Cold chain management
Cold chain management
Sequential Steps of Cold Chain Management
1. Cold Chain Equipment Setup and Maintenance
Cold Chain Equipment Setup and Maintenance
At National / State / Regional level:
At District level:
Cold Chain Equipment Setup and Maintenance
At planning unit (PHC) level:
Deep Storage - Ice Storage and
Freezer packs Cold box transport
(140 litres)
Storage - Transport of
Vaccines and vaccines and
Ice lined diluents diluents
Vaccine
refrigerator
carrier
(140 litres)
Cold Chain Equipment Setup and Maintenance
Cold Chain Equipment Setup and Maintenance
i. Ambient temperature – more the ambient
temperature, less will be the holdover time
ii. Frequency of opening of lid and use of basket
Hold over time iii. Quantity of vaccines kept inside (equipment
empty/loaded)
iv. Condition of the ice pack lining (frozen/partially
frozen/melted) inside
Cold chain contingency plan?
Cold chain room
Receiving and Storing Vaccines
1. The PHC receives vaccine supplies from the District Vaccine Store (DVS)
2. Key actions:
a. On arrival, check the vaccine shipment for cold chain indicators
(temperature log, VVM, and ice pack condition)
b. Store vaccines in the ILR immediately
c. Maintain the storage hierarchy
Temperature monitoring
1. The PHC staff routinely monitor the ILR temperature
twice daily
2. Key Actions:
a. Use a thermometer to check the ILR temperature
and record it in the temperature log book
b. Take corrective actions if the temperature is
outside the acceptable range (e.g., adjust
thermostat settings or report to the supervisor)
Temperature monitoring
Vaccine sensitivity to heat, cold and light
Vaccines sensitive
Vaccines sensitive to heat Vaccines sensitive to freezing
to light
• BCG (after reconstitution) Most Most BCG
•
• OPV, Rota sensitive sensitive • Measles/MR
• HepB • JE
• IPV RVV
•
• PCV
• MR
• Penta
• Rotavirus
• IPV
• JE
• DPT
• DPT
• TT
• BCG (before reconstitution)
• TT,
• Penta, HepB, PCV
Least Least
sensitive sensitive
Vaccine sensitivity to heat, cold and light
Control Panel
1. Green light
2. Red light (in DF control panel only)
3. Yellow switch (In ILR control panel
only)
4. Thermostat
5. Thermometer
Vaccine Distribution to Session Sites
1. Vaccines are sent from the PHC to outreach session sites weekly.
2. Key Actions:
a. Condition ice packs by keeping them at room temperature until water sloshes
inside.
b. Place them in the vaccine carrier.
c. Pack vaccines in the carrier according to the expected number of children at
the session site.
d. Verify that the VVM is within the usable stage and that vaccines are not
expired before dispatch
Preparing of ice packs
Steps of conditioning of ice packs
Packing of cold box
1. Place conditioned ice packs at the bottom and sides
2. Load the vaccines in cardboard cartons/ polythene bags
3. Never place freeze-sensitive vaccines in direct contact
with the ice packs. Surround them with OPV/BCG/JE
vaccines
4. Keep a thermometer in the cold box
5. Place two rows of conditioned ice packs above the
vaccine vials
6. Place a plastic sheet to cover the ice packs kept on top
to ensure full holdover time
7. Securely close the lid of the cold box
Packing of Vaccine carrier
Stock Management and Recording
Key Actions:
1. Regularly update the stock register with incoming and outgoing vaccines, noting the
VVM status, expiry dates, and quantity.
2. Conduct a physical count of vaccines at the end of each month to reconcile with the
records and report any discrepancies.
Handling Vaccine Wastage and Expiry:
3. Identify unusable vaccines by checking VVM and expiry date and segregate them from
usable stock.
4. Document wastage appropriately and dispose of expired or damaged vaccines
following the waste management protocols (e.g., sending to disposal pit)
Checking vaccines for correct maintenance of cold chain
Heat damage – Vaccine Vial Freeze damage – Shake test
Monitor (VVM) 1. TEST’ vial – Vaccine vial which is suspected to
Label containing a heat-sensitive have been frozen
material to record cumulative heat 2. ‘CONTROL’ vial – Vaccine vial of the same
exposure over time antigen, same manufacturer and the same batch
number as the suspected vaccine vial – frozen to
-20°C overnight in the Deep Freezer.
End of immunization day
Unopened vials If VVM is intact and in usable stage, retain the vial
1. Open Vial policy applies only for DPT, TT, Hepatitis B, Oral Polio Vaccine
(OPV), Liquid Pentavalent, PCV and injectable IPV
2. Can be used upto four weeks provided:-
Opened vials a) Expiry date not passed
b) Vaccine vial monitor (VVM) not reached discard point
c) Vaccine vial septum not submerged in water or contaminated
d) Aseptic technique has been used to withdraw all doses
Does not apply to Measles/MR, BCG, Japanese Encephalitis (JE) vaccines
Ensure all open vials have recorded date and time of opening
Role of technology in vaccine dispensing
1. NCCMIS: National Cold Chain Management Information System
Comprehensive web-based database for various cold chain equipment and their
related information across the country used in the UIP
2. eVIN: Electronic Vaccine Intelligence Network
a. ensures effective management of the immunization supply chain
b. It includes components like: eVIN registers, eVIN technology, training of cold
chain handlers and VCCMs
3. U-WIN
Reasons for failure of cold chain
1. Voltage fluctuations, lack of stabilizers, lack of proper wiring and earthing
2. Improper cleaning and defrosting of cold chain equipments
3. Prolonged time taken for repair of equipment
4. Lack of trained Cold Chain Technicians (CCTs)
5. Lack of documentation of power cuts/generator running/defrosting in the log books
6. Temperature charting not done meticulously
