Vaccine Ordering and Fridge Inspections

In order to be compliant with the mandatory requirements for vaccine storage and handling, facilities must:

• Maintain vaccine fridge temperatures between +2°C and +8°C
• Keep a minimum/maximum thermometer in the fridge to monitor temperatures
• Check fridge temperatures twice daily and record in a log book

Reporting a cold chain incident to SWPH 

• Place all exposed vaccines in a bag marked “DO NOT USE”
• If your fridge has returned to a temperature between +2°C and +8°C, keep the vaccine in your fridge. If your fridge is still out of range and if you have access to another stable, monitored and inspected fridge (i.e. another fridge inspected by SWPH in your building), store the vaccine in that fridge until the other is stable. You may also keep the vaccine in a monitored hard-sided cooler for a short period of time until your fridge returns to appropriate temperatures.
• Call SWPH immediately at 1-800-922-0096 to report the vaccine exposure.

• 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.
• After a cold chain incident, you will be asked to fax copies of the fridge temperature logs to SWPH. You may have to submit your temperature logs for a few days to show that the fridge has stable temperatures before you can order vaccine again.
• Wasted vaccines which cannot be used are placed in a bag marked with the name of the institution or office that is returning them and “DO NOT USE”. The bag should be sent back to SWPH with a completed vaccine return form.
• The Public Health Nurse may choose to visit you 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.