Cold Chain Management of Vaccines	Authorised by: Charge Nurse Newborn
	Aug 2008

Storage of Vaccines	Vaccines for Newborn Services	Transporting of Vaccines from Pharmacy	Storage of Vaccines in Newborn Services
Fridge Used for Storing Vaccines	Vaccines Exposed to Temperatures outside +2 to +8 degrees	Reviews of Fridges	Other Related Documents

Storage of Vaccines

The cold chain storage refers to the system of transporting and storing vaccines at +2 to +8°C to avoid cumulative irreversible loss of potency from thermal insult. Vaccines are freeze sensitive. The cold chain starts at the vaccine manufacturers and finishes when the vaccine is administered to the patient.

Vaccines for Newborn Services

Vaccines are on imprest in NICU. The imprest is supplied weekly by Pharmacy.

Transporting of Vaccines from Pharmacy

A chilly bin with ice packs is used.

Vaccines are placed in the shredded paper in the chilly bin. Then a 10mm thick sheet of polystyrene is placed on top of vaccines. Ice packs go on top of polystyrene. (Vaccines are kept separate from the ice packs to avoid freezing of freeze sensitive vaccines). The time taken to transport vaccines should be kept to a minimum. Vaccines are immediately unpacked upon arrival at NICU.

Storage of Vaccines in Newborn Services

Vaccines are stored in the dedicated vaccination fridge in NICU. They are kept in their individual boxes in container (in case an ampoule breaks). The lid is kept off the container to allow air to circulate.

Do not store vaccines in the door or on the bottom shelves.

Fridge used for storing vaccines

A good seal, regular defrosting and minimising the number of times the fridge door is opened will also help temperature stability.
Non self-defrosting fridges are the best for the storage of vaccines.

Power failure

Secure the power supply of the fridge by displaying a notice against turning off the power. During a power failure of less than one hour, vaccines should be left in the fridge and the door not opened. For a failure of more than one hour the vaccines should be transferred to a chilly bin.

Monitoring

A minimum – maximum thermometer is essential and must be checked and recorded daily by the Hospital Aid. This will show not only the current temperature, but also the highest and lowest temperature since the thermometer was reset, and the time of recording. If the thermometer is taken out of the fridge, it should be reset after it has been in the fridge for at least an hour. Otherwise the room temperature will create a false maximum. See Cold Chain Management, Reviews of Fridges.

Vaccines exposed to Temperatures outside +2 to +8°C.

Vaccine	Temperature below 0°C	Temperature between +8°C and +25°C
BCG	Use	<5 days – Use >5 days – Do Not Use
Infanrix-hexa®	Do Not Use	<5 days – Use >5 days – Do Not Use

Immunisation Advisory Centre Co-ordinator facilitators are available to advise on fridge performance and if vaccine damage is suspected. (They also do a yearly 24 hour check).
Before discarding any vaccine, please consult with Pharmacy.

Cold Chain Management, Reviews of Fridges

Aim

To meet the requirements of the Immunisation Co-ordination Programme. (DHB requirements). To maintain recommended fridge and freezer temperatures.

Objectives

To ensure:

Vaccines are maintained in best possible condition.

Appropriate storage of medications/IVN

Appropriate storage of breast milk/formula.

Responsibility

A senior nurse is the co-ordinator of Newborn Services Cold Chain Management and will liaise with the Immunisation Advisory Centre Co-ordinator.
Newborn Services Cold Chain Management Team (Nurses/Hospital Aids/Clerks).

Frequency

Daily monitoring and recording of fridge/freezer max/min temperature by Hospital Aids in Newborn Services.
Spot checks.
Daily temperature charts on view on Immunisation and Medication fridges.
Previous monthly charts filed in Cold Chain Management Information Folder (yellow) kept in NICU office.
Cold Chain Management Team completes monthly and two monthly audit checklist.
Six monthly battery change on fridge/freezer electronic thermometer.

Procedure

All fridge/freezers within the Newborn Service have:
- Electronic max/min thermometer and temperature chart attached.
- Fridge range between +2°C to +8°C.
- Freezers containing frozen breast milk are maintained at -20°C.

Alarms

Vaccination and medication fridges have ‘alarm’ thermometers.

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