How to Maintain Cold Chain in an Esky. Barbara Wilson Immunisation Coordinator Public Health Unit Albury ANI Update 2014

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1 How to Maintain Cold Chain in an Esky Barbara Wilson Immunisation Coordinator Public Health Unit Albury ANI Update 2014

2 How to maintain Cold Chain in an Esky? What do we mean by Cold Chain? Cold Chain is the system of transporting and storing of vaccines within the safe temperature range of +2 C to +8 C, to ensure that we provide effective and potent vaccines to our clients. Cold chain begins from the time the vaccine is manufactured, continues through to vaccine distribution centre and ends when the vaccine is administered. If we don t protect our vaccines they won t protect our community.

3 Principles of Safe Vaccine Storage Management: All vaccines should be stored in a purpose-built refrigerator (DO NOT store in Bar or Cyclic Defrost Fridges). Have a nominated person responsible for the vaccines & there must also be a nominated backup person. Ensure Policies, procedures & protocols are current, including responding to cold chain breaches & power outages. Ensure all staff involved are trained in transportation, storage & administration of vaccines and data logger downloading. Preform Annual vaccine storage self-audits - self audit tool is available on Staffnet and the Local Health District Webpage: as per Reference link below Monitoring fridge temperature Twice Daily and report any temperature breaches <+2 C & >+8 C to relevant authorities.. Staffnet: MLHD: Population Health/Public Health (Health Protection)/Immunisation Coordination/Immunisation General SNSWLHD: Service Improvement/Public Health (Health Protection)/Immunisation Coordination/Immunisation General External: Murrumbidgee LHD: Southern NSW LHD:

4 What type of Cooler? Select a cooler that meets your service needs The minimum size for storing Vaccines is 10litres, as the risk of freezing episodes usually occur in the first 2 hours. Polystyrene are only suitable for storing vaccines for up to 4hours. Coolers generally have limited cold life and therefore not adequate for vaccine storage over prolonged periods (more than 8hrs) or in extreme conditions.

5 How many ice/gel packs are required? This will depend on: What is the Ambient temperature Duration vaccines are to be stored in the esky Type of cooler used Number of vaccines Cooler capacity Size & type of ice/gel packs

6 What is the difference between Ice Packs & gel Packs? There are Many types of Ice packs & Gel packs available.

7 What is the difference between Ice Packs & gel Packs? ICE PACKS Are filled with water and can come out of the freezer at a temperature as low as -18 C. Conditioning Ice Packs: Remove from freezer Lay ice packs in a single row on their side (5cm around to allow maximum air exposure), thus reducing conditioning time. Wait until ice packs sweat (can take C) An Ice pack is conditioned as soon as water begins to slosh about slightly inside ice pack.

8 What is the difference between Ice Packs & gel Packs? GEL PACKS Gel packs contain chemicals that depresses the freezing point of the pack, ensures the gel remains < 0 C for longer than water-filled packs (check with Manufacture before purchasing). Conditioning Gel Packs: Gel packs usually take longer to condition and recommend to follow manufacturer instructions, to remove the initial chill factor of gel packs. Below is a guide to Conditioning of Gel packs: Gel Pack Size Ambient Temperature Conditioning Time Gel Packs <750g Temp >+15 C 45mins Temp <+15 C 1 hour Gel Packs >750g Temp >+15 C 1 hour Temp <+15 C 1½ hours

9 How to Pack an Esky The greatest risk to vaccines when placed in an esky is freezing and this usually occurs in the first 2 hours after packing. There are 2 storage options available - depending on how long the vaccines need to be stored for and the ambient temperature OPTION ONE can be used for storing vaccines for up to 8 hours. OPTION TWO packing vaccines into a polystyrene container which is then placed into a larger cooler (Esky).

10 How to Pack an Esky OPTION ONE (Store vaccines for up to 8 hours) Step 1 If time permits chill the inside of the cooler prior to use by placing ice/gel packs in the esky for a few hours and then remove. Place conditioned ice/gel packs on bottom if needed.

11 How to Pack an Esky Step 2 Place polystyrene chips or other suitable insulating material at the bottom of the cooler, this eliminates hot & cold spots (Polystyrene chips are preferred as it promotes air circulation). If using bubble-wrap, avoid wrapping vaccines tightly.

12 How to Pack an Esky Step 3 Place vaccines in esky with a Min/Max thermometer probe in the centre of the vaccine stock.

13 How to Pack an Esky Step 4 Surround the vaccines with packaging material (eg. polystyrene chips) to allow cold air to circulate. Step 5 Place the conditioned ice/gel pack(s) on top, close and seal the lid of the cooler. If using a larger cooler, place conditioned ice/gel packs around the sides of the cooler as well as on top.

14 How to Pack an Esky Step 6 Secure Min/Max thermometer on outside of esky & monitor the temperature before leaving for the session, upon arrival, prior to administrating vaccines and hourly throughout the immunisation session or power outage on appropriate document.

15 How to Pack an Esky OPTION TWO Is when the vaccines are packed into a polystyrene container which is then placed into a larger cooler. Steps: 1. The Polystyrene container is packed with vaccines (as per Option One). 2. Then place the polystyrene container inside a larger cooler and surround it with ice/gel packs and secure lid. 3. Monitor the esky temperature before leaving for the session, upon arrival, prior to administrating vaccines and hourly throughout the immunisation session on appropriate document.

16 Preparing Min/Max Thermometers Suppliers ACTROL Available on stores: REPLACE - Min/Max thermometer every 3yrs and record date of purchase on back of Min/Max thermometer. BATTERY - must be replaced every 12 months. ICE SLURRY - must be attended after each battery change. Record battery change & ice slurry on back of Min/Max thermometer and Twice Daily Temperature chart/graph.

17 Preparing Min/Max Thermometers After an Ice Slurry is completed the Min/Max Thermometer probe should be placed in an empty Vaccine Box. Guidelines for Min/Max Thermometer Battery Change & Ice Slurry Test and Storage can be found on Staffnet or the Local Health District Webpages: as per Reference link below. Min/Max thermometer probe can be stored in the bottom of the fridge, in readiness for the next clinic or power outage. Staffnet: MLHD: Population Health/Public Health (Health Protection)/Immunisation Coordination/Immunisation General SNSWLHD: Service Improvement/Public Health (Health Protection)/Immunisation Coordination/Immunisation General External: Murrumbidgee LHD: Southern NSW LHD:

18 Monitoring Esky Temperature Min/Max thermometer temperatures must be recorded hourly ensure the temperature is maintained between +2 C to +8 C. to An additional esky of ice/gel packs may be required and ice packs added or removed as required, depending on how long vaccines are in the esky for and the external ambient temperature.

19 Monitoring Esky Temperature Vaccine Storage Record Staffnet: MLHD: Population Health/Public Health (Health Protection)/Immunisation Coordination/Immunisation General SNSWLHD: Service Improvement/Public Health (Health Protection)/Immunisation Coordination/Immunisation General External: Murrumbidgee LHD: Southern NSW LHD:

20 Monitoring Esky Temperature All vaccines that have been continuously stored between +2 C to +8 C can be returned to the Vaccine specific fridge at the completion of a outreach clinic or when the power resumes. If there has been a power outage, only return the vaccines to the fridge once the temperature is between +2 C and +8 C. Remember to reset the fridge temperature min/max and document all activity on the Twice Daily Fridge Temperature chart/graph.

21 Documentation All activity must be recorded on the Fridge Temperature Chart / Graph and the fridge temperature reset after the door has been open and maximum temperature returns to <+8 C. Fridge Temperature Chart / Graph are available on Staffnet and the Local Health District webpage: as per Reference link below Staffnet: MLHD: Population Health/Public Health (Health Protection)/Immunisation Coordination/Immunisation General SNSWLHD: Service Improvement/Public Health (Health Protection)/Immunisation Coordination/Immunisation General External: Murrumbidgee LHD: Southern NSW LHD:

22 Reference: National Vaccine Storage Guidelines Strive for 5, 2 nd edition. NSW Health, Immunisation Provider Kit, Version 1.0