Impfkühlschrank- und Impfstoffmanagement in Hausarztpraxen: Eine repräsentative, Web-basierte Umfrage unter Hausärzten (Keep Cool I)

Abstract

The purpose of this study was to analyse vaccine refrigerator and vaccine management in primary care and to identify physician- and practice-related influencing factors. Adequate cooling of vaccines in a temperature range of 2-8°C is essential to assure vaccine effectiveness. Studies from various countries have demonstrated cooling chain problems. We surveyed general practitioners about the quality of their vaccine refrigerator and vaccine management and aimed at identifying physician- and practice-related influencing factors. A cross-sectional, web-based questionnaire survey was performed among 3 physician populations in primary care: a 10% random sample of general practitioners (n=954), all teaching physicians of the Universities Duisburg-Essen (n=221) and Halle-Wittenberg (n=92). Surveyed were items on the following 6 aspects: (1) responsibilities within practice teams, (2) vaccine ordering and storing, (3) criteria for the vaccine pre-selection, (4) stocking system inside the refrigerator, (5) wrapping, and use of stocking boxes, (6) refrigerator and temperature control. The quality indicator "comprehensive refrigerator management" was defined to include 4 aspects: (1) separate refrigerator, (2) written temperature documentation (temperature-logbook), (3) regular storage control (wrapping, temperature and expiration date), and (4) storage in original wrappings. A total of 278 physicians participated in the survey (22%). Of these, 80% had a separate refrigerator, 52% reported written temperature documentation, 93% documented regular storage control addressing vaccine wrappings, temperature and expiration dates, and 95% reported vaccine storage in original card box wrappings. A "comprehensive refrigerator management" was realised by 42% of the practices. This indicator was reached more frequently by practices with 3 or more physicians (p=0.01) and those with an additional qualification in travel medicine (p=0.036). Our survey showed good results for most aspects of the refrigerator and vaccine management but room for improvement with regard to temperature documentation.

Effectiveness of the online-eLearning program KeepCoool at improving the vaccine cold chain in general practices

“…Also, 20.3% to 52.6% of the practices incorrectly stored vaccines in door shelves [ 12 , 13 , 17 ]. In a 2014 survey among German general practitioners (GP), 16% reported cold chain breaches as error or near error, and only 51% reported to document refrigerator temperatures twice a day as recommended [ 18 , 19 ].…”

Vaccine cold chain in general practices: A prospective study in 75 refrigerators (Keep Cool study)

“…According to a systematic literature review, freezing temperature exposure occurred in approximately 33.3% of refrigerators used for vaccine storage in ten wealthier countries [14]. In our prior cross-sectional questionnaire study, 16% of German general practices self-reported experiencing cold chain breaches either as an error or near-error, and 49% lacked adequate monitoring and documentation [15,16]. The Keep Cool study aims at ensuring optimal vaccine storage conditions: after visual inspections of refrigerators used to store vaccines and a baseline temperature survey of seven days, general practices with temperature violations are offered access to a tailored online learning program [17,18].…”