Cold Chain Management - Alberta Health Services

1. Refrigerators for vaccine storage
Cold Chain Management
1.1. Laboratory-grade refrigerator—highly recommended.
� This is a purpose-built unit that responds well to temperature fluctuations.
1.2. Domestic refrigerator
� These are designed for food storage and not for the requirements of vaccine storage
� Precautions and fridge modifications are needed in order to store vaccines. 1
� There are two types of domestic refrigerators:
- Frost-free (recommended) - they provide more uniform temperatures.
- Manual/cyclic defrost - there are significant temperature variations and are not
recommended.
1.3 Bar-style refrigerator—not recommended
� This unit is unpredictable in terms of maintaining temperatures and should not be used for
overnight vaccine storage.
� When this unit is used, diligent monitoring of temperature is essential.
1.4 An y refrigerator
� Whenever possible, medications and/or other products (e.g., lab specimens) should not
be stored with vaccines.
� If medications and/or other products (e.g., lab specimens) must be stored in the vaccine
storage unit, they must not be stored on the same tray/container as the vaccine to avoid
medication error.
2. Thermometers for monitoring vaccine temperature
2.1 Minimum and maximum thermometers
� These are available in fluid-filled and digital forms
MinMax Digital Digital w/standard probe Digital w/biosafe liquid encased probe
1 Reference: Public Health Agency of Canada (2007). National Vaccine Storage and Handling Guidelines for Immunization Providers
Influenza Vaccine Storage and Handling 1 of 4
Cold Chain Management
September 9, 2011

� Digital thermometers have two components:
1. A display that mounts to the outside of the refrigerator unit, and
2. A probe on a cord (usually 1 to 3 meters long) that is placed inside the refrigerator unit
(allows the temperatures to be read without opening the door).
- A setting of +5°C provides the best safety
margin for temperature fluctuations within +2°
and +8° C.
- Those with a min/max feature are easy to read
because they display a number indicating the
temperature and do not require interpretation.
- Accurately monitor temperatures with enclosed
temperature-buffered sensor. Bottle insulates
sensor from rapid temperature changes when
refrigerator door is opened.
Note: Temperature monitoring is the only way to be
certain the unit remains within the recommended range.
2.2 Other types of thermometers are available but not recommended.
These include:
� fluid filled biosafe liquid
� bi-metal stem
� household mercury
N
Fluid filled
biosafe liquid
Bi-metal stem
Household
mercury
Note: The above thermometers are NOT recommended for monitoring refrigerator
temperatures.
Influenza Vaccine Storage and Handling 2 of 4
Cold Chain Management
September 9, 2011

3. Handling and storing influenza vaccine
3.1 Influenza vaccine
� Must be monitored and recorded consistently using temperature log sheet according to
work day
- Site staffed up to 9 hours—must monitor/record twice daily
- Site staffed over 9 hours—must monitor/record three times in a 24-hour period; and
- Site staffed over 12 hours—must monitor/record four times in a 24-hour period
3.2 Temperature log sheet
� Should be kept on refrigerator door
� Obtain a copy of the temperature log sheet from public health, or
� Use the sample form in the National Vaccine Storage and Handling Guidelines for
Immunization Providers.
3.3 Storage of vaccine
� Must maintain temperature between +2º and +8º Celsius
� Must store vaccine in the middle of refrigerator and not in the door
3.4 Check expiration date
� Use vaccines that will expire soonest first.
3.5 Date vial when opened
� Important for influenza as vaccine is only potent 28 days after first puncture into the
Fluviral® multidose vial; please check specific product monograph for stability information.
� Record on each vial the date and time the vial was opened.
� Immediately put vial back in the refrigerator or in an insulated container after dose has
been withdrawn.
� Check the shelf life of
each individual vial.
3.6 Keep extra containers of
water in refrigerator for
the sole purpose of
helping to maintain
temperatures.
Influenza Vaccine Storage and Handling 3 of 4
Cold Chain Management
September 9, 2011

4. Designated and backup persons responsible for vaccine storage and
handling
4.1 Authorized provider/designate is responsible for ensuring safe storage and handling of
provincially funded vaccine.
4.2 Whenever possible there should be a backup person designated.
4.3 There must also be a designated person who is an authorized provider responsible to audit the
temperature log sheet.
� Person who audits must sign and date the log sheet weekly
5. Ensuring a secure electricity supply
5.1. Protect refrigerator unity power supply
� Avoid outlets with built in circuit switches.
� Avoid outlets activated by a wall switch.
� Use a safety-lock plug or outlet cover.
� Post a “Do Not Unplug” sign next to the refrigerator’s electrical outlet.
� Label the fuses/circuit breakers.
� Consider installing a 24/7 temperature alarm.
6. If the temperature drops below +2º or rises above +8º Celsius
When this happens, it is called a “col d chain break”
6.1 Quarantine the vaccine in a functioning refrigerator.
� Complete a cold chain break report form for funded vaccines and report the incident to
Public Health in your area.
� Check product monograph and/or with manufacturer for information on stability of nonprovincially
funded vaccine.
6.2 Vaccines are not hazardous material and therefore can be safely discarded in a sharps
container.
Influenza Vaccine Storage and Handling 4 of 4
Cold Chain Management
September 10, 2012