1. health and fitness

How to Maintain Cold
Chain in an Esky
Barbara Wilson
Immunisation Coordinator
Public Health Unit – Albury
ANI Update 2014
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.’
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: http://www.mlhd.health.nsw.gov.au/keepinghealthy/public-health/immunisation
Southern NSW LHD: http://www.snswlhd.health.nsw.gov.au/keeping-healthy/public-health/immunisation
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.
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
What is the difference between Ice Packs & gel
Packs?
There are Many types of Ice packs
& Gel packs available.
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 1 hour @ +20°C)
•
An Ice pack is conditioned as soon as water begins to ‘slosh’ about
slightly inside ice pack.
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
Temp >+15°C
1 hour
Temp <+15°C
1½ hours
Gel Packs >750g
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).
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.
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.
How to Pack an Esky
Step 3 – Place vaccines in esky with a Min/Max thermometer
probe in the centre of the vaccine stock.
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.
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.
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.
Preparing Min/Max Thermometers
• Suppliers – ACTROL www.actrol.com.au
• Available on stores: 503556
• 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.
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: http://www.mlhd.health.nsw.gov.au/keepinghealthy/public-health/immunisation
Southern NSW LHD: http://www.snswlhd.health.nsw.gov.au/keeping-healthy/public-health/immunisation
Monitoring Esky Temperature
Min/Max thermometer temperatures must be recorded hourly to
ensure the temperature is maintained between +2°C to +8°C.
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.
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: http://www.mlhd.health.nsw.gov.au/keepinghealthy/public-health/immunisation
Southern NSW LHD: http://www.snswlhd.health.nsw.gov.au/keeping-healthy/public-health/immunisation
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.
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: http://www.mlhd.health.nsw.gov.au/keepinghealthy/public-health/immunisation
Southern NSW LHD: http://www.snswlhd.health.nsw.gov.au/keeping-healthy/public-health/immunisation
Reference:
 National Vaccine Storage Guidelines – ‘Strive for 5’, 2nd
edition.
 NSW Health, Immunisation Provider Kit, Version 1.0