each working day Monitoring devices include:   Thermometers. Temperature record sheets. Refrigerator and freezer thermostat. Cold chain monitoring card (CCM) Vaccine vial monitoring(VVM) Freeze watch indicator. Vaccine shake test .

22. CONT… Thermometer: every piece of cold chain should be fitted with a thermometer. Different types may be used, commonly mercury thermometer. i.e Dial thermometer ,Stem thermometer Temperature record sheets: Record temperature of refrigerator or freezer. Twice Daily: in the morning and afternoon. Any malfunction then should be reported. Refrigerator or Freeze thermostat: Used to control storage Temperature. Thermostat is set to suitable temperature.

23. VACCINE VIAL MONITOR(VVM) A VVM is a label containing a heat – sensitive material which is Placed on a vaccine vial to register cumulative heat exposure over time . Reading the stage of the VVM:- Stage 2: The inner square is lighter then the outer Circle. if the expiry date has not been passed : use the vaccine Stage 2: The inner square is still lighter than the outer Circle. if the expiry date has not been passed : use the vaccine

24. CONT… Discard Point : Stage 3: The color of the inner square matches that of the outer circle : Don’t use the vaccine Beyond the discard point Stage 4: The color of the inner square is darker than the outer Circle. Don’t use the Vaccine. The VVM does not directly measure vaccine potency but gives information about the main factor that affects potency i.e Heat exposure over a period of time.

25. USABLE AND UNUSABLE STAGES OF VVM

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