Immunization
Maintaining Optimal Vaccine Storage and Handling (Cold Chain)
Background:
Vaccines can lose their potency and effectiveness if they are exposed to heat and/or cold. To maintain maximum potency of vaccines, all vaccines must be kept between +2°C and +8°C at all times. Administering improperly stored vaccines can result in a poor immune response and a lack of protection for clients.
Cold Chain incident:
A cold chain incident occurs when vaccine refrigerator temperature readings are outside the required range of +2°C to +8°C. Call the Toronto Public Health (TPH) Vaccine Information Line at 416-338-2030 right away. Do not use the vaccines. TPH nurses will assess the stability and potency of each vaccine in the refrigerator. Vaccine stability is determined by the type of vaccine, temperature reading and length of exposure.
Vaccine Staff Management:
- Train all members of your office in proper vaccine storage and handling practices.
- Dedicate one staff (and a back-up person) to monitor the vaccines twice daily.
- Ensure staff are aware of new information regarding vaccine storage and handling.
Vaccine Refrigerator:
- Dedicate a good functioning refrigerator for vaccine storage use only. Pharmacy/lab-style/laboratory grade refrigerators are highly recommended for large storage of vaccines. Mini and bar-style refrigerators are generally not recommended to store vaccines due to unstable temperatures.
- Ensure that refrigerator is sufficient size to accommodate required stock of vaccines.
- Place water bottles on empty shelves and door shelves for bar and domestic refrigerators.
- Store only vaccines in refrigerator (no food, beverages and /or medical/laboratory specimens).
- Keep vaccines in the middle of refrigerator away from the walls, floors and cold air vents.
- Place short expiry dated vaccines in front of long expiry dated vaccines.
- Keep all vaccines in their original boxes organized by product types.
- Install a Velcro door latch to ensure the refrigerator door properly closes.
- Defrost freezer when ice is more than 1 cm thick.
- Ensure that refrigerator electrical outlet is not accessible or is covered by a metal cage.
Vaccine Refrigerator Temperature Monitoring Device:
- Ensure that every vaccine refrigerator is equipped with a functioning temperature monitoring device that can measure minimum, maximum and current or continuous temperatures. Data loggers and wireless temperature monitoring devices are highly recommended as they can record temperatures continuously.
- Check vaccine refrigerator temperatures twice daily and document in a temperature log book. Data loggers and wireless temperature monitoring system must be checked visually twice daily and documented to ensure that the devices are recording temperature between +2°C and +8°C at all times.
- Ensure that all temperature monitoring devices are calibrated or accuracy tested yearly. Contact manufactures or vendors of the devices for information on performing accuracy testing.
- Change battery of digital min-max thermometers every six months.
Vaccine Ordering at the Ontario Government Pharmaceutical and Medical Supply Service (OGPMSS):
- Keep zero/minimum stock of vaccines during planned periods of premise closure.
- Ensure that no more than one month stock of vaccines is stored in refrigerators.
- Place orders only for the quantity of vaccines required between scheduled delivery dates.
- Contact the OGPMSS at 416-327-0837 to obtain a Return Authorization Number (RAN) and complete a Non-Reusable Vaccine Record to return expired or spoiled vaccines.
Receiving Vaccines from the OGPMSS:
- Verify the shipments with the order form while the OGPMSS truck driver is present. Request the OGPMSS truck driver take back excessive doses of vaccines if ordered and/or received in error.
- Examine the shipments for Vaccine Cold Chain temperature breach and /or evidence of damage to products.
- Place vaccines in refrigerators immediately, placing newer vaccine behind older vaccine.
- Notify OGPMSS immediately if there are any discrepancies in your vaccine shipment.
- Have expired/spoiled vaccines bagged and attached with a properly completed Non-Reusable Vaccine Record prior to your expected vaccine delivery date. Provide the expired/spoiled vaccine bag to the OGPMSS driver for return.
How do I get more information?
Call the Toronto Public Health (TPH) Vaccine Nurses Line at 416-338-2030.