SYSTEM OF COLD CHAIN AND VACCINE MANAGEMENT

Er. S.C.Jena, State Cold Chain Officer

Directorate of Family Welfare, Orissa

1
Objective of Vaccine Management & Cold
Chain Training
1. Immunisation is one of the most cost effective and strong
primary public health programme.
2. Health personnel is providing immunisation services to
pregnant women and children in the community is most critical
by cold chain.
3. Thus storage of vaccines at the recommended temperature is
crucial for an efficient immunisation.
4. Even the most expensive and sophisticated equipment will not
ensure an effective cold chain if not correctly used and
managed by health personnel.
5. High quality immunisation coverage under UIP by cold chain.
6. Vaccine is biological substance and progressively loses
potency.
2
Objective of Vaccine Management & Cold
Chain Training Contd
To improve knowledge, skills & responsibilities
Strengths and good practices at field level
To improve performance gap of immunization program
Effective cold chain maintenance at all level
Effective stock management of vaccine and logistics
Good record keeping and computer data base planning
Develop internal capacity for self assessment
Strengthen future planning and inventory of cold chain system
Satisfactory transport arrangement (vaccine & logistic distribution
plan)
3
 Objective of Vaccine Management &
Cold Chain Training Contd
To improve capacity of cold chain equipment,
preventive maintenance & maintain correct storage
temperatures
Increasing immunization coverage, quality
vaccination (potent vaccines)
To ensure an efficient vaccine, cold chain
management and logistics system to forecast and
deliver adequate supplies of vaccines in a timely
manner.
Re-orientation training needs of cold chain handlers,
for better field work and good practices.
To provide better immunization services to your
community for the sake of our children and mother.
4
 Vaccine Characteristics
Immunity
Target Diseases (VPDs)
Polio
Measles
Diphtheria
Whooping Cough
Tetanus
Tuberculosis
Hepatitis B
5
System of Cold Chain

System of
storing &
transporting
vaccines at
recommended
temp. from
point of
manufacture
to the point of
use.
6
Supply of vaccines

7
Cold Chain is the back bone of EPI

8
 Status of WIC/WIF & Vaccine Supply
SL LOCATION NAME OF THE NO. WITH YEAR DISTRICT COVERED REMARK
. OF THE MACHINE & SIZE OF INSTALLATION
N MACHINE
O.
1 State HQ, HURRE WIC 31 cum One 1985 Bulk storage for STATE Working
Bhubaneswar
WIF 24 CUM HURRE One 11.11.99 Cuttack / Jajpur / -do-
2 -do- (NON C.F.C.) Jagatsinghpur /
Kendrapara / Puri /
3 -do- YORCO WIC-16M3 30.8.2003 Khurda / Nayagarh / Not
Dhenkanal / Angul
4 Balasore RVS Foster WIC 16.5 cum One 1986 Balasore / Bhadrak / Working
Keonjhar / Mayurbhanj

5 Phulbani RVS Foster WIC 16.5 cum One 1986 Phulbani / Boudh / Working
Kalahandi

6 Ganjam RVS Foster WIC 16.5 cum One 1986 Ganjam / Gajapati Working

7 Sambalpur Foster WIC 16.5 cum One 1986 Sambalpur / Deogarh / Working
RVS Bargarh / Bolangir /
Nuapada / Sonepur

8 Sundargarh HURRE R/K 16cum One 2.12.99 Sundargarh / Jharsuguda Working

RVS (NON C.F.C) WIC

9 Koraput RVS HURRE R/K 16 cum One Jan. 2000 Koraput / Malkangiri / Working
(NON C.F.C) WIC Nabarangpur /Rayagada
9
 Vaccine Safety
Action for Vaccine Safety
Know the correct storage temperature for every vaccine.
Keep the door closed
Lock the door
Monitor the storage temperature
Stack the vaccine correctly
Organize storage for earliest-expiry-first-out ( EEFO)
Avoid frozen vaccine
Know the contingency plan.

10
List vaccine most to least sensitive to heat and those damaged
by freezing
Vaccine Sensitivity to heat
Range Vaccines
Most Sensitive BCG ( After Reconstitution)
OPV
Measles( Both before & After reconstitution)
DPT
BCG ( Before Reconstitution)
DT
TT, Hep B
Less Sensitive

Vaccine Sensitivity to Freezing

Range Vaccines
Most Sensitive Hep B

DPT
DT 11
Less Sensitive
TT
 Freezing of Vaccines and diluents

Thus, storage of vaccines at the recommended temperature

is crucial for an efficient Immunisation.
Unaffected by freezing are:
BCG
OPV
Measles
Vaccines freeze at temperatures just below zero
BCG and measles vaccines must not be frozen after
reconstitution
Diluents for any vaccine must never be frozen
12
 Vaccine Sensitivity to Light

Exposure to ultraviolet light will cause permanent

an irreversible loss of potency of some vaccines
These vaccines are supplied in dark brown vials
Protect these vaccine against sunlight and
florescent ( neon) light
BCG
Measles.

13
 Summary of Vaccine Sensitivities
Vaccine Exposure to Heat / light Exposure to Cold

Heat and Light Sensitive Vaccines

BCG Relatively heat stable, but Not damaged by
sensitive to light freezing.
OPV Sensitive to heat and light Not damaged by
freezing.
Measles Sensitive to heat and light Not damaged by
freezing.

14
 Summary of Vaccine Sensitivities
Condt
Vaccine Exposure to Heat / light Exposure to Cold

Freeze Sensitive Vaccines

DPT Relatively heat stable Freezes at 3C
(Should not be frozen)
Hep B Relatively heat stable Freezes at 0.5C
(Should not be frozen)
DT Relatively heat stable Freezes at 3C
(Should not be frozen)
TT Relatively heat stable Freezes at 3C
(Should not be frozen)
15
 Correct Diluents use for Freeze
Dried Vaccine
The Freeze Dried Vaccine and their corresponding
diluents are correctly ordered, received, stored and
distributed.
The vaccines are always used with their corresponding
diluents.
Diluents are maintained at +2 deg + 8 deg C same as
the vaccine before reconstitution.
Only the diluents provided by the manufacturer.
Diluents for BCG 1.25 ml normal saline
Diluents for measles 2.5ml pyrogen free double
distilled water.
16
 ESSENTIAL ELEMENTS FOR VACCINE
MANAGEMENT & COLD CHAIN
Safety & Potency of the Vaccine
Personnel to organize & manage vaccine distribution
Equipment for storage & transport of vaccine
Transport facilities (Vaccine Van)
Maintenance of Equipments
Monitoring & Supervision
Procedures
Storage Temperature
Building and Storage Capacity
Stock Management
Effective Vaccine Delivery
Correct use of Diluent
Multi dose - / Open vial policy
Vaccine Wastage Control
Logistic Management
Report Return (RIMS)
17
 Monitoring Cold Chain Condt
Key activities Daily tasks
Control & Ensure to check & record
adjustment of the temperature twice a day
temperature (morning & evening)
Adjust thermostat (if
necessary)
Arrangement of Make sure that vaccines,
vaccines, diluents diluents and ice packs are
& ice pack loaded according to the
instructions.
General Clean, dry & store cold
maintenance boxes & vaccine carriers
that have been used during
the day.
Check the stabilizer
Reporting In case of equipment
failure, long interruptions of
electricity, act according to
the emergency plan
Weekly tasks Monthly tasks
Personally check the Analyse the trend of the
temperatures & cross temperature chart.
check with the record Discuss any abnormalities in
expected pattern with your
supervisors.
Check & remove expired
stock
Re-supply in time & avoid
stock out /overstock
Check if the Clean & dry the inside of the
refrigerator and /or refrigerator & / or the freezer
the freezer needs to Clean the outside of the
be defrosted refregerator &/or the freezer
from dust.
Defrost regularly
Complete all the monthly
reporting (UIP) formats
according to the instructions
and send to the next 18
level.
 The correct Storage Temperature
Primary Intermediate Health Health
Center Post
Region District
6 months 3 months 1 months 1 month Daily Use
OPV -15 C to 25 C
BCG WHO no longer recommends that freeze
Measles dried vaccines be stored at 20C . Storing
them at 20deg c is not harmful bur is
unnecessary. Instead these vaccines should be +2 C to +8 C
kept in refrigeration a transported at + 4C to
+ 8 C

DPT,
Hep - B,
TT
Diluents vials must NEVER be frozen . When the manufacture supplies a freeze-dried vaccine packed together
with its diluents . ALWAYS store the product between + 4 deg C and + 8 deg C . Where space permits, diluents
supplied separately form the vaccine may be store safely in the cold chain between + 4C and + 8C .
Six moth s is the maximum recommended storage time at primary level. This includes those period required
19 to
obtain clearance from the national regulatory authority.
 Supply of Vaccine
Stock Entry
Manufacture Date
Expiry Date

Since vaccine loose potency even under perfect storage conditions

they have expiry dates.
The expiry date is only valid for those vaccines that have been
stored correctly
Never keep expire vaccines in the cold chain mark DO NOT USE
and remove them from the cold chain ( Do the same with vaccines
with VVMs at or beyond the discard point)
Temperature Recording twice daily
FIFO
FEFO
Cold Chain Status (VVM) 20
 POTENCY TEST-VVMs

Potency lost cant be regained

Re-constituted vacc. Should not be used beyond 4 hours.
Shake Test if T-series vacc. Was frozen
OPV as indicator of quality of cold-chain
Note VVM stage
Samples for testing = No. of PHC
WIC=5%, Dist. HQ=15%, PHC=50%, Out reach=30%
Reserve Cold Chain.

21
 OPV taken as indicator of quality of cold -chain

Attached to all vaccine vials

Decision to use, use-first, or discard

VVM discard overrides expiry date

Expiry date discard overrides VVM

Not used on reconstituted vaccine

22
 The Vaccine Vial Monitor VVM
The VVM is a temperature monitoring device
attached to the vaccine vial by the manufacturer.

The VVM will progressively change color with heat

exposure.

Why are VVMs important

Prevent delivery of heat damage vaccine
Reduce vaccine wastage
Indicate cold chain problems
Serve as a tool to manage vaccine stocks
facilitate immunization outage

23
 The Vaccine Vial Monitor VVM

Times recorded for a VVM attached to a OPV vial

Exposure Temperature Time for VVM to reach

discard point
Room temperature +25C 8 days
Room temperature +20C 20 days
In a refrigerator +4C 180 days
In a freezer 20C Over 2 years
24
 Shake Test- How -2?
To determine if DPT /DT/
TT/ Hep - B / Typhoid frozen
any time.
Visually evaluate the vial, frozen or
not ?
Check if the liquid is homogenous
Freeze control vials
Let the control vial thaw completely
an label it (Do not heat up)
Shake the control an suspect vials
Evaluate the sediments rates.
Take 2 vials of the same vaccine
from the same manufacturer & batch
number.
25
 The Shake Test Example (2)

Use Vaccine Do not use Do not use

The Vaccine starting The Vaccine is almost all clear with thick sediment at the bottom of the vial
to clear & has no
sediment at the bottom
of the vial 26
 Shake Test- Contd

Freezing damages certain vaccines.

Accidental freezing is frequent in most cold
chains.

Freezing during transport can be avoided.

Freezing during storage can be avoided.

Monitoring temperature is important.

27
28
 Icepacks how to handle
Make Ice packs as follows
Fill with clean cold water and put the cap on tightly , do
not fill the icepack completely . Water will expand
when frozen , so leave sufficient room for expansion
about 4 cm from the top.
Hold each icepack upside down and squeeze it to make
sure that there is no leak.
Put the icepacks upright or on their sides in the freezer
and leave some space in between if possible .Close the
door.
Leave them in the freezer for at least 48 hours to freeze
solid.
29
 Icepacks , Important

You do not have to refill ice packs every time

you use them. Use the same water repeatedly
Only use icepacks that have a mixture of ice and
water.
When using wet ice ,place the vaccines in an
water proof container.
During IPPI program use only frozen icepacks in
vaccine carrier.
30
 Ice Pack Conditioning
The following procedure is recommended
Layout icepacks preferably in single rows but
never in more than two rows.
Leave a 5 cm space all round each icepack.
Wait until there is a small amount of liquid water
inside the icepacks. This will take upto15minutes
to one hour at ambient temperature rather less at
higher temperature. Shake one of the icepacks
every few minutes. The icepack is conditioned as
soon as it begins to move about slightly inside its
container.
31
32
Measles

33
 Temperature Monitoring

Temperatures should be recoded twice a day

in the morning and in the afternoon
One staff member should be responsible
If the temperature is out side the limits action
should be taken to protect the vaccines
Always read from the thermometer inside the
cold chain equipment
Use graphical chart attached to the outside of
the equipment to register the temperature

34
How to adjust the temperature
If the Temperature is too high
If the temperature is too low
Thermostat
It may be set to maximum cooling in DF and allow temp. to
reach 20 deg C for 6 to 8 hrs and then adjusted.
In ILR it may be set to maximum for 48 hrs. till the lined
tubes are fully frozen and then adjusted.
Temp. record of each ILR / DF - Adjust Thermostat at
particular position.
Do not adjust the Thermostat button during the power
failure, wait and check again. 35
 Refrigerator-if the temperature is outside the safe limits

Temperature Action
At or below 0C Take immediate action to correct the low temperature and
VACCINE AT RISK ensure that the problem does not arise and adjust thermostat.
Check freeze-sensitive vaccines
Do a shake test
Make a report
Between +8Cand +10C If there has been a temporary power failure no further action
is necessary.
Check that the refrigeration unit is working, monitor the
situation closely, do not take action directly but wait until the
next temperature inspection and take appropriate action if
temperature is not within the normal range at that time

Above +10C Take immediate action to implement the agreed contingency

VACCINE AT RISK plan
make a report 36
 Freezer if the temperature is outside the safe limits

Temperature Action
Below 25C Adjust Thermostat
Check that the temperature is within the normal range at the
time of the next inspection

Above 15C If there has been a temporary power failure,nofurthur action

is necessary's temperature rise (2 hours) to +10C is
permissible following an extended power cut.
Check that the refrigeration unit is working , monitor the
situation closely and take appropriate action if conditions are
not normal at the time of the next inspection. Action if
temperature is not within the normal range at that time.

Above +10C Take immediate action to implement the agreed contingency

VACCINE AT RISK plan
make a report
37
 DO NOT FORGET

All vaccines suffer loose potency gradually, even at correct

storage temperatures- observe expiry dates.
All vaccines suffer much faster loss of potency when
exposed to temperatures above +8C
Any loss of vaccine potency is irreversible
Damage due to successive exposures to heat or light is
cumulative
Hepatitis B , DPT & TT are destroyed by freezing
BCG and measles vaccines are damaged by exposure to
strong light as will as heat.

38
 Maintenance of Cold Chain Equipment

1. Equipments supplied by GoI

2. Maintenance by GoO
3. Equipment for storage and transport
State Level: WIF, WIC & Vaccine Van
Reg. Level (RVS): WIC, DF (Chest Freezer 300 lt.),
ILR (300 lt.),Vaccine Van, Cold Box (20 lt.)
Dist. Level: DF (300 lt.), ILR, Cold boxes, Vaccine Van
Block Level: DF (140 lt.), ILR, Cold box &Vaccine Carrier
Sub Centre Level: 5 lt. Cold boxes, Vaccine Carrier (4 Ice Pack)

39
 Cold Chain Equipment
Walk in Freezers ( WIF)
For bulk storage of OPV ,Vaccine and
freeze ice packs
Temperature maintained around 20C
Two sizes : 16.5 & 32 Cu.m
Two identical cooling units & standby
Generator
Stores 3 months requirement + 25 % buffer

40
 Walk in Coolers ( WICs)

For bulk storage of vaccine at State &

Regional level ( 4-5 dist)
Temperature maintained + 2C to + 8C
Two sizes : 16.5 & 32 Cum
Two identical cooling units & standby
Generator
Stores 3 months requirements + 25 % buffer
41
 ILRS & DEEP FREEZERS
FULT FINDIG AND SOME IMPORTANT TECHNICAL INFORMATION

Equipment will not work

Equipment will work but no cooling or less cooling
Observation the Green Control lamp on the front panel
- Not Glowing (Detect in Power Supply)
- Glowing (Detect in the equipment)
- Power Available
- Power not Available
- Check the Compressor
- Running (No Cooling or less Cooling)
- Not Running
Breakdown Reporting

42
Deep Freezer ( DFs) (SB-
(SB-300 and SB-
SB-140)

Vaccine Storage Capacity of SB-300

= 188 ltr.and SB-140 =128 ltr.
Cabinet temp: - 18 deg to 20 deg C
For storing OPV and freezing ice
packs
Hold over time : 300 lt : 18- 26 hrs,
140 lt: 18-22 hrs
Vaccine storage capacity : 300 lt >
1.5 lakh, 140 lt > 65,000 doses
Ice-pack freezing capacity: 300 lt >
35-40 ( 12-14 kg) , 140 lt> 25-20 ( 8-
10 kg)
Diluents should not be kept in Deep
Freezer
Eletrolux TCW-1151 (240 lt) unit
can also be used as a Deep Freezer
43
44
Ice Lined Refrigerator ( ILRs) 300lt & 140 lt

Net storage volume of MK-140= 85 ltr.

The cfc ILR(Model: MK-140/142) has a bank

of frozen ice on all the four sides, inside the
cabinet. The ice lining consists of plastic
ice packs filled with water and supplied
along with the ILR. This lining improves
the ability of the equipment to keep the
vaccines below +8C by upto 60 hours in
case of power cut above +43C. At ambient
temperature below + 30C the vaccines can
be kept for more than 72 hours.

So it is a temperature catalyst.
Opinion invited if chemical
icepack like freezol pack are
placed inside & a Fan is fitted
in compressor compartment
45
46
 Non CFC Deep Freezer/ ILRs
It is widely agreed that chlorine derived from man-made
substances, including chloroflurocarbon (CFC) and
hydrochlorofluorocarbon (HDFC) refrigerants released into the
atmosphere, is responsible for depletion of the ozone layer. Ozone
depletion is linked to increased ultraviolet B radiation at the earths
surface, which in turn is associated with skin cancer and the
destruction of plants and aquatic life.
The International community has recognized this problem and is
committed to the elimination of the refrigerants in question.

They are of same design except for the control panel

Non-CFC equivalent of the old CFC models:
ILR : MK 140-> MK 144, MK 300 -> MK 304
FZR: SB 140-> MF 144, SB 300-> 304 47
Automatic voltage Stabiliser Ideally Different components of Automatic
Voltage Stabilizer:-

VOLTMETER :.

INPUT-OUTPUT SELECTOR :

QUICK START : A snappy press button that

allows instant output without the two-minute wait.
(The stabilizer has a switch-on time delay of 2
minutes. The minute indicator lamp will also
glow and output to equipments will be available
after 2 minutes. In case of first switching, you
may bypass this time delay by pressing the
switch for a few seconds and obtain quick-start)

MAINS INDICATION : This lamp glow to indicate

availability of output to the equipments.

VOLTMETER ON/OFF SELECTOR : Continuous

use of Voltmeter may be damaging. Keep this
switch normally OFF. Only to read input or
output voltage on the voltmeter, put this switch
ON.

48
Automatic voltage Stabiliser Contd.

Various Features:-
Reduce range of fluctuation of main voltage of155-280V.AC
to a smaller range at output of 220 +/-10 volts.
One stabilizer can supply two smaller (140 lt.) or one larger
(300 lt.) equipment,
2 sets of terminals on side for connection to ILR/Freezer,
3 wires from equipment (Brown to L-Line, Bluie to N-Neutral
& Green/yellow to E-Earth) are to be connected to appropriate
terminals Voltage Stabilizer.
Plug of supply cable of stabilizer should be connected to wall
socket properly.

49
 Automatic voltage Stabiliser Contd.

Important Notes:-
Cuts off output automatically when input goes below
150volts or over 280 volts.
Re-start automatically when the supply voltage comes
within the range again.
Output available only after 2-5 min after switching ON.
A Circuit Breaker (MCB) is at the back or side of the
stabilizer, which trips OFF in case of overload. When
tripped, should be put ON and the equipment should run if
the problem is over.
In case MCB trips OFF again and again, inform technician.
50
 Important Notes
The temperature inside ILR , Cold Box , Vaccine Career &
Day should be in between + 2 & + 8 centigrade
The Temperature in Deep Freezer should be at 20
centigrade.
Only in emergency Polio and Measles vaccine can be store
in Deep Freezer otherwise it should be used exclusively for
preparing ice packs
One Stabiliser individually is needed for MK 300 or SB
equipments but only one Stabiliser is sufficient for MK
140 and SB 140 ( Twin set ) installed at PHC

51
 Important Notes Contd.
The hold over time of electrical or non-
electrical Cold Chain equipment depends upon
the following factors
Frequency of opening of Lid
Quantity of vaccine kept inside
No exposure to direct sunlight
Condition of Ice packs inside non-electrical Cold
Chain Equipments.

52
Installation of Equipment & Power Supply Arrangement

The equipment are to be installed in a well

ventilated room avoiding direct sunlight or any
other source of heat.
Power-supply socket.
Install the equipments on a level floor firmly.
Leave minimum 10 cm space on all sides.
Examine the level.
Examine the compressor compartment.
Check the mounting bolts.
Check incoming & outcoming electrical
connections.
53
Connect the leads of power supply cord.
 Vaccine Transportation Equipment

Cold Boxes - 5 ltr

Vaccine Storage Capacity - 1,500
doses
Hold Over Time : ( at + 30 C) :
90 hrs
Ice pack capacity = 36 nos.
Cold Box 20 Ltr
Vaccine Storage Capacity = 6000
doses
Hold Over Time : ( at + 30 C) - 6
days
- Ice pack capacity = 96 nos.

54
 To Pack Cold Box

Use recommended numbers of ice-packs

Place fully frozen ice-packs side by side against the inside
walls an bottom , as per drawing on the cold-box.
Stack the vaccines & diluents in their boxes , loose ones in
plastic bags.
Place packing material between PDT/DT/TT vaccine and
ice-packs they should no touch the ice-packs
Secure the lid tightly

55
 Care to be taken.

Clean & dry after every use.

Check inside & outside for cracks & rubber seal
for breakage
If required , adjust tension on the latches to close
lid tightly
Lubricate hinges & locks periodically

56
Vaccine Carrier With 4 Ice packs

To carry 16-20 vials from PHC to

outreach sessions.
4 fully frozen ice-packs to be used
in the space proved fro them
Wrap vaccines with thick paper &
put them in polythine bag.
Place some packing materials
between T-series vaccines & ice
packs
Secure the lid tightly
Clean & dry after every use. 57
 Day Carrier With 2 Ice packs

To carry 6-8 vials from

PHC to outreach sessions.
Hold over time is 6-8
hours only
Not used during R.I
programme.

58
DIAL THERMOMETER Temp- Recording
Record temp ILR/Freezer twice daily

Plastic housing
Overall diameter : 70 mm
Indication : -50C to + 50C

* ALCHOHOL STEM TERMOMETERS :

Temp. range : - 50deg C ( - 40C) to + 50C
Plastic Housing

Use : For measuring vaccine storage

temperature Bi-metal operation
Remarks:- It will never come in direct contact with ice pack ,
thereby better than stem thermometer- Opinion invited

59
 Dial Thermometers
External reading:
Remote sensors, stem or capillary
Alarm contacts
Vapor pressure more accurate/costly
Bi-metal require recalibration
Some include max/min temperature
indication
Used in intermediate stores
Place sensors 1) in coolest place 2)
in warmest place

60
 Stem Thermometers
Alcohol/glass
Dont use LCD type!
Accurate
Some provide max/min reading
Used in peripheral vaccine stores
Place
1) in coolest place
2) in warmest place

61
 Preparation of Ice Pack
Check for any leakage an fill plain water up
to the level mark in ice-packs for freezing.
Wipe them dry. ( Never add salt to water)
Stake ice packs on the floor horizontally ,
on its edge,keeping space of 1-2 mm from
each other for air circulation
Always keep 50-60 frozen ice-packs at any
given time at PHC

Conditioning of Ice Packs

62
 Some Essential Tips regarding Cold Chain
Electrical Cold Chain Equipment
Name of Place of Vaccine Storage Ice Pack Hold Over Time
Equipment Installation Capacity Freezing at different
Capacity Temperature
ILR MK 300 ( Vest District HQ 60,000 doses ( Mixed Antigen) Nil At 43C for 22 hrs
frost) 2,00,000 doses ( if only OPV) At 32 C for 26 hrs
75000 DPT /TT
DF SB 300 ( Vest District HQ 1,20,000-2,00,000,Doses of 24-26 At 43C for 22 hrs
Frost) OPV At 32 C for 26 hrs
ILR MK 140 ( Vest PHC 2,50,000 Doses ( Mixed Nil At 43C for 68 hrs
Frost Antigen) At 32 C for 72 hrs
50000-80000 doses ( if only
OPV)
DF SB 140 ( Vest PHC 76,000-1,20,000 doses of OPV 16-20 At 43 C for 22 hrs
Frost) At 32 C for 26 hrs
Indian DF Capacity Freezing Capacity Total storage Capacity
Should be used 280 ltrs 25 Ice packs per day 250 ice packs
for making Ice
packs only & not
200 ltrs 20 Ice packs per day 200 ice packs
for vaccine
storage as hold
over time is very 130 ltrs 15 Ice packs per day 150 ice packs 63
less
 Non Electrical Cold Chain Equipment
Name of Place of Vaccine Storage Ice pack Hold over
Equipment Installation capacity Freezing time at
capacity different
Temperature
Cold Box 20 District HQ 6000 Doses ( Mixed 72-96 Ice 5-7 days ( 168
ltrs Antigen) Packs hrs)
200000 doses ( only
OPV) with 24 Ice packs
Cold Box 5 PHC 1500 doses ( Mixed 36 Ice 3-4 days
ltrs PHC (N) Antigen) packs (100hrs)
5000 doses ( only OPV )
with 24 Ice packs
Vaccine Districts 16-20 Vials 4 packs 24-36 hrs
carriers ( 1.7 /PHC/SC
ltrs)
Day carriers ( Districts 6-8 Vials 2 packs 6-8 hrs
0.85 ltrs) /PHC/SC

64
Non Electrical Cold Chain Equipment

The vaccine distribution system is planned and

implemented in timely fashion
Sufficient stocks of vaccines and diluents are
available for supply to the lower level storage.
Staff is knowledgeable on how to estimate the
vaccine requirements.
A system is in place for managing the short
supplies if is occurs
The cold chain monitoring cards are correctly
used in all deliveries.
65
 Storage of Vaccines
Care to be taken while storing vaccine
Keep packets of vaccine in neat rows,
Keep different vaccine separately,
Make holes on the vaccine boxes,
Keep about 2cm space between rows for circulation of air,
Keep a separate thermometer with the vaccine.
Store DPT, DT, TT & BCG vaccine away from inside walls or
bottom of ILR. Better keep them in the baskets,
Store OPV & Measles vaccines at the bottom of ILR,
Diluents may not be stored in ILR. But, it should be at vaccine
temp. at the time of reconstitution. (For seasons, keep required
quantity in ILR a day ahead & carry in Vaccine Carrier with the
vaccines),
Record time for which vaccines exposed to above +8C and also
DPT, DT & TT to below 0C. 66
 Recommended Vaccine Storage Time
&Temperature .
Vaccine Shelf life of Transport to State /Dist Transport to PHC
vaccine State/Dist Store PHC

DPT/DT/TT 1 yrs at +2to +2to +8C 3 months at +2to +8C 1 month at

+8C +2to +8C +2to +8C

BCG 12 months at +2to +8C 3 months at +2to +8C 1 month at

+2to +8C +2to +8C +2to +8C

Oral Polio 2 Yrs at 20 C 20 C to 3 months at 20 C to + 8 1 month at

or 120 days at +8C 20 C deg C +2to +8C
+2to +8C

Measles 2 Yrs at 20 C 20 C to 3 months at 20 C to + 1 month at

1 yrs at +2to +8C 20 C 8C +2to +8C
+8C

67
 Logistic
A system to make sure that people, information , supplies,
equipment and finance are in the right place at the right time
in the right quantity in the right condition at the right cost
Need assessment for sub center level micro planning and work
plan.
Calculate monthly requirement of vaccine and logistics from the
sub-centre level micro planning.
Estimate quantity for your PHC and urban planning reflect in
Annual Action Plan.
Storing properly till Utilisation.
Maintain both expendable & non-expendable vaccine, materials (
syringes), Hub Cutters, equipments etc.
Maintain stock ledger.
68
 Listing of Logistic
Vaccines and diluents, dropper
AD Syringes ( Auto Disable Syringes)
Disposable Syringes (Reconstitution)
Hub Cutter
Black and Red bags
Immunisation Card / Register
Counter foils bag
Monitoring charts
Tally Sheets
Vaccine Carriers
Ice Packs
Cold Boxes
ILR, DF, Voltage Stabiliser
Thermometer/ Freeze Indicator, Cold Chain Monitoring Card
Temperature Monitoring Booklet
69
Polythine for Vaccine Transport.
 How to estimate Vaccine Requirement
for the year ?
Please consider & estimate (To be calculated by each Health
Worker)
No of beneficiaries.
No. of doses of each vaccine.
Wastage and multiplication factor.
No of sessions.
Calculate by using demographic data Population,Birth Rate,IMR,
Age sp.Death rates
Requirement of Vaccine =
Total No.of children proposed to be vaccinated (target) X
No.of doses to be given X wastage factor
70
 Vaccine Logistics Contd.
Estimating beneficiaries in a sub center area say
Birth Rate = 30
IMR = 60
Population = 5000

No of Live births = Birth RateX Population of the area =

30/1000X5000 = 150

No of Pregnant Women = No of Live Birth + 10% (for

pregnancy wastage) 150 + 15 = 165

No of infants alive at 1 yr = 150-(150X60/1000=9)=141

(IMR being 60/1000)

71
 Vaccine Logistics Contd.

No of children below 5 yrs = Approx. 13% of

population = 13/100 X 5000 = 650
No of children at 5 years = Population X 2.42% =121

No of children at 10 years = Population X 2.4%

= 5000 X 2.4% = 120

No of children at 16 years = Population X 2.12 %

= 5000 X 2.12 % = 106

72
 Vaccine Logistics
Estimating Vaccine requirement:-
Taking example of BCG for annual target of 150 infants in a health
centre area.
No. of doses needed- Target population X no of doses per person X
wastage factor =150 X 1 X 1.33 = 200 approx. (Wastage factor
for vaccine = 100 .
100-Wastage Rate
= 100 . = 1.33
100-25
Add Buffer/safety/reserve stock = 25% of the requirement i.e.
200 X 25 /100=50
Total doses needed for one year=200+50=250 (25 vials) However
actual number of vials will depend upon the number of sessions
planned.
73
 ESTIMATED NUMBER OF BENEFICIARIES SUB CENTRE
LEVEL (Population: 5000)
Example
Beneficiary % Calculation Population Number
Pregnant Women 5000 X 2.76% 138
Live Births 5000 X 2.50% 125
Infants at 1 year 5000 X 2.32% 116
Children 1-2 years 5000 X 2.30% 115
Children below 5 years 5000 X 13% 650
Children at 5 years 5000 X 2.42% 121
Children at 10 years 5000 X 2.40% 120
Children at 16 years 5000 X 2.12% 106
74
 Vaccine Logistics Contd.
Calculating beneficiaries for each antigen as for
1. TT = No of Pregnant women X 2 doses
2. BCG = No of infants X 1dose
3. OPV = No of infants X 5 doses (include the birth does for
home deliveries)
4. DPT = No of infants X 4 doses
5. Hep. B = No of infants X 3 doses
6. Measles = No of infants X 1dose
7. DT = No of children at 5 yrs X 1dose
8. TT (10 year) = No. of children at 10 years X 1 dose
9. TT (16 year) = No. of children at 16 years X 1 dose
75
 Vaccine Logistics Contd.

Estimating requirement of vaccine vials for

Each session should have one vial of BCG
1. TT = (No of beneficiaries/sessionX 1.33)/10
2. BCG = No of beneficiaries/session X 1.33)/10
3. OPV = No of beneficiaries/session X 1.33)/20
4. DPT = No of beneficiaries/session X 1.33)/10
5. Hep. B = No of beneficiaries/session X 1.33)/10
6. Measles = No of beneficiaries/session X 1.33)/5
7. DT = No of beneficiaries/session X 1.33)/10
8. TT (10)= No of beneficiaries/session X 1.33)/10
9. TT (16)= No. of Beneficiaries per session X 1.33)/10
76
 Vaccine Logistics Contd.

Vitamin A Solution required (Annually)

Children below 1 yr of age (1 dose of 1 lakh unit) = 141 doses
Children between 1-5 yrs (2 lakh units) = 509 (650-141)X2 X 2
= 2036 doses
(Westage Factor = 1.11)

Diluents with Vaccines

No of diluents (Sodium Chloride ampoules) for BCG = No of BCG
vials required
No of diluents (Double distilled water ampoule) for Measles = No of
Measles vials
77
 Vaccine Logistics Contd.

Requirement of ADS and Disposable Syringes.

0.1 ml ADS = No of beneficiaries for BCG + 10%wastage fac

0.5 ml ADS = (No of beneficiaries for
DPT3dose+1 Booster dose +Measles
+DT5yrs(1dose) +TT(PW) (2dose) +TT10yr
(1dose+TT16yr1dose+Hep.B3dose)+10% wastage fac
5.0 ml Reconstitution = (No of BCG vials + No of Measles
vials)+10%wastage fac.
While putting indents for AD Syringe the calculation will be
Estimated No. of Particular type of Syringe required X 1.11
25% as buffer stock has been added at district level. 78
 Vaccine Wastage Rate
Vaccine usage rate = Number of doses administered x 100
Number of doses issued
Number of doses issued including doses used for
immunization and all doses discarded or lost for any
reason (including expiry, VVM indication, cold chain
failure, freezing, missing inventory or routine discard of
open vials of vaccine at the end of a session).
Vaccine wastage rate = 100- vaccine usage rate

79
 Proper storage of vaccines (1)
Only vaccines in the cold chain equipment
Leave space between the boxes so that the air can
circulate
Prevent boxes of freeze sensitive vaccines touching
the evaporator or ice-lining
Keep vials in a box
o Freeze-sensitive vaccines always in the baskets
o OPV, Measles and BCG at the bottom of the ILR
o Watch out !!

80
 Proper storage of vaccines (2)
No expired vaccines or vaccines with VVMs at or
beyond the discard in the cold chain.
Keep the following vials in a box marked "USE
FIRST"
o Vials close to expiring
o Opened vials (do not used)
o Vials with VVMs that show more heat exposure than
other vials

81
 Proper storage of diluents
In transit locations : where space permits in the cold
chain between +4 deg and +8 deg C.
At the point of use : always between +4 deg and +8
deg C. Never in the freezer or at the bottom of a ILR
WATCH OUT

When vaccines are being reconstituted, the diluent

should be at same temperature as the vaccine, so
keep sufficient diluents in the refrigerator for the
needs within 24 hours.
82
 EEFO Handling
Earlier - Expiry-First-Out
Sometimes a later delivered vaccine has an expiry
date which is earlier This vaccine should be used
first.
More safe than FIFO (First-In-First-Out)
Always check expiry dates supply the vaccine with
the shortest shelve live
Correct store organization is essential for EEFO

83
 Calculating storage capacities
How to calculate storage volume for an estimated
quantity of vaccines
Vaccines occupy a certain space per dose based on :
the vial size
the type of packing
the number doses in a vial
Estimating the required cold chain capacity for
vaccination storage
The internal volume of cold chain equipment cannot
be fully utilized, space is needed for air circulation
84
and units should not be overloaded.
 How to calculate storage volume for an estimated quantity of
vaccines

It is assumed that the quantity of doses that are

needed is known (including wastage).
The following formula should be applied for each
different vaccine :
Estimated vaccine (doses) x volume/packed dose (cm3)
= storage volume in cubic centimeters

The storage capacity or refrigeration equipment is expressed in litters

therefore :
Storage volume (in cm3) = storage volume in litters
1000
85
 Vaccine storage capacities for
different ILRs & Freezers
Make Model Type Vaccine storage
capacity (Ltrs.)
MF-304 Vestfrost Freezer 172
SB-302 -do- 188
SB-300 -do- 188
SB-140 -do- 128
MK-304 Vestfrost ILR 108
MK-300/302 -do- 108
MK-140142 -do- 85
TCW-1151 ELX-ILR/Freezer 169

86
 Vaccine stock registration
Physical stock counts (1)
Responsible staff should know how to carry out a
systematic physical stock count and how to
reconcile any errors found in the stock records.
Supervisors should ensure that physical inventory
checks are being done regularly.
The count should also match diluents and droppers
to the correct vaccine batches.

87
 Vaccine stock registration
If a discrepancy is found : count the stock again, if
the second count gives the same result as the first,
the stock record is probably in error, and must be
corrected.
Take the following action :
o If more vials are counted than are recorded : Record the
additional amount as a 'new arrival' with an explanation
of the reason in the notes column of the stock record
form.
o If fewer vials are counted than are recorded : Record the
missing amount as 'discarded' with an explanation of the
reason in the notes column of the stock record form.88
 Vaccine stock registration
Effective stock management (1)
As a minimum, the following information should be
recorded for vaccines :
o quantity (in doses)
o Type
o Manufacturer
o vial size
o manufacturing batch or lot number(s)
o expiry date for each batch or lot
o VVM status (1,2,3,4)
o CCM card status (A,B,C,D,) ( Presently not introduced)
89
o Freeze indicator status if present ( -DO-)
 Vaccine stock registration
Dispatch (2)
General dispatch issues
o Distribute well before the expiry date is reached EEFO
o Heat-exposed vaccine may have to be issued ahead of the
EEFO sequence
o Ensure sufficient of the correct diluent for the specific
vaccine
o Record all transactions and update stock registrar and
indent

90
 Vaccine stock registration
Maintaining correct stock levels (3)

General dispatch issues

o Responsible staff should know how to monitor stock
levels and how to assess whether they are sufficient to
meet anticipated demand.
o Staff should also know how to avoid excessive stock
levels.

91
 Vaccine stock registration
Effective stock management (4)
Enter each delivery of each vaccine and diluent in
the record system as soon as it is received, don't wait
until later. Keep the balances updated at all times.
Use the standard Stock Control Registration Forms
for the appropriate vaccines and other consumables.

92
 Check the Stock Register
Monthly inventory of vaccines and diluents
Number of does received from district store and date
Number of does issued from the PHC to immunization
sessions and dates
Number of does administered to children during
immunization sessions
Number of does return to the PHC
Number of vials discarded (due to freezing, heat
exposure (VVM),breakage,expiry etc.)
Calculate next months stock requirements
93
 Vaccine stock registration
Indents
The proper indent forms should be used when
requesting supplies. There are indent form available
for the sub-depots, township hospitals and for
midwifes.
When receiving indents the staff should know how
to check the quantities by comparing them with
previous indents and with expected demand. Where
unexpectedly high or low requisitions are received,
these should be checked before supplying.
94
 Vaccine Supply Management
Control of Vaccine Stock (Dist.store)
Receive vaccine as per users requirement
Dont allow large stock to accumulate
Stock should be rotated such that no vaccine is kept for
more than 3 months at district store
All vaccines stored between +2C to +8C are safe for 3
months
Batch of vaccine received first should be utilized first.
If stock fall short of 3 months requirement:Write to SIO
If stock fall short of 2 months requirement: Inform SIO by
telephone/in person. 95
 Vaccine Supply Management
Contd..
Supply of Vaccines (Dist. Store)
Before supplying, check:
Requirement of PHC (session-wise),
Utilisation during previous month,
Balance in hand in PHC
Supply adequate quantity to meet PHC
requirement.
Transport vaccines in Cold Boxes or Vaccine Carrier
only,
Check ice-packs before packing vaccine,
Send by shortest rout. 96
 Vaccine Supply Management Contd..
Distribution of Vaccine from PHC level
PHC should collect vaccine minimum once in a month/at regular
interval.
Make correct estimation of requirement (not less or not much more).
keep 25% as buffer stock,
Dont keep vaccine for more than one month at PHC,
Stock should be rotated such that no vaccine is kept for more than 3
months at PHC.
Before supplying, check:
Actual requirement of SC,
Ice-packs in Vaccine carrier are fully frozen,
Diluents are cooled before use (but not frozen),
Follow First-in First-out rule (FIFO)---(??)
97
Follow First to expire First to out (FEFO) rules.
 Vaccine Supply Management Contd..
Returned vaccine to PHC
All vaccines removed from ILR/Freezer must be used or returned ILR/Freezer after
immunization session on the same day,
Receive vaccines returned next day only is ice-packs are not fully melted.
Opened vials returned from session to PHC are to be discarded,
Keep returned vaccine separately, mark if returned once or twice.
Vaccines returned unused & unopened must be used in the following session, or
failing this during the third session. If not used even in session, discard it.
Re-constituted BCG & Measles Vaccines should not be used after 4 hrs of re-
constitution,
If ice in the container is completed for less than one day:
Examine VVM on OPV. If at stage I or II, can be used. If III & IV discard the
OPV
Marj & return other vaccines to ILR/Freezer for use on next session.
If ice in the container is completed melted for more than one day, discard all the
vaccines.
Keep records of:
Vaccines administered
98
Batch No & Expiry date of Vaccine.
 Vaccine Supply Management Contd..
Collection of vaccine from Dist. Store
When Collected from Dist.Store:
Make sure you carry enough Cold-Box/Vaccine carrier,
Check types & quantity of vaccine & diluents received against indented,
Check expiry date of vaccines
Pack Cold-box/Vaccine Carrier quickly & properly. Diluents need not be
transported in cold-box/Vaccine Carrier,
Use shortest route to PHC,
Transfer vaccines to ILR/Freezer quickly,
When delivered by Dist. Store
Confirm the arrival time
See if vaccines transported in Cold-Box/Vaccine carrier with ice-packs
or ice,
Check types & quantity of vaccine & diluents received against needed,
Check expiry date of vaccines,
Transfer vaccines to ILR / Freezer quickly
99
 Vaccine Supply Management Contd..
Collection of vaccine for Sub-Centre/Village level.
Vaccines are collected/ delivered on the day of use only,
Only required quantity must be supplied,
Vaccine carrier must have frozen ice-packs,
VVM of OPV should not cross Stage-II,
Immunization should be carried out in a room/shade
Take out only one vial of each vaccine at a time when needed,
OPV & Measles vaccines must be kept on an ice-pack/cup of ice
during the session,
Wrap BCG ampoules with foil or dark paper,
Open carrier only when necessary, secure lid immediately after
opening,
After session, return all opened & unopened vials to PHC
100
 Improving Vaccine Use
Types of Vaccine Wastage
Vaccine wastage in Vaccine wastage in opened vials
unopened vials
Expiry In addition to the types listed in the
VVM indication previous column:
Heat exposure Discarding remaining doses at end
Freezing of session
Breakage Not being able to draw the number
of doses indicated on the label of a
Missing Inventory vial.
Discarding unused vials Poor reconstitution practices
returned from and outreach
session Submergence of opened vials in
water
Loss of labels
Suspected contamination 101
 Improving Vaccine Use Contd.
Avoidable vaccine wastage factors :-
Poor stock management resulting in over-supply
and vaccines reaching expiry before use
Cold chain failure that exposes vaccines to
unacceptably high or low extremes of temperature.
Incorrect dosage, e.g. the administration of three
drops of OPV instead of two, or the injection of
0.6 ml of vaccine instead of 0.5 ml.
Vials lost, broken or stolen.
Unavoidable vaccine wastage factors:-
Reconstituted vaccines that have to be discarded at
the end of the session
102
Format of Vaccine Indent & AD Syringes
Vaccine Opening Received Total Consumed Balance at the Requirement
Balance During During Month end of Month for the coming
Month month
DPT

OPV

Dropper
BCG

Diluent
Measles

Diluent
TT

DT

AD Syring (0.1ml)

A.D.Syring(0.5ml)

Syringe 5ml (Disp)

Vit-A 103
 Indent next months vaccine
Sl.N Name of Balance at Received Total Total Doses Doses Wastage Discarde Balance at Requiremen
o the item the beginning from available Issue to administe returned in doses d due to the end of t for next
of each Dist. during the red for back freezing/ the month month
month Office the SubCentr immunisa from the VVM
during month e during tion session (heat
the the unused exposure)
month month
A B C (A+B) D E F G H I=C-
(E+G+H)
1 DPT 70 100 170 120 75 20 25 10 60

2 OPV

3 BCG

4 Measles

5 TT

6 DT
7 Diluent
(BCG)
8 Diluent
(Measles)
9 Vit-A

10 Hep-B

11 ADS

12 Disposabl 104
e
Syringes
Improve the way vaccines and supplies are issued to Sub-centres: Dos and
Donts for health centres to follow when issuing vaccines to Sub-Centres:-
Dos Dont
Issue vaccines for only one session at a time. Issue vaccines more than 24 hours before the vaccination
session.

Follow first to expire, first to out (FEFO) and first in, first Place TT, DT, DPT, or HepB vaccines next to ice packs in
out (FIFO) procedure for issuing vaccines vaccine carrier.

Maintain a record of vaccines issued at the PHC Do not issue vaccines that have been returned unopened more
than three times.

Have the ANM report the number of doses consumed and

the number of doses returned to the PHC at the end of the
day.

Make sure that vaccine carriers are loaded properly

ANMs to ensure return of partially used and unused vaccine

vials to the health center within 24 hours of the
immunization session.

Keep a box labeled RETURNED USED for returned used

vials that can not be reused.

Keep a box labeled RETURNED USED in the ILR for all

unused vaccines that can be used in subsequent sessions.

Ensure that diluent and vaccines are not frozen. 105

 Preventive Maintenance of ILR / DF
Steps to be followed for defrosting:-
Take out all the vaccines, diluents and frozen ice packs; transfer them
to a cold box lined with frozen ice packs.
Turn off the power supply to the refrigerator.
Leave the door open and wait for the ice to melt. Do not try to remove
the ice with a knife or ice pack, since doing so can permanently
damage the refrigerator.
Open the stopper at the bottom of the ILR/DF so that the water drains
out.
Clean the inside of the refrigerator and door seal (esp.the rubber) with
a cloth.
Turn the refrigerator on again.
When the temperature in the main section falls to 8dC or lower, return
the vaccines, diluents, and ice packs to their appropriate places.
106
 Preventive Maintenance of Cold Chain Equipments Contd
Checklist for Preventive Maintenance:-
External Internal Technical
1. The exterior is clean. 1. Lid seals properly without 1. Temperature is within
gap. prescribed limit (if not,
2. It is firm on the floor 2. Lit seal is clean set the thermstat)
3. It is properly leveled 3. Ice lining tubes/ice packs are
in proper position 2. Voltage stabilizer is
4. Its sides are at least 4. Ice lining tubes/ice packs working properly &
10 cm away from filled with water to proper equipment are
walls. level. connected through it.
5. Thickness of frost formation 3. Plug of the voltage
5. It is away from direct is less than 6 mm.
sunlight stabilizer is fitted
6. Vaccines are neatly placed
properly to the power
6. Room is well with space for air circulation.
line.
ventilated 7. DPT, TT, HepB & DT are
kept in the basket in the ILR 4. Connection of
7. It is opened only & not touching the cooling equipment to voltage
when necessary surface. stabilizer is not loose.
8. Thermometer has been kept
amongst the vaccine.
5. There is no abnormal
9. Temperature is recorded
noise.
twice a day. 6. Compressor mounting
107
bolts are tight.
 Why Goals are Important ?
Goals provide us direction
Goals are measurable tools of our
achievements
Goals also show the trends of our
performance and help us in taking
corrective actions
Goals help us to do self evaluations of our
success or failure
108
 Proposed Goals

Maintain < 2% sickness of cold chain equipment at any

point of time at all level

Maintain response time of Equipment <48 Hrs in plains &

<72 Hrs in Hill terrain

Maintain down time <7 days in plains and <10 days in hill
terrain

Keep all WICs / WIFs operational at any point of time

109
 Sickness rate of Equipment
Sickness rate of equipment is the percentage
of sick equipment against supplied/Installed ?
BER equipment should not be considered as
sick equipment
Maintain an excel worksheet at district &
state level to monitor % sickness rate
Share quarterly status report with MOHFW

110
 Response & Down Time
Register the sickness report on the day of its receipt
Attend the complaint with spares, as early as possible to
maintain the national objective of response time
Date of Receipt of report date of response = response
time
Maintain average response time of a district & state as per
national guide line
Review cold chain maintenance on quarterly basis with
technicians , Identify the reasons of not being able to
achieve and take corrective actions
Share feed back to RCHOs & RMs

111
 Why Monitoring is important ?
This system will improve the vaccine quality
It is a monitoring tool for self assessment
It will develop the culture of time wound repair
It will accelerate the repair work of CCE
It will reduce sickness rate of equipment
It will improve transparency in repair work
It will exert pressure on management to extend
back up support.
Ultimately improved cold chain management
system
112
 What is response time ?

R T is the Time taken to attend the equipment after

receiving the intimation of its break down
Date of receiving the sickness report date of attending
the equipment = response time
MOHFW is proposing to introduce 48 Hrs ( two days)
response time in plains & 72 Hrs ( three days) in Hills
Monitoring of RT & DT is even more important in the
states/districts where repair is out sourced
Non-availability of spare parts and funds should not be the
reason for not monitoring this indicator
113
 Down time of equipment
Down time of equipment is the time taken to complete the
repair after its reporting
Date of report date of completion of repair = down time
of the equipment
Some time response & down time could be the same
MOHFW proposes to fix 15 days & 21 days down time in
plains & hills respectively
System of monitoring this system helps in reducing the
down time of equipment lying pending for want of major
repairs
Ultimately helps in improving the quality of vaccine
Good Management practice 114
 Float assembly (Simile of spare wheel)
Norms of float assembly at WIC location / District HQ:-

1. ILR MK- 140 5% at WIC point

2. Freezers SB 140 5% at WIC point
3. Voltage stabilizer 1 KVA-20% at District HQ (to
ensure timely replacement)

The district mechanic should have some contingency funds

available with him for minor repair.

115
 Break Down of Equipment

Break Down Reporting

- Confirm before reporting that the
equipment is getting power but not
working / cooling.
- Intimate service centre directly through
most reliable means of communication
- Provide all detail as given in the format
for Breakdown Reporting.
116
 INSPECTION REPORT OF OUT-OF-ORDER EQUIPMENT

1 Name of PHC / ILR Point : _________________ , District: ______________

2 Type of equipment (ILR / Deep Freezer) : ________________________
3 Make ( Vestfrost / Electrolux / Anand) : __________________________
4 Model No. (MK / NMK / SB / MF ,
300 / 302/ 304 / 140 / 142 / 144 / ----) : __________________
5 Machine Serial No : (8 digit No.):
6 Not working since (date) : _____
7 Defect summery:
Machine gets power but not working
Machine working but no cooling
Machine working but less cooling
Abnormal noise
Others
8 Detail of the defects observed from checking / testing and repairs done :
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________

Signature:_________________
Date: ____________________

117
 Contingency Plans for Emergency Situations
Alternate Storage arrangement

Identify most suitable alternative arrangement for each equipment.

List out the resources and actions involved and the persons identified
to carry out the same.

Make aware all concerned, of the requirement and the activities that
may be necessary during emergency and educate/train them
accordingly.

Identify more than one alternative for assurance (stand by
arrangement)

Periodically check availability of the identified requirement and
awareness of the persons concerned.

Have a list with emergency contact names & mobile phone numbers
in the ILR points.

Documented the plan, paste the poster on the ILR points.

Trained other staff who work with vaccines.
118
 Contingency Plans for Emergency Situations
Contd
Alternatives for Emergency situations
Type of failure Equipment Primary Health Centre Districts
ILR Observe temperature of vaccines. Similar to PHC
If it reaches 8C, transfer and store
Power failure them in cold boxes with frozen
of longer ice-packs from the freeser Place
duration (more thermometer inside the cold box.
than 6-8 hours) No action required as vaccines are
not preserved in freezer. If OPV is preserved
Freezer in freezer, transfer
them to cold box
and preserve with
frozen icepacks or
commercial ice in
polythene bags.
Place thermometer
inside the cold
119 box.
 Contingency Plans for Emergency Situations
Contd
Alternatives for Emergency situations
Type of Equipment Primary Health Centre Districts
failure
Equipment ILR a) Store vaccines in cold boxes a) Store in cold
Breakdown with frozen icepacks. box with frozen
(Select suitable icepacks
alternative b) Transfer to domestic b) Transfer to
indicated) refrigerator if available in other ILR or
the vicinity. Refrigerator
available.
c) Transfer to any nearby PHC c) Transfer to any
or other departments vaccine other storage
storage facility if available. facility available.

120
 Contingency Plans for Emergency Situations Contd
Alternatives for Emergency situations
Type of failure Equipment Primary Health Centre Districts
Freezer a) Freeze icepacks in domestic a) Store vaccine in
refrigerator/s or in commercial ILRs or refrigerator
ice factory, if available. available
b) Collect required quantity of b) Despatch vaccines
frozen icepacks from nearby for PHC using
Equipment PHC in cold boxes commercial ice.
Breakdown
(Select suitable c) Distribution c) Ask recipient of
alternative vaccine to bring
indicated) frozen icepacks while
coming for collection.

Disconnect the stabilizer and obtain Replace from float

Voltage assemblies
Stabilizer replacement immediately from
immediately from
District/Regional HQ and reconnect.
District/Regional HQ
stock

121
THE DOS & DONT USE OF ILR / FREEZER
DOS
Keep the equipment in a cool room away from direct sunlight and at least 10 cms
away from the wall.
Keep the equipment properly leveled.
Fix the plug permanently to the socket.
Use voltage stabilizer.
Keep the vaccines neatly stacked with space between the stacks for circulation or
air.
Keep the equipment locked and open it only when necessary.
Defrost periodically (detailed subsequently).
Check the temperature twice a day and maintain a record, which should be
supervised and signed by the concerned supervisor/Medical Officer regularly.
Take remedial action if the temperature is not maintained within the prescribed
limit.
Outside the equipment paste a notice that helps the user during a break down.
Whom to contact and where to check for a blown fuse
Alternate place for storing vaccines. 122
 THE DOS & DONT USE OF ILR / FREEZER
DONTs
Do not keep other drugs.
Do not open the top unnecessarily. (Paste this message on the top of the ILR)
Do not keep food or drinking water I the DFs / ILR
Do not keep more than one months requirement at PHC headquarters and 3 months
requirement at district level.
Do not keep vaccines, which have expired.
Do not sit on the deep freezer / ILR.
Vaccines should be transported/stored in cold boxes only with sufficient number of hard
frozen ice packs.
Ice packs are frozen at 20C hard frozen ice packs (frozen at 20C) should be kept out of
deep freezer for about 10 minutes before laying out in the cold box.
The vials of DPT, TT & DT vaccines should not be placed in direct contact with the frozen
ice packs.
If the duration of storing vaccines is likely to be more than 6 hours, Day Carriers should not
be used.
The temperature record should be used to monitor and control the temperature and to take
follow up action as required.
Vaccines are damaged by heat whether they are exposed to a lot of heat in a short time (e.g.,
as a result of keeping vaccine in a closed vehicle in the sun) or a small amount of heat over a
long period (e.g., as a result of the frequent opening of a refrigerator door). 123
THE DOS & DONT USE OF ILR / FREEZER
DONTs Contd..
Keep 25% additional vaccines as buffer stocks for any unforseen
demand. The stocks must be rotated so that no vaccine is kept for
more than three months.
The batch of vaccines, which is received first, should be utilised first.
Do not keep vaccines for more than three months at the district stores.
Do not keep vaccines for more than one month at PHC
Do not store any vaccines at sub-centres or outside cold chain.
All vaccines are safe at temperatures between +2 to +8C for months.
Keep all vaccines at +2 to +8C. If you have a Freezer, polio and
measles vaccines should be kept in them.
DPT, DT and TT vaccines should not be frozen. DO NOT ALLOW
THEM TO FREEZE.
Transport vaccines in Cold Boxes or Vaccine Carriers only.
Check ice packs before packing vaccines.
Travel by the shortest route. 124
LET US CARE OF THE VACCINES FOR THE SAKE OF OUR
CHILDREN & MOTHER

Thank You for Sharing 125