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Vaccine Storage in Practice

Safe storage of vaccines and managing medical fridges in GP Practices

A whopping 76% of this wastage could have been avoided according to UK Health Security Agency*, saving the NHS approximately £4.4 million.

It is said that the amount of vaccine wastage reported is likely to be under-reported and the true financial cost is even greater.

We have written this vaccine fridge guide to help busy healthcare professionals who have a responsibility to minimise financial risk and to help sustain supplies, reducing vaccine waste whilst still ensuring the safety of their patients.

*Republished Version July 2022

 

If you’re looking for products, please view our medical fridge range

Vaccine Effectiveness

As we know, vaccines (just like any medicine) can lose their effectiveness if they become too hot or too cold at any time and, like most things, naturally biodegrade over time which is why there are storage conditions, expiry dates and lot/batch numbers.

If vaccines are stored outside of the recommended temperature range, including during transportation, they can lose potency.  This cannot be reversed and may then fail to protect the patient due to an ineffective immune response.

Correct storage, handling and administration of vaccines can significantly reduce unnecessary waste, cost and improve patient safety.

Vaccine Management

It is advised that staff ordering and taking delivery of vaccines should follow this advice:

  • Put them in the fridge ASAP

    Vaccines should be stored according to the manufacturer’s summary of product characteristics (SPC).

    They are usually between +2˚C and +8˚C and protected from light and transferred to a fridge promptly after delivery.

  • First in, First out

    Ensure you rotate stock by putting the vaccines with the shortest expiry date to the front of the fridge and the longest at the back.

    This will not always correspond with the order in which they are delivered, so make sure you check!

  • Do not stockpile

    Place orders every two to four weeks, according to need

  • Don't be a "Last-Minute Lucy"!

    Vaccines can be in short supply and high demand, so ensure you place your orders in time so there is an adequate supply for your clinics.

The Vaccine Fridge

The Green Book gives detailed guidance on the use and maintenance of the vaccine fridge and includes the following:

  • Do not use a domestic fridge

    Vaccines must be kept in a validated fridge which is specifically designed for pharmaceutical products, even if a domestic fridge has the same temperature range.

  • No food or specimens

    Only store pharmaceutical products in your vaccine fridge.  Never store food or clinical specimens alongside vaccines.

  • Don't save electric...?

    The fridge must be on 24/7/365 as long as it is holding cold chain pharmaceuticals, especially vaccines.

    To reduce the risk of switching off the electric, especially as we become more environmentally friendly and cost focussed, consider installing a switchless socket or simply label the plug “DO NOT SWITCH OFF”

  • Keep it cool. Keep it locked.

    The temperature must be maintained between +2 and +8⁰C and the vaccine fridge must be kept secure.

    It should only be accessible to authorised practice staff and should therefore be kept locked or in a locked room when authorised staff are not present.

  • Give me space!

    For the temperatures to remain consistent, it’s important to use a fridge large enough to allow space around the vaccine packages in order for the air to circulate.  The MHRA recommends that you stock the fridge up to 75% capacity.

    You could upgrade to a larger fridge or get another small one to use in tandem, though the more fridges you have, the more maintenance and administration to ensure they are compliant.

  • No ice, ice baby!

    The fridge must be kept clean and have no build-up of ice. Most vaccine fridges will have an auto-defrost function built-in, but you must ensure you:

    – Include it in Portable Appliance Testing (PAT)

    – Calibrate the temperature gauge

    – Keep the fridge serviced according to the manufacturer’s recommendations

  • No fancy packaging

    Keep vaccines in their original packaging.

    This will help with identifying the vaccine, keeping it safe and secure and may have more information on the box than on the label.  If you “decant” the bottles, there is more risk of damage and losing vital information.

  • Keep the fan clear

    Do not stack vaccines above the fan as this will block it and reduce the airflow.

  • Location, location, location

    Choose the correct location for your fridge.  It should be in a dry, well-ventilated area, away from direct sunlight and heat sources such as radiators.

Cold Chain Policy

All providers should have a policy which includes how to handle vaccines to maintain the cold chain from the point of delivery to administration.

The policy should include transport of vaccines outside the practice, actions to take in the event of a breach in the cold chain and details of how the practice will ensure learning from cold chain incidents.

Temperature monitoring

Whilst a data logger (built-in like this fridge or separate like this one) is useful, it isn’t a replacement for “old-fashioned” manual temperature monitoring.

If you would like copies of our Fridge Temperature Monitoring Book with free gift, please contact us.

According to the Green Book, the person making the recording of the fridge temperature should:

Observe the 4Rs:

Read ❆ Record ❆ Reset ❆ React

  • Read:

    daily reading of the thermometer’s maximum, minimum and current temperatures at the same time every day during the working week

  • Record:

    recording temperatures in a standard fashion and on a standard form, including signing each entry on the recording sheet

  • Reset:

    resetting the thermometer after each reading. The thermometers should also be reset when temperatures have stabilized after periods of high activity

  • React:

    the person making the recording should take action if the temperature falls outside +2˚C to +8˚C and document this action.

Data Loggers

Data loggers are useful to gain more detailed information about the fridge temperature if there is a cold chain failure, for example a power cut and can be helpful in decision-making and for audit purposes.

As detailed above, a Data Logger is not a replacement for manual recording of temperatures of the intergral fridge thermometer (min, max and current), which you must do every working day as well as reset the min/max thermometer. Doing this will give you assurance that the fridge contents have been stored correctly and are safe to use.

Checking a Data Logger weekly or monthly risks missing cold chain breaches, resulting in the possibility of using vaccines stored improperly outside of their temperature range.

CQC Inspections

According to the CQC website, during an inspection, inspectors will expect to see evidence of maintenance of the cold chain.

Providers will be asked to show how they follow the Public Health England recommendations. This includes receipt of vaccines into the practice until administration to the patient.

Inspectors may also ask to see evidence of the log of fridge temperatures, maintenance checks and a policy for what to do if a temperature breach occurs. Inspectors may also check the fridge to see if the vaccines are being stored appropriately.