Proper Vaccine Handling, Storage, and Temperature Monitoring
Vaccines are life-saving substances that prevent the spread of potentially devastating communicable diseases like measles, polio, and smallpox. With rising human populations and increasingly concentrated urban areas, vaccines are more important than ever.
Proper storage and handling of vaccines plays a large role in their effectiveness—in fact, the success of vaccines is largely attributable to proper storage and handling from the time they are manufactured. Storage and handling errors can result in:
- Decreased potency and reduced protection from vaccines
- Thousands of dollars in wasted vaccine product and necessary revaccination
- Potential safety issues
Ultimately, vaccination handling errors can result in loss of patient confidence. Proper handling of vaccines is a shared responsibility between manufacturers, distributors, healthcare administrators, and providers. Let’s look at some best practices for proper handling and storing vaccines.
Handle with Care: Vaccine Storage and Handling
Every facility should have detailed written procedures for both routine storage of vaccines an emergency plan for vaccine retrieval and storage, in case of a power outage, natural disaster, or other emergency. Staff members should receive training on all of the following:
- Ordering vaccines and accepting deliveries
- Proper handling and storage of vaccines
- Managing vaccine inventory
- Procedures for handling potentially compromised vaccines
- Emergency vaccine storage plan
- Appropriate storage units and temperatures
- How to use temperature monitoring equipment
Potential back-up locations for vaccine storage include hospitals, pharmacies, and the Red Cross. Power outages and natural disasters are not the only situations in which vaccines can become compromised. Leaving a vaccine out unrefrigerated for any length of time can potentially compromise its safety and potency. Vaccines kept at the wrong temperature because of human error or failure of a refrigeration unit can also compromise the product.
Ensure that not only facility staff members, but custodial and security staff, are up-to-date with emergency procedures for vaccine in case of a power outage or natural disaster.
The Vaccine Cold Chain
Vaccines must be constantly kept at certain temperatures—this is referred to as the vaccine cold chain. The first line of defense in the cold chain is the cold storage unit at the vaccine manufacturing facility. Vaccines are kept in cold storage trucks during transport and immediately transferred to refrigeration units set to the appropriate temperature on arrival at their final destination (generally the provider facility).
Heat is not the only exposure that could potentially compromise a vaccine. Light and excessive cold can also damage certain vaccines and reduce their potency. Potency that is lost cannot be restored. It’s important to take immediate corrective action when the temperature reading is outside the recommended range for the vaccine in question. This may require calling the vaccine manufacturer for guidance and troubleshooting.
The physical appearance of a vaccine is not a reliable indicator of its potency. In some instances the vaccine will appear the same, while in others a vaccine will show physical evidence of reduced potency, including clumping that does not go away when the vial is shaken.
Here are recommendations for appropriate temperatures for various vaccines, according to the Centers for Disease Control.1
Store in Refrigerator (between 35°F and 46°F):
- Human papillomavirus (HPV2 and HPV4)
- Influenza (LAIV, IIV, RIV)
- Rotavirus (RV1 and RV5)
Store in Freezer (between-58°F and +5°F)
This is not an exhaustive list, but represents a sample of some of the most common vaccines.
Vaccine Storage and Temperature Monitoring Equipment
Investing in appropriate storage equipment is equivalent to ensuring your facility’s vaccine supply. The CDC recommends standalone units that either refrigerate or freeze (not both, like typical household refrigeration units). Combination refrigerator/freezer units typically have cold spots and fluctuations in temperature that risk damaging the vaccines—most of us have likely experienced pulling something out of the back of a home refrigerator and finding it partially or completely frozen. These units may simply pose too great a risk for storing vaccines.
Pharmaceutical or custom-built units are good choices. Freezers should be kept between-58°F and +5°F, and refrigeration units should be kept between 35°F and 46°F. If you must use a combination unit, the CDC recommends using only the refrigerator portion of the unit. Additionally, the refrigeration compartment should be partially filled with gallon-size jugs of water to absorb some of the cold air that blows in from the freezer in order to prevent vaccines from freezing.
Among the most vital lab supplies is a vaccine thermometer. There are several types of vaccine temperature monitoring devices to choose from, including continuous monitoring devices, and digital data loggers.
Continuous monitoring devices: These devices provide information about excursions (the length of time a storage unit has been operating outside the recommended temperature) and when the excursion occurred. Detailed information is provided on all temperatures that are recorded at scheduled intervals. Among the features the CDC recommends for continuous monitoring devices are:
- A digital display on the outside of the device that allows viewing of temperatures without opening the door to the storage unit
- Alarm to alert when temperatures are out of range
- Accuracy within +/-1°F (+/-.5°C)
- Continuous monitoring capabilities that allow for both short-term and long-term temperature readings
Digital data loggers: These devices are also used for continuous temperature monitoring and recording, and are typically battery operated. They can be programmed to take several temperature readings at set intervals throughout the day. One of the main advantages of digital data loggers is that they can record and store thousands of individual temperature readings. This information can be downloaded for review and archiving. Many data loggers are accompanied by software that provides the user with additional options, including the ability to set the frequency of temperature readings and review minimums and maximums. Among the features to look for in a digital data logger, according to the CDC, are:
- Alarm for out-of-range temperatures
- Minimum of 4,000 temperature storage readings
- Temperature readings that include current, minimum, and maximum
- Programmable logging rate
- A device that is VFC compliant
Temperature alarms: Alarms are useful tools to alert staff to vaccine storage unit temperature problems; however, it’s important to note that they are only effective when responded to appropriately.
Storing and handling vaccines is a complex process that requires diligent monitoring by facility staff members and clearly outlined procedures, including emergency procedures. Having the right cold storage equipment and vaccine thermometers will ensure the efficacy and safety of your facility’s vaccines, reducing losses and improving patient confidence.