Identification of Potential and Actual Breaches in the Cold-Chain within a Tertiary Hospital

Background: Vaccines are biologicals that need a strict storage environment from the time of manufacture to ensure that they are potent at the time of administration. The National Vaccine Storage Guidelines (NVSG) provide clear directives for appropriate vaccine storage within healthcare institutions. Aim: To compare current hospital vaccine storage and transport practices to NVSG. Method: Areas within the hospital where vaccines were stored were identified. A senior staff member from each area was asked a series of questions about their cold-chain management. A temperature logging device recorded the temperature for 24 hours on different shelves within each refrigerator and a visual inspection was made of each refrigerator and its environs. The temperature of vaccines transported from pharmacy stores to a ward was also monitored. Results: 4 of the 12 refrigerators examined failed to meet the temperature requirements and only 1 refrigerator fully met the NVSG criteria. Temperatures recorded in purpose-built vaccine refrigerators were outside the required range for 4.5% of the period monitored and domestic refrigerators were outside the range for 34% of the period. Temperatures varied more between shelves in domestic refrigerators than in purpose-built refrigerators. Conclusion: Potential breaks in the cold-chain were identified. The issues were addressed through the promotion of the NVSG throughout the hospital and the introduction of purpose-built refrigerators in areas with a high level of vaccine use.