Cold Chain Logistics for Vaccines
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ScribdTranslationsCOLD CHAIN
COLD CHAIN
The 'Cold Chain' is a set of activities that
they are arranged like links or steps of a type
logistic forming a chain that starts with the
reception, handling, transport and
safe storage of vaccines, with the
purpose of keeping them within the ranges of
required temperatures to guarantee its power
immunological, from the moment it leaves the laboratory until its
final application, includes the syringes as an element
also important.
COLD CHAIN LEVELS
CENTRAL LEVEL
At the National or Central level, it is equipped with refrigerated chambers to maintain
cooling and freezing temperatures, with capacity to store vaccines
for long periods of time. Refrigeration equipment is also available to
freeze cold packages.
REGIONAL LEVEL
It constitutes the second level of the 'Cold Chain', located in the departments or
provinces. They have refrigerators to store and preserve immunobiologics
for limited periods of time, they also have additional equipment for
freeze cold packages.
LOCAL LEVEL
Ubicado en hospitales, centros y puestos de salud, zonas rurales, etc. Cuentan
with refrigerators and/or complementary elements to maintain the
immunobiologics for short periods of time.
GENERAL CONSERVATION STANDARDS OF THE
VACCINES
LEVEL Central Regional Local
TIME 6 to 18 months 3 to 6 months 1 to 3 months
VACCINES TEMPERATURE
Antimeasles
Anti-American
Anti-poliomyelitic - 15 ºC a - 25 ºC
Measles and Rubella
Measles, rubella, and mumps
BCG
DPT
0 ºC a 8 ºC
Hepatitis B
ELEMENTS OF THE COLD CHAIN
Human resources: Which includes all those people who
directly or indirectly they have to manipulate, transport,
distribute and apply the immunobiologics or monitor that the teams
refrigerators where they are stored, meet the requirements
established
Material resources: They are refrigeration equipment (chambers of
cooling and freezing, freezers, refrigerators, boxes
cold, thermoses, ice packs and thermometers), essential
in the process of storage, transportation, and preservation of
immunobiologicals.
Financial resources: Necessary to ensure the operation of
human resources, materials, and the maintenance of the network.
COLD CHAIN EQUIPMENT
Cold rooms (cold chamber): It is a refrigeration equipment used for
storage and preservation of immunobiologicals in large quantities. Two
types of cameras are distinguished according to the storage temperature:
Freezing cold chamber
It maintains freezing temperatures between -15ºC and -25ºC. Among these
temperatures remain at the Central and Regional level for viral immunobiologics
such as: Antipoliomyelitis, MMR (measles, mumps, and rubella) and M (measles and
rubella
2. Refrigerated cold chamber
It maintains storage temperatures between +2ºC and +8ºC. In this range, it...
they maintain bacterial immunobiologics at all levels, such as: DPT, BCG;
viral immunobiological for Hepatitis B and combined immunobiologics, such as the
Pentavalent (DPT+HB)
Thermal vehicle: Used for transportation of
immunobiologicals from the Airport to the National Center of
Biological and from this to the different Health Regions. They are
vehicles that have a refrigeration unit capable of
maintain the appropriate temperature.
Refrigerator: The refrigerator is an essential item.
to maintain the immunobiologics of the PAI. It is given all
possible attention for it to function efficiently, in a way
especially those installed at the operational levels with
logistical deficiencies.
COMPLEMENTARY CHAIN EQUIPMENT
COLD
Cold boxes: It is a box whose insulating structure is made of polyurethane.
it may be covered with plastic or another similar material; and has
different dimensions. It is used in transportation of
immunobiologicals from the Central, Regional, Area, and
occasionally from this to the local.
Terms: Container of small dimensions made with
polyurethane or polystyrene insulating walls; it may or may not have
coating, is used for the transport of immunobiologicals
between the Central, Regional, Area and/or Local level. They are indicated for
fulfill vaccination activities both inside and outside the walls
Cold packages: Plastic containers with characteristics
special, with their content properly frozen, that can
maintain the temperature inside a thermal container to
conservation of immunobiologicals.
Thermometers: They are a very important tool for
the monitoring and control of the temperature of the equipment
refrigerators of the cold chain. There are different types of
termómetros: de cristal líquido, bimetálico y de varilla de vidrio.
LOGISTIC PROCESS
Central level, specialized staff of the vaccine warehouse
who is in charge of reception, conservation, packaging and
shipping of vaccines to the whole country
Regional level: cold chain technical staff under the
supervision of the person in charge of DIREMID and the coordination of the
ESNI
REDy Micronetwork Level: responsible for immunizations
together with the head of DEMID-pharmacy
Local level: responsible for immunizations.
RECEPTION OF VACCINES
Determine the available space conditions on the equipment
refrigerators of health establishments, based on the scheduling and
request made.
Sort all cold packages and keep in permanent freezing.
the quantity or number that may be required to meet the
conservation actions.
It is necessary to schedule and prepare the distribution table of biologicals.
at the different levels, in a timely manner.
Fulfill the duties described for the reception conditions.
temperature and routine processes to be followed by the staff in charge of the
reception
If there is no storage capacity in the existing equipment in the
warehouse that receives, the alternative plan will be applied
contingency for the storage of immunobiologics:
DISTRIBUTION
This procedure is carried out according to each level taking
take into account the internal provisions of the organization of the
Warehouse, Collection Center or Vaccination Clinic, also
the following criteria must be considered:
Requirement
Accessibility
Conditions of the means of transport
Duration of the transfer of supplies
CONSERVATION
In order for vaccines to maintain their efficacy.
It is necessary to ensure immunization in everything.
moment the thermal stability, the accessibility, the
expiry and photos stability and, for this, it is necessary
take into account that the devices
vaccine storage must be
away from any source of heat and sunlight
direct. Its use will be exclusive for vaccines.
GENERAL CONSIDERATIONS
Vaccines should never be placed at the door of the
refrigerators, as this is an area where the vaccines are
exposed to large temperature changes.
The placement of vaccines in the refrigerator must be such
a way that allows air circulation between them.
In case of a power supply cut lasting
less than 4 hours, refrigerators are capable of maintaining the
optimal temperature, if the door is not opened.
The loss of immunizing capacity of a vaccine depends on,
in addition to the temperature threshold reached, of the time of
exposure to that temperature and whether it was present
lyophilized or reconstituted.
External factors such as exposure to light (radiation
Ultraviolet rays can lead to the inactivation of vaccines.
weakened live ones, so they need to be kept in
darkness and not exposing oneself to sunlight, nor fluorescent light, nothing
more than the minimum time necessary.
Once the vaccine is reconstituted, its stability time is
very short, needing to be administered immediately.
Vaccine distribution by
type:
First level: Viral vaccines
(APO, SPR, AMA, HVB, HIB)
Second and third level:
Bacterial vaccines (DPT,
DTP, BCG
ROLE OF THE NURSE IN IMMUNIZATIONS
FOR CHILDREN UNDER 5YEARS OLD
NURSE RESPONSIBILITY AT THE LEVEL
OPERATIONAL:
MANAGEMENT:
Planning based on local programming.
Supplies logistics
Budget Management
Monitoring and supervision of coverage
ASSISTANCE: Direct attention in the different strategies.
Vaccination at fixed site
House-to-house vaccination
Vaccination at mobile site
Vaccination in campaigns
COLD CHAIN LOGISTICS
TEACHER: Health promotion activities
RESEARCH
Suspected cases
Desertion
Teamwork in health–epidemiology and laboratory
INTERVENTION OF THE NURSING PROFESSIONAL
IN THE IMMUNIZATION SERVICE