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

Abstract

IntroductionProtecting vaccines from freeze damage is considered one of the most poorly addressed problems in vaccine management. Freezing may impair the potency especially of adsorbed vaccines. The Keep Cool study aims at ensuring optimal vaccine storage conditions in general practices. This publication analyses the baseline data using standardised temperature recordings.MethodsThis prospective study in German general practices analysed 7-day temperature recordings of refrigerators used for vaccine storage. Temperatures were recorded continuously using a standardised data logger with an accuracy of ±0.4 °C. The prevalence rates of refrigerators within the target range (2 to 8 °C) and of those reaching critically low temperatures (≤0 °C) were calculated. In addition, the cumulative time and the duration of single episodes beyond the target range were computed. To assess for structural deficits, the prevalence of refrigerators with a cycling of >5 °C was determined. Generalised linear mixed models were applied to analyse correlating factors between the dependent variables ‘within temperature range’ and ‘reaching critically low temperatures’ with practice characteristics.ResultsThe study included 64 of 168 practices (38.1% response rate) with 75 refrigerators. The prevalence of refrigerators with temperatures within the target range was 32.0% (n = 24), and 14.7% (n = 11) reached critically low temperatures <0 °C. 44.0% of refrigerators (n = 33) showed temperatures >8 °C and 28.0% (n = 21) <2 °C. Of the 168 hours recorded per refrigerator, the average cumulative time >8 °C was 49 hours, <2 °C 75 hours and ≤0 °C 74 hours. The longest consecutive period of critically low temperatures was 168 hours (mean: 39±53). The prevalence of refrigerators with a cycling range of >5 °C was 29.3%.ConclusionGiven the importance of immunisation, the results of our study call for action, as two-thirds of the refrigerators exhibited cold chain breaches and 15% reached critically low temperatures threatening vaccine potency.

Assessment of Factors Affecting Vaccine Cold Chain Management Practice in Bahir Dar City Health Institutions, 2019

“…In this study, out of 14 health facilities, only 9 (64.3%) had functional thermometer. In order to effectively maintain the cold chain system, there should be at least one functional thermometer to control the temperature of refrigerator in every day in the health facility since these facilities are expected to provide vaccination services for their communities on a daily basis the must regulate the temperature of the refrigerator in order to maintain the potency of the vaccine [23,24].…”

Visual inspection of vaccine storage conditions in general practices: A study of 75 vaccine refrigerators

“…The main objective is to improve vaccine storage conditions in German primary care practices. The primary outcome is the number of refrigerators with temperatures within the target range (2°C to 8°C) for seven days [23]. This manuscript presents the results for one of the secondary outcomes, namely the quality of vaccine refrigerator management as assessed by direct visual observations using a checklist.…”

“…In response to the deficits, the Keep Cool study was initiated with the aim of ensuring good vaccine storage conditions. The Keep Cool intervention study consisted of three parts: after a baseline temperature survey of seven days (part one), general practices with temperature deficits were offered access to an online learning program (part two) [23] and were followed up seven weeks later [24]. This publication describes the baseline data of the Keep Cool study focusing on the quality of vaccine refrigerator management assessed in checklist-based direct observations of refrigerators.…”

Design of Solar Powered Vaccine Backpack

“…Unfortunately, both practices, even with refrigerator or freezer compartments of the householdgrade combination storage units do not perform as well as recommended by WHO cold chain practice [9]. Research in one of developed Europe countries, shows that only one-third of the refrigerators fulfilled the cold chain requirements, and more than 15% threatening vaccine potency [10]. There is a gap of cold chain equipment providing a promising avenue for new technological research [6,11].…”