SKILL PRESENTATIONSKILL PRESENTATION

COLD CHAIN AT PHC. COLD CHAIN AT PHC.

COLD CHAIN INDICATORS AT PHC.COLD CHAIN INDICATORS AT PHC.

Hema

DEFINITON.DEFINITON.

COLD CHAIN AT PHCCOLD CHAIN AT PHC::-- ICELINED REFRIGERATORS .ICELINED REFRIGERATORS .-- COLD BOXES .COLD BOXES .-- VACCINE CARRIERS.VACCINE CARRIERS.-- DAY CARRIERS. DAY CARRIERS. -- ICE PACKS.ICE PACKS.-- THERMOMETERS AND VVM.THERMOMETERS AND VVM.

ESSENTIAL ELEMENTSESSENTIAL ELEMENTS

PERSONNELPERSONNEL

EQUIPMENTEQUIPMENT

MAINTAINENCE OF EQUIPMENTSMAINTAINENCE OF EQUIPMENTS

TRANSPORTTRANSPORT

MONITORINGMONITORING

ICE LINED REFRIGRATORSICE LINED REFRIGRATORS

CAPACITY :140 L.CAPACITY :140 L.

NET VACCINE STORAGE CAPACITYNET VACCINE STORAGE CAPACITY: : 85 L.85 L.

TWO SECTIONS: TWO SECTIONS: SECTION A SECTION A SECTION BSECTION B

DO’ S AND DONT’SDO’ S AND DONT’S

ICE LINED REFRIGERATORICE LINED REFRIGERATOR

STORAGE OF VACCINESSTORAGE OF VACCINES

VACCINES NOT TO BE FROZEN.VACCINES NOT TO BE FROZEN.

RECONSTITUTED / MULTIDOSE VACCINE.RECONSTITUTED / MULTIDOSE VACCINE.

DILUENTS .DILUENTS .

SHELF LIFE VS EXPIRY DATE.SHELF LIFE VS EXPIRY DATE.

COLD LIFE OF VACCINE.COLD LIFE OF VACCINE.

FIRST IN FIRST OUT PRINCIPLE.FIRST IN FIRST OUT PRINCIPLE.

DURING POWER FAILURE :DURING POWER FAILURE :< 4 HRS < 4 HRS ––> 4 HRS > 4 HRS ––

DURING DEFROSTINGDURING DEFROSTING

VACCINE STOCK .VACCINE STOCK .

THERMOMETERS THERMOMETERS –– DIAL AND STEM DIAL AND STEM

COLD BOXCOLD BOX

USED FOR TRANSPORTATION AND USED FOR TRANSPORTATION AND STORAGE (EMERGENCY ) OF VACCINES . STORAGE (EMERGENCY ) OF VACCINES .

5 L ( 1500 DOSES OF VACCINE) .5 L ( 1500 DOSES OF VACCINE) .20 L ( 6000 DOSES OF VACCINE) .20 L ( 6000 DOSES OF VACCINE) .

NET VACCINE STORAGE CAPACITY: 22 LNET VACCINE STORAGE CAPACITY: 22 L

INSULATION THICKNESS : 105 MMINSULATION THICKNESS : 105 MM

HOLD OVER TIME : 5 L HOLD OVER TIME : 5 L –– 90 HRS.90 HRS.20 L 20 L –– 6 DAYS .6 DAYS .

VACCINE COLD BOXVACCINE COLD BOX

VACCINE CARRIERSVACCINE CARRIERS

FOR CARRYING SMALL QUANTITES OF FOR CARRYING SMALL QUANTITES OF VACCINE ( 16VACCINE ( 16-- 20 VIALS) .20 VIALS) .

VACCINE STORAGE: 1.7 LVACCINE STORAGE: 1.7 L

INSULATION THICKNESS : 40 MM . INSULATION THICKNESS : 40 MM .

FOUR ICEPACKS.FOUR ICEPACKS.

HOLD OVER TIME: 48 HRS.HOLD OVER TIME: 48 HRS.

VACCINE CARRIERVACCINE CARRIER

DAY CARRIERSDAY CARRIERS

CARRYING SMALL QUANTITIES OF CARRYING SMALL QUANTITIES OF VACCINE ( 6 VACCINE ( 6 --8 VIALS ) .8 VIALS ) .

HOLD OVER TIME: 6 HRS.HOLD OVER TIME: 6 HRS.

2 ICEPACKS.2 ICEPACKS.

USE IS NOT ENCOURAGED.USE IS NOT ENCOURAGED.

ICE PACKSICE PACKS

USED TO COOL COLD BOXES, VACCINE USED TO COOL COLD BOXES, VACCINE CARRIERS .CARRIERS .

VOLUME: 0.36 LVOLUME: 0.36 L

WT: 80 GMS.VIAL HOLES : 22 MM, 28 MM .WT: 80 GMS.VIAL HOLES : 22 MM, 28 MM .

FLAT PLASTIC CONTAINERS THAT AREFLAT PLASTIC CONTAINERS THAT ARE7/8 TH FILLED WITH WATER .7/8 TH FILLED WITH WATER .

FROZEN TO FROZEN TO --20 * C .20 * C .

PREPARATION OF ICEPACKS.PREPARATION OF ICEPACKS.

? ADDITION OF SALT TO ICE PACKS.? ADDITION OF SALT TO ICE PACKS.

SWEATING OF ICEPACKS .SWEATING OF ICEPACKS .

VACCINE VIAL MONITORVACCINE VIAL MONITOR

DEFINITION .DEFINITION .

INFLUENCE OF TIME AND TEMPERATURE.INFLUENCE OF TIME AND TEMPERATURE.

TYPES OF VVM.TYPES OF VVM.

VVMVVM

ORDER OF HEAT SENSITIVITYORDER OF HEAT SENSITIVITY

RANGERANGEMOST SENSITIVEMOST SENSITIVE

LEAST SENSITIVELEAST SENSITIVE

BCG ( RECONSTITUTED)BCG ( RECONSTITUTED)OPVOPVMEASLESMEASLESHEP BHEP BDPTDPTDTDTBCG BCG TTTT

WHY SHOULD VVM BE USED?WHY SHOULD VVM BE USED?

IS THE VVM ACCURATE?IS THE VVM ACCURATE?

DO ALL THE VACCINES CARRY VVM?DO ALL THE VACCINES CARRY VVM?

IF A VIAL CARRIES A VVM , DO WE NEED IF A VIAL CARRIES A VVM , DO WE NEED TO KEEP IT IN COLD CHAIN?TO KEEP IT IN COLD CHAIN?

WILL THE COLOUR CHANGE REVERSE IF WILL THE COLOUR CHANGE REVERSE IF RETURNED TO COLD CHAIN ?RETURNED TO COLD CHAIN ?

WHAT HAPPENS IF EXPOSED TO BRIEF WHAT HAPPENS IF EXPOSED TO BRIEF EXPOSURE OF MODERATE HEAT?EXPOSURE OF MODERATE HEAT?

CAN A VACCINE WHICH HAS CROSSED ITS CAN A VACCINE WHICH HAS CROSSED ITS EXPIRY DATE BE USED IF THE VVM IS EXPIRY DATE BE USED IF THE VVM IS INTACT?INTACT?

WILL VVM REGISTER IF VACCINE WILL VVM REGISTER IF VACCINE FREEZES? ?FREEZES? ?

VVM WITH SOME HEAT EXPOSUREVVM WITH SOME HEAT EXPOSURE--SHOULD WE USE IT ?SHOULD WE USE IT ?

IS THERE A LIMIT TO NUMBER OF TIMES IS THERE A LIMIT TO NUMBER OF TIMES AN UNOPENED VIAL WITH VVM CAN BE AN UNOPENED VIAL WITH VVM CAN BE TAKEN FOR OUTREACH?TAKEN FOR OUTREACH?

DO VVM INCREASE THE COST OF COLD DO VVM INCREASE THE COST OF COLD CHAIN?CHAIN?

VACCINE WITH VVM VACCINE WITH VVM

–– TOBE USED IN AREAS WITH POOREST TOBE USED IN AREAS WITH POOREST COLDCHAIN.COLDCHAIN.

–– ARE NOT PROXY INDICATORS OF HEAT ARE NOT PROXY INDICATORS OF HEAT EXPOSURE OF OTHER VACCINES WITHOUT VVM .EXPOSURE OF OTHER VACCINES WITHOUT VVM .

VACCINES WITHOUT VVMVACCINES WITHOUT VVM–– SHOULD BE USED FIRSTSHOULD BE USED FIRST . .

SHAKE TEST.SHAKE TEST.

REVERSE COLD CHAIN.REVERSE COLD CHAIN.

SHAKE TESTSHAKE TEST

COLD CHAIN FAILURECOLD CHAIN FAILURE

DEFINITION .DEFINITION .

WHAT TO DO ? WHAT TO DO ?

WHOM TO CONTACT ?WHOM TO CONTACT ?

DO YOU KNOW?DO YOU KNOW?

DOWN TIME DOWN TIME

RESPONSE TIMERESPONSE TIME

COLD CHAIN SICKNESS RATECOLD CHAIN SICKNESS RATE

SICKNESS REPORTINGSICKNESS REPORTING