Vaccine Ordering and Fridge Inspections

To be compliant with the mandatory requirements for vaccine storage and handling, facilities must:

• Store vaccine in SWPH inspected fridges and maintain between +2°C and +8°C
• Maintain a temperature monitoring device eg. minimum/maximum thermometer in the fridge to monitor temperatures.
• Document min/max/current fridge temperatures twice daily in a log book.

Cold Chain Incident

A cold chain incident occurs when the vaccine is exposed to temperatures outside the +2°C and +8°C range. This can happen in your refrigerator or during transport from SWPH to your facility.

Responding to a cold chain incident

When you notice vaccine storage temperatures are out of the required range:

• Call SWPH immediately at 1-800-922-0096 to report the vaccine exposure. After business hours please call 1-800-922-0096 and listen to the prompts to speak with an on call staff member.
• Review your contingency plan. If the fridge remains out of range, move the vaccine to another SWPH inspected fridge.
• Ensure none of the exposed vaccine is used until directed by Public Health.
• Complete the Adverse Storage Conditions form and fax, along with the fridge temperatures to SWPH.

Based on the details of the cold chain incident, a SWPH nurse will determine the next steps with you.

• Vaccines that have been exposed and may still be used are marked with a red dot and stored in the vaccine fridge under cold chain. Use these vaccines first.
• You may have to submit your temperature logs in 5-7 days to show that the fridge has stable temperatures before you can order vaccine again.
• Vaccines not suitable for use are considered wastage and need to be placed in a bag marked “DO NOT USE”. The wasted vaccine is returned to SWPH with a completed vaccine return form.
• The nurse may complete an on-site inspection after a cold chain incident if it’s serious (i.e. large amounts of wasted vaccines) or if a face-to-face conversation would be helpful.
• A data logger may be placed in your fridge to gather additional information. Data loggers provide continuous temperature recording (at pre-determined intervals) that can be downloaded onto a computer and printed. Data logger readings and reports can be very useful in determining fridge functioning.

There are many effective practices that can be adopted to achieve the best possible vaccine storage and handling:

• Order small amounts of vaccine more often to decrease vaccine wastage in case of a cold chain failure.
• Ensure the vaccine refrigerator is large enough to accommodate the required stock of vaccine.
• Store vaccines on the middle shelves. Never store vaccines in the door shelves, bottom drawer or close to the freezer section, as they could be exposed to significantly warmer or colder temperatures in these locations.
• Storing filled water bottles on the lower shelf and door of the refrigerator may help to maintain an even, stable temperature inside.
• With the exception of these water bottles, do not store anything else in the refrigerator except for vaccines (no food, drinks or lab specimens).
• Ensure that the electrical outlet and refrigerator plug is secured to prevent the refrigerator from accidentally being unplugged or turned off.
• Always ensure that the refrigerator door is closed tightly – a Velcro lock will ensure that the door is not accidentally left ajar. Making sure the refrigerator is level will also help keep the door closed.
• Defrost the refrigerator when there is more than 1 cm (¼”) of ice in the freezer compartment.
• Train all members of your office in proper vaccine storage and handling. Staff should be familiar with the Vaccine Storage and Handling Guidelines.
  
• Organize vaccines by type with shorter expiry dates at the front of the refrigerator so that they may be used first.
• Check vaccine expiry dates regularly and return expired vaccines to SWPH with the vaccine return form.

Using a digital min/max thermometer

A digital min/max thermometer is a thermometer that accurately records the highest and lowest temperatures reached inside the refrigerator since the thermometer was last reset.

• If the thermometer has an IN/OUT switch, make sure it is always in the OUT position.
• The temperature probe should be placed in an empty vaccine box that is positioned in the middle of the refrigerator. This location provides the most accurate temperature readings.
• The thermometer’s batteries should be changed twice annually.
• Temperatures on the min/max thermometer should be read twice daily and the thermometer reset or cleared after each reading.