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

ABSTRACT: INTRODUCTION:Adequate vaccine storage is a prerequisite to assure vaccine effectiveness and tolerability. In this context, maintaining the cold chain (2°C to 8°C) is the paramount objective. To establish quality-ensured cold chain maintenance, compliance with several structural and procedural aspects is necessary. MAIN OBJECTIVE:The aim of this publication is to assess the quality of vaccine refrigerator management in general practices. METHODS:This study describes baseline results of an intervention study. To evaluate the quality of vaccine refrigerator management, visual inspections were conducted of refrigerators used to store vaccines in general practices of a German teaching practice network. The study instrument was a checklist with ten quality criteria based on international best practices for vaccine storage. A data logger recorded refrigerator temperatures for 7 days. We analyzed associations between reaching more than half (6+) of the ten quality criteria and temperature data. RESULTS:The study included 64 of 168 practices (38.1% response rate) with 75 refrigerators. No practice fulfilled all 10 quality criteria. On average, 4.7 (standard deviation = 1.9) criteria were met. The most frequent deficits were: no drawers/bins/baskets for vaccines (81.3%), no temperature logbook near refrigerator (75.0%), no temperature recording device in the center of the refrigerator (54.0%), vaccines boxes with contact to outer walls (46.3%), and refrigerator unsuitable for vaccine storage (44.6%). Refrigerators with better management (?6 quality criteria) were more likely to have temperatures in the target range (62.5% vs. 27.5%, p = 0.008). CONCLUSION:We identified a large number of avoidable vaccine storage errors. Effective strategies, e.g. web-based programs, to improve vaccine storage conditions in general practices are needed.

SUBMITTER: Thielmann A

PROVIDER: S-EPMC6890257 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Project description:INTRODUCTION:Protecting 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. METHODS:This 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. RESULTS:The 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%. CONCLUSION:Given 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.

Project description:Cold chain maintaining is least stable at its end, where domestic storage often represents one of the most critical links because of storage time and inappropriate temperatures, increasing the risk of food-borne outbreaks in domestic households. Considering the time-temperature profile of refrigerators as a food safety indicator, the purpose of this study is to gain insight into refrigeration temperatures in parallel with refrigerator and household characteristics that could potentially influence the refrigeration temperatures. During a 24 h period in 15-min intervals, internal temperature of the test product, refrigerator air and ambient air temperatures were measured with one penetration and two air probes coupled with a data logger. The internal temperature of the test product was measured with pre-prepared "Karlsruhe Test Material", which had thermal properties similar to those of lean beef. Refrigerator and household characteristics were collected with a predefined observational sheet and short, structured questionnaire. In total, 50 households and their refrigerators were included. Gaps related to the cold storage and cross-contamination were observed. Temperature displays were present in 16% while control thermometers were not observed at all; 20% of the refrigerators enabled 24 h average internal temperature lower than 4 °C, 30% between 4 and 6 °C and 50% over 6 °C. Refrigerator age, type and load were observed but had no significant impact, which suggests thermostat setting as a key factor influencing refrigerator temperatures. Food distribution inside refrigerators was related to the refrigerator load with significant risk for cross-contamination in overpacked refrigerators. High temperatures combined with a non-systematic distribution of food in the refrigerator, expired dates of durability, and non-systematic cleaning strategies allow favourable preconditions for food infections occurring at the end of the food supply chain. Tailored acceleration of existing food safety messages could and should help consumers to minimise food safety risks, improve food quality, and reduce food wastage.

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

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