COLD CHAIN

1. Cold Chain Surveillance Coordinator Provincial EPI cell

2. What is cold chain system • From the manufacture to the recipient, all the steps n
people involved in keeping the vaccine in the required temperature is called the cold
chain system
3. The cold chain • Vaccines are sensitive biological. • Needs special attention. •
Damages by heat – freezing. • Once potency is lost – cannot be regained. • Requires
special storage mechanism. • From manufacturer to site of use. • Two major factors. •
Staff • Equipment
4. Current vaccine management system
5. EPI cold rooms • Peshawar. • Malakand. • Mansehra. • Kohat. • Bannu. • [Link].
6. Location of cold rooms
7. Vaccine storage • Ideal temperature (2 to 8 ) so that pneumococcal, penta & TT do
not freeze • Polio if needed to be stored for more then 3 months can be stored in – 20.
• Thermometers • Dial, cold chain monitor card, mercury • VVM, Shake test
8. Conclusion. • Good installations are available. • Have trained staff posted. • Have the
vaccine storage capacity for entire divisions. • Working back up is available in most of
the cold rooms. • Stock registered are maintained.
9. Conclusion-2 • Cold rooms remained out of order for considerable time. • No
mechanism for local repair. • No allocation for POL of generators. • Did not serve
during the past 2 years. • No proper supervision mechanism of concerned staff. • No
leave account maintained. • No written job description of staff. • Not trained on
storekeeping.
10. Conclusion-3 • No procedures for • Receiving vaccines. • Issuing vaccines. (vit A
during NIDs) • No proper vaccine management system. (Frequency & quantity of
vaccine) • Vaccine is collected from provincial cold room instead of divisional. •
Divisional cold rooms are under utilized. • No allocation for maintenance and repair.
11. Suggestions • Much more is desired to be done. • Vaccine management system. •
Date of collection – vaccine stock at different levels. • Regular review/signing of stock
registers. • Mechanism for monitoring of the system. • Development of SOPs for
various tasks. • Using checklists for various occasions.
12. Suggestions-2 • Ensuring vaccine stock at every level. • Collection of vaccine from
divisional, instead of provincial cold room. • Allocation of maintenance and repair
funds beyond the PC-1 period. • POL issue for generators to be taken.
13. Suggestions-3 • Training of personnel on storekeeping practices. • Installation of
automatic temperature recording equipment. • Developing mechanism for utilization
of technical staff. • Provincial cell should deliver vaccine to cold rooms.
14. Proposed vaccine management system • Vaccine should be collected from federal
cell on quarterly basis. • Provincial store to supply vaccine to cold rooms. • Divisional
cold room have 3 months quota. • Districts will collect vaccine from divisional cold
rooms. • District stores – 2 months supply. • EPI centers – 1 month stock.

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15. Checklist for receiving vaccine • When Vaccine Consignments Arrive at the Storage
Point : • All details of the consignment must be checked. • All detail be recorded in the
stock register. • District • Name of cold room/store/health facility • Name of
storekeeper/worker • Designation • The type of vaccine • The quantity received (in
doses) • The vaccine manufacturer • The batch or lot number. • The expiry date. • The
status of the VVM • Balance
16. Issuing vaccine • Record of each consignment leaving the store is appropriate. • All
details should be recorded. • The quantity issued. • Batch number. • Expiry dates . •
To whom issued. • The remaining balance.
17. While vaccine is in storage • All vaccines must be systematically arranged . • Older
stock should normally be distributed first. (FIFO). • Expiry must be checked regularly.
• All stocks must be distributed well before their expiry date. • Ensure that no batch
or lot remains too long in storage. • Regularly check the integrity of the stocks by
reviewing the status of VVM. • Any expired, damaged or vials with VVMs beyond the
discard point should not appear in the stock balance.
18. Vaccine demand • Requirement/Target. • Vaccine in balance. • Consumption in
previous month (s) • Vaccine received in previous month. • Vaccine issued. •
Vaccination coverage.
19. Thank you
Temperature-Sensitive Drugs List + Storage Guidelines
We are living in a time of unprecedented medical innovation. Modern medicine has
provided solutions to diseases and ailments that were thought to be impossible to cure or
manage just a century ago. Consider, for example, how quickly the global medical
community was able to create the COVID-19 vaccines.
The reality, however, is that there are so many challenges in storing and transporting
pharmaceutical products. Many drugs are sensitive to temperature variations, resulting in
them requiring careful storage and handling to maintain their potency. In this guide, you’ll
find a temperature-sensitive drug list as well as information on how to store and transport
medication for you or your family.
Temperature-sensitive drugs list
Drug sensitivity comes down to two key factors: time and temperature. Most drugs and
pharmaceutical products have a short shelf-life so they need to be transported quickly and
carefully to ensure that they remain safe and with a long enough usage window. Once
delivered, they need to be stored correctly because most drugs react negatively to
fluctuating temperatures which could cause them to become ineffective or even harmful.

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‍ oth in transportation and storage of your drugs, you face the challenge of dealing with
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time and temperature factors. You have to be able to handle your medication according to
temperature-sensitive pharmaceutical product requirements. Let’s explore a temperature-
sensitive drug list and some examples for each.
‍Refrigerated medications (2°C - 8°C / 36°F - 46°F):
‍Examples of drugs that need to be refrigerated:
 Some insulin medications (Humulin, Novolin, Lantus)
 Certain Antibiotics (Amoxicillin/clavulanate suspension)
 Biological Products (monoclonal antibodies)
 Typhoid vaccine, live oral
 Amphotericin B and ophthalmic
 Interferon gamma-1b
 Other injections like interferon and Filgrastim (more examples include Alprostadil
injection, Calcitonin injectable, and Etanercept injection)
 Some eye drops (latanoprost and chloramphenicol)
 Ear drops (chloramphenicol)
 Nasal sprays (Fortica, Miacalcin)
 Oral drops (Lorazepam intensol oral concentrate, Neurontin)
 Ritonavir capsules (Norvir)
 Cervical gel (Prepidil)
‍ efrigeration not only extends the shelf life of drugs and pharmaceuticals but also
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safeguards patients from receiving compromised doses. Refrigeration plays a crucial role in
preserving the integrity of medications by preventing degradation, chemical changes, or
loss of potency that may occur when exposed to higher or lower temperatures. Many
pharmaceuticals, including vaccines, insulin, and certain antibiotics, are highly susceptible
to temperature fluctuations. Drugs that require refrigeration must be kept between 2 - 8
Celsius.
‍Frozen Medications (-20°C / -4°F or colder):
Examples of drugs that need to be Frozen:
 Varicella chickenpox vaccine (Varivax)
 Zoster shingles vaccine (Zostavax)
 RNA and DNA samples
 Blood and plasma products
‍
When certain medications are exposed to higher temperatures, molecular structures can
break down, proteins may denature, and the overall stability of the drug can be
compromised. Freezing pharmaceuticals at specified temperatures helps to slow down or
inhibit these processes.
‍ reezing effectively puts the pharmaceutical in a state of suspended animation, preventing
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or significantly delaying the deterioration of its therapeutic properties. The meticulous
control of temperature is particularly critical for ensuring the efficacy, safety, and extended
shelf life of temperature-sensitive pharmaceutical products, contributing to their overall
quality and reliability for patient use.

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‍Controlled Room Temperature (15°C - 25°C / 59°F - 77°F)
Examples of drugs that can be stored at room temperature:
 Inhaled Medications (Albuterol inhalers)
 Certain Antibiotics (Amoxicillin capsules, cephalexin)
 Antifungal Medications (Fluconazole)
 EpiPens (epinephrine):
 Birth Control Pills (Ortho Tri-Cyclen, Yaz)
Many medications can be stored at room temperature due to their inherent stability under
moderate environmental conditions. The formulations of these drugs are designed to
withstand a range of temperatures without significant degradation.
‍ harmaceutical manufacturers carefully select excipients (ingredients) and design drug
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formulations to enhance stability and reduce susceptibility to temperature-related changes.
This allows medications to remain potent and safe when stored at typical room
temperatures, which is important for both patients and healthcare providers.
‍Storage and handling guidelines
Those who handle temperature-sensitive drugs must adhere to their specific storage
guidelines to ensure the integrity and efficacy of temperature-sensitive pharmaceutical
products. These are the storage guidelines to be mindful of when storing temperature-
sensitive medications:
‍1. Read and follow instructions
Always adhere to the storage instructions provided by the medication's packaging or your
healthcare provider. This information typically includes the recommended temperature
range and any specific storage conditions.
‍2. Use a dedicated storage area
Designate a specific storage area for medications, especially those requiring refrigeration.
This helps minimize temperature fluctuations and ensures a more controlled environment.
‍3. Check expiry dates
Regularly inspect medication for expiration dates and discard any that have expired.
Expired medications may not only be less effective but could also pose potential health
risks.
‍4. Maintain consistent temperatures
Keep medications within the recommended temperature range. For refrigerated items, use
a dedicated refrigerator with a consistent temperature, avoiding placing medications in the
door where temperatures may fluctuate.
‍5. Use insulated packaging for travel
When traveling with temperature-sensitive medications, use insulated packaging or a cool
pack to maintain the required temperature. Check with your healthcare provider for
specific travel recommendations.

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‍8. Keep medications in original packaging
Store medications in their original packaging with proper labeling. This ensures you have
all the necessary information, including dosage instructions and potential side effects.
‍7. Be aware of medication interactions
Some medications may interact with each other, and their stability can be affected when
stored together. Consult with your healthcare provider or pharmacist for advice on proper
storage when taking multiple medications.
‍9. Regularly monitor storage conditions
Periodically check the storage conditions of your medications, especially those in the
refrigerator. If you suspect any deviation from the recommended conditions, consult your
healthcare provider or pharmacist.
‍10 Dispose properly
Dispose of unused or expired medications according to local regulations. Do not flush them
down the toilet unless instructed to do so, as this may have environmental implications.
Many pharmacies offer medication disposal services.
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‍What medications are kept in cold storage?
Common medicines requiring refrigeration include:
 Eye and ear drops: - most eye/ear drops can be kept at room temperature for 28 days
after opening. Chloramphenicol. ...
 Reconstituted Antibiotics: - once reconstituted most need to be discarded after 1 to 2
weeks. Amoxicillin. ...
 Tablets: Leukeran. ...
 Injections: ...
 Other
What common medications need to be refrigerated?
Drugs stored in the medicines refrigerator include: vaccines; insulin; chemotherapy drugs;
topical preparations, such as some types of eye drops; and other treatments such as
glucagon, which is used to manage severe hypoglycaemia.

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What medicines require cold chain?
Five Most Common Cold Chain Drugs
 Vaccines must be cooled all the time. ...
 Glaucoma is treated with eye drops which are temperature sensitive. ...
 Aerosol spray, commonly known as asthma inhaler. ...
 Insulin often has to be stored at certain temperatures. ...
 Used for several cancer treatments: Biologicals.
Do antibiotics need to be refrigerated?
Vaccines and antibiotics often need to be refrigerated to prevent alteration of their chemical
structures; such alteration can result in less potent or ineffective medications.
What are the 2 types of cold chain?

There are two types of cold chain packaging systems: active and passive. Active systems
consist of cold chain transport containers featuring advanced electric or battery-powered
temperature controls. Active systems often have built-in cooling units or rely on dry ice as a
coolant.21 Nya. 2020
What are the 4 cold chain equipment?

The common cold chain equipment used in Health Posts are refrigerators, cold boxes,
vaccine carriers, ice-packs and foam pads.
What is the difference between cold chain and cold storage?
- Cold storage is a static part of Cold chain which can help in preservation of perishable
commodities. On the other hand, Cold chain actually helps in marketing of those
commodities at a lucrative price in distant markets which is more important for the farmers
and a necessary requirement.
What temp is cold chain storage?

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The “Cold Chain” is the system of transporting and storing vaccines within the temperature
range of 35°F (2°C) to 45°F (8°C). The cold chain begins when vaccine is manufactured,
moves through to the state distribution center and ends with the local immunization
provider at the time of administration.
What is the disadvantage of cold chain?

shipsy
 Equipment Breakdown. Sudden malfunctioning of equipment is one of the biggest
challenges in cold chain logistics management. ...
 Excessive heat exposure. This problem could occur during the loading and unloading
phase of the temperature-controlled goods. ...
 Human errors. ...
 Damaged goods. ...
 Higher cost.
What is the temperature range for cold chain storage?
The term “cold chain” for uninterrupted refrigeration has given way to “temperature-
controlled.” The spectrum ranges from ambient, or controlled room temperature (20°C to
25°C), to refrigerated (2°C to 8°C), to cryogenic (below 0°C to as low as −150°C).
How do you control a cold chain?
Maintaining the correct temperature is paramount in Cold Chain Management. This
involves using temperature-controlled storage facilities, refrigerated trucks, and even
advanced technologies like insulated packaging and temperature-monitoring sensors to
ensure products remain within specified temperature ranges.
Which thermometer is used in cold chain?

Probe thermometers are one of the most common temperature measuring devices used in
the cold chain sector.9 Ugu. 2020
How do you transport a cold chain?

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Cold chain shipping and tracking. As we mentioned above, transporting cool cargo requires
specialized equipment known as reefers or freezers. Those are special refrigerated trucks,
railcars, cargo ships, and aircraft.
What are the risks of cold storage?
Common Risks of Cold Storage Warehouses. Exposure to the extreme temperatures needed
to store many perishable goods can lead to discomfort, impaired physical performance, or a
feeling of numbness in the hands and feet, not to mention a risk of hypothermia or frostbite
in extreme situations
What is the importance of cold chain?
A cold chain is used to transport temperature-sensitive products that require a controlled
environment to maintain their quality, safety, and integrity.
What is the storage temperature in a pharmacy?
Ideally, all medicines storage areas would be controlled between 15ºC and 25ºC, which is
suitable for all ambient medicines. Pharmacy departments are expected to be able to
provide this level of temperature control for medicines.
What are the 3 main components of cold chain?
The cold chain has three main components: transport and storage equipment, trained
personnel, and efficient management procedures. All three elements must combine to
ensure safe vaccine transport and storage .
Who is responsible for cold chain?
A vaccine and cold-chain handler (VCCH) is trained and designated to maintain the cold
chain. It is also necessary to look into the dry storage areas, i.e. storage of syringes and
diluents, and ensure that they are safely stored and accessible.
Who is responsible for maintaining the cold chain?
Each site where vaccines are stored must have a trained and designated person responsible
for receipt and safe storage of vaccines. This person should identify another trained person
to deputise in times of absence.
Where should thermometers be placed inside cold storage units?
Place the glass with the thermometer in the middle of the compartment. It should be
halfway from front to back and halfway from top to bottom of the compartment. Allow 12
hours to reach accurate temperature measurement.
What are the 2 types of thermometers?
A thermometer is a device that measures temperature. The two types of thermometer are:
 Clinical thermometer: Clinical thermometer is used to measure the body
temperature. The temperature range of a clinical thermometer is 35°C-42°C.
 Laboratory thermometer: Laboratory thermometer is not used for the purpose of
measuring body temperature. It can be used to measure the temperature of chemicals
in the laboratory. The temperature range of a laboratory thermometer is -10°C-
110°C.

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What do you mean by cold chain temperature?
A cold chain is a temperature-controlled supply chain comprising refrigerated production,
storage and distribution facilities supported by equipment that can constantly maintain the
required low-temperature range. However, it's far more complex than it sounds.
What are the principle of cold chain?
It takes a chain of precisely coordinated events in temperature-controlled environments to
store, manage and transport these life-saving products. This is called a cold chain. Vaccines
must be continuously stored in a limited temperature range – from the time they are
manufactured until the moment of vaccination.
Which drugs are stored in freezer?

Eye drops such as cyclosporin dan sodium chloride 3% Ear drops such as sodium
bicarbonate 5% Antibiotic syrups / suspensions which are compounded from powder such
as amoxycillin supension. Medications to be kept frozen means medications that should be
stored below freezing temperature of -10 to -20°C.
How should medicines be stored?
Know that heat, air, light, and moisture may damage your medicine. Store your medicines in
a cool, dry place. For example, store it in your dresser drawer or a kitchen cabinet away
from the stove, sink, and any hot appliances. You can also store medicine in a storage box,
on a shelf, or in a closet.
What is drug storage?
Medication storage refers to the careful and proper handling of medications to ensure their
integrity, efficacy, and safety. It involves following specific guidelines and procedures to
maintain the quality and potency of medications.
How vaccines are stored?
The vast majority of vaccines should be stored at between 2-8⁰C in a refrigerator, with a
preferred average of 5⁰C, though some should remain frozen in a range between -15 to -
50⁰C. Additionally, many should be protected from light and are packaged appropriately, as
UV-light can damage them.

What vaccines are stored in the freezer?

Varicella vaccine (A) and MMRV vaccine (C) MUST be stored in the freezer. MMR vaccine
(B) can be stored in the refrigerator or freezer. Recombinant zoster vaccine (D) MUST be
stored in the refrigerator.

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Which vaccine should not be stored in freezer?
DPT, DT, dT, TT, Hepatitis B and typhoid contains such adjuvant and so can not be frozen.
Lyophilized or powder type of vaccines do not freeze as they have no liquids in it and so
storage in freezer compartment or lower shelves do not make difference.
What vaccines need to be refrigerated?
Most vaccines (all inactivated vaccines and live nasal spray influenza vaccine) must be
stored between 2° to 8°C (36° to 46°F), which is the recommended refrigerator
temperature. Live varicella (chickenpox) and Zostavax (shingles) vaccines must be stored
frozen between -50° to -15°C (-58° to +5°F).
What injections should be kept in the fridge?
These include insulins, antibiotic liquids, injections, eye drops and some creams. These
medicines must be stored between 2ºC and 8ºC. This guidance describes how you must
manage medicines which need to be in the 'cold chain'.
Which equipment is used to monitor the temperature in a cold storage?
Temperature sensor: A device that reads the temperature at a specific location within a cold
room, freezer room, refrigerator or freezer unit. Sensors may be connected individually or
collectively to a logger unit or directly to a base station.
Which vaccine kept in ice pack?
Ice-pack: A water-pack frozen to a temperature between -5°C and -20°C before use. Ice-
packs are used frozen for the transport of oral polio vaccine (OPV), and used conditioned
(see procedure for conditioning further down) for the transport of all other vaccines.

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