Vaccine Storage and Handling
There are few immunization issues more important than the appropriate storage and handling of vaccines. Vaccine-preventable disease rates have decreased in part because of proper storage and handling of vaccines. Exposure of vaccines to temperatures outside the recommended ranges can decrease their potency and reduce the effectiveness and protection they provide. Storage and handling errors can cost thousands of dollars in wasted vaccine and revaccination. Errors can also result in the loss of patient confidence when repeat doses are required. It is better to not vaccinate than to administer a dose of vaccine that has been mishandled. Vaccine management, including proper storage and handling procedures, is the basis on which good immunization practices are built.
Vaccines must be stored properly from the time they are manufactured until they are administered. Assuring vaccine quality and maintaining the cold chain is a shared responsibility among manufacturers, distributors, public health staff, and health-care providers. A proper cold chain is a temperature-controlled supply chain that includes all equipment and procedures used in the transport and storage and handling of vaccines from the time of manufacture to administration of the vaccine. By following a few simple steps and implementing best storage and handling practices, providers can ensure that patients will get the full benefit of vaccines they receive.
Storage and Handling Plans
Every facility should have detailed written protocols for routine and emergency vaccine storage and handling and they should be updated annually. These policies and procedures should be available in writing as a reference for all staff members and easily accessible. A routine storage and handling plan provides guidelines for daily activities, such as:
-Ordering and accepting vaccine deliveries
-Storing and handling vaccines
-Managing inventory
-Managing potentially compromised vaccines
-Every facility should also have an emergency vaccine retrieval and storage plan. The plan should identify a back-up location where the vaccines can be stored. Considerations when choosing this site include appropriate storage units, temperature monitoring capability, and a back-up generator that can maintain power to the vaccine storage units. Potential back-up locations might include a local hospital, pharmacy, long-term care facility, or the Red Cross.
There should be an adequate supply of packing materials and portable refrigerators and freezers or qualified containers and packouts on hand to accommodate the facility’s largest annual vaccine inventory (e.g., flu season). A refrigerated truck may be needed to move large inventories of vaccine.
Power outages or natural disasters are not the only events that can compromise vaccine. Forgotten vials of vaccine left out on the counter or doses of vaccine stored at improper temperatures due to a storage unit failure are other examples of how vaccines can be potentially compromised. Protocols after an event will vary depending on individual state or agency policies. Contact the local or state health department immunization program (hereafter referred to as “immunization program”), vaccine manufacturer(s), or both for appropriate actions or guidelines that should be followed for all potentially compromised vaccines. Do not discard vaccines unless directed to by the immunization program and/or the manufacturer.
Staff Training and Education
Assign a primary vaccine coordinator who is responsible for ensuring that vaccines are stored and handled correctly at each facility. Designate at least one alternate (back-up) vaccine coordinator who can perform these responsibilities in the absence of the primary coordinator. These responsibilities include, but are not limited to, the following tasks:
Ordering vaccines
Overseeing proper receipt and storage of vaccine deliveries
Organizing vaccines within the storage unit(s)
-Temperature monitoring of the storage unit(s) (i.e., current temperature at least 2 times each workday).
-Recording temperature readings on a log
-Daily physical inspection of the storage unit(s)
-Rotating stock so that vaccines closest to their expiration dates will be used first
-Monitoring expiration dates and ensuring that expired vaccines and diluents are removed from the storage unit(s) and not administered to patients
-Responding to potential temperature excursions
-Overseeing proper vaccine transport
-Maintaining all appropriate vaccine storage and handling documentation, including temperature-excursion responses
-Maintaining storage equipment and maintenance records Maintaining proper documentation for the VFC program in participating facilities
-Ensuring that designated staff is adequately trained
-A physician partner or member of management should be directly involved with the clinical staff that is responsible for vaccine storage and handling. Management staff should have a clear understanding of the vaccine replacement costs and clinical implications of mismanaged vaccines.
All personnel who handle or administer vaccines should be familiar with the storage and handling policies and procedures for their facility. This includes not only those who administer vaccines, but also anyone who delivers or accepts vaccine shipments and anyone who has access to the unit(s) where vaccines are stored. Vaccine storage and handling training should be provided to all new personnel who handle or administer vaccines, including temporary staff.
Continuing education for staff is essential when new vaccines are stocked and when there are any changes to the storage and handling guidelines for a particular vaccine. CDC has a free web-based storage and handling module as part of the online training tool, “ You Call the Shots,” at http:// www.cdc.gov/vaccines/ed/youcalltheshots.htm. Continuing education credit for a variety of healthcare professionals and a certificate of completion are available. Many immunization programs and professional organizations also offer vaccine storage and handling training programs.
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