Vaccine Storage and Handling Module

Which vaccine should never be transported or stored frozen? Option A Pneumococcal. Option B Zoster. Option C Varicella.

A is Correct. Both pneumococcal conjugate and pneumococcal polysaccharide vaccines are inactivated and should be stored in the refrigerator at temperatures between 2°C and 8°C (36°F to 46°F). Varicella vaccine and zoster vaccines are shipped frozen.

At the end of a month, you review the storage unit temperature logs. You notice that the temperature has been exactly 6°C at every single check. Which action would be advisable? Option A Test the thermometer to make sure that it is working properly. Option B Move the thermometer to a different location in the storage unit. Option C Assume that there has been no variation in the storage unit temperature. Option D Purchase a thermometer that measures the unit's temperature range.

A is Correct. Even when the storage unit thermostat is set at a particular temperature, there most likely will be a slight variation from one thermometer reading to another. If the thermometer does not fluctuate at all, test it to make sure it is working properly. You can do this by placing it outside the storage unit and noting whether the gauge rises in response to room temperature.

Which measure best protects the cold chain when vaccines that require refrigeration are transported from the vaccine storage unit to another location for administration? Option A If transporting vaccine on a hot day, keep the insulated container inside the interior of the car and not inside the trunk. Option B If transporting vaccine on a cold day, place the insulated container in the trunk rather than inside the heated car. Option C If transporting vaccine on a hot day, pack the vaccine up against the frozen coolant packs inside the insulated container. Option D If transporting vaccine on a cold day, do not include chilled coolant packs inside the insulated container.

A is Correct. On a hot day, vaccine can become overheated in a hot trunk. Always transport vaccine in the interior of an air-conditioned car. Some vaccines are damaged by freezing. The temperature in a car trunk on a cold day may drop low enough to freeze vaccine.

You accidentally leave a vial of vaccine on a counter overnight. The vaccine is supposed to be frozen and it has thawed to room temperature. What would be the correct action for you to take? Option A Discard the vial and report the loss to the vaccine coordinator. Option B Return the vaccine vial to the freezer and use as soon as possible. Option C Immediately notify the vaccine coordinator or immediate supervisor. Option D Do not refreeze, but administer the vaccine as soon as possible.

A is Incorrect. The answer is C. Immediately notify the vaccine coordinator or immediate supervisor of this break in the cold chain. He or she will determine whether the vaccine is still usable or whether it needs to be discarded. All staff must understand that admitting mistakes and discarding vaccine, if told to do so by the vaccine coordinator, is the correct action to take. Any other action could result in people being injected with damaged or ineffective vaccine.

Some vaccines contain live virus. What method do you think would be best for discarding an expired live virus or live bacteria vaccine? Option A Kill all live microbes present in the vaccine and discard the vials in the trash. Option B Dispose of vials of live vaccine in a sharps container as hazardous waste. Option C Flush live vaccine down the toilet and rinse vials before placing in the trash. Option D Place live vaccine vials in a labeled paper bag and discard in the trash.

B is Correct. Live virus vaccines (e.g., MMR, yellow fever, vaccinia) or live bacteria vaccines (e.g., typhoid capsules, BCG) are considered hazardous waste. In many clinical settings, all vaccine vials (for both live and inactivated vaccines) are discarded in sharps containers, which are considered hazardous waste containers.

You open a vaccine shipping container and note that the temperature monitor indicates that the inside of the container reached an unacceptable temperature during the shipping process. What should be your first action? Option A Call the vaccine manufacturer for further instructions. Option B Put the vaccine in a bag marked "Do Not Use" and place it in its required storage location. Option C Examine the vaccine for visible damage and, if none noted, immediately re-cool to recommended temperature. Option D Check the current temperature of the vaccine and, if it is in range, store the vaccine as recommended.

B is Correct. Whenever a temperature monitor indicates that a vaccine has reached an unacceptable temperature, take action. First, place the vaccine in a bag marked "Do Not Use," seal the bag shut, and place the bag away from other vaccines in its usual storage location (refrigerator or freezer). Then, contact the vaccine coordinator or the vaccine manufacturer for further instruction. The vaccine still may be useable or it may need to be discarded.

What else can be put in the refrigerator and freezer where vaccines are stored? Option A Beverages. Option B Your lunch. Option C Client specimens. Option D Other medications.

D is Correct. Do not store anything except other medications where you store vaccines. This minimizes opening and closing the refrigerator and freezer doors, and cuts down on potential spills and contamination in the vaccine storage area.

What is the first thing that you should do when a shipping container of new vaccine arrives? Option A Call the vaccine manufacturer for further instructions. Option B Promptly place the container in the refrigerator or freezer, as appropriate. Option C Discard all old or outdated vaccine in the refrigerator or freezer. Option D Open the shipping container and check the contents.

D is Correct. In all circumstances, the first thing that you should do when a new vaccine shipment arrives is to open the shipping container and check the contents. If it is the correct vaccine, the vaccine vials are in good shape, the cold chain has been maintained, and the vaccine is not outdated, then store the vaccine according to the manufacturer's recommendations. If not, take additional steps as necessary.

Which is NOT an important reason for storing and handling vaccines and immunologic drugs properly, as indicated by their manufacturers' instructions? Option A To prevent the risk of administering an impotent or subpotent vaccine. Option B To prevent the waste of an expensive healthcare resource. Option C To ensure adequate doses of antibodies to help prevent an infectious disease. Option D To ensure that the vaccine storage area remains orderly and organized.

D is Correct. The three main reasons it is important to store and handle vaccines and other immunologic drugs properly are to: 1.make sure vaccines remain effective at preventing disease. 2.make sure immune globulins contain enough effective antibodies to help prevent or cure disease. 3.save expensive immunologic drugs from being destroyed by heat or freezing. While orderly organization of vaccines is highly recommended, this is not a reason for them to be kept in the refrigerator or freezer. You can keep drugs neat and organized on shelves or in drawers, but to keep vaccines effective you must store them in the refrigerator or freezer, as indicated by the manufacturers' instructions.

cold chain

The "cold chain" extends from drug manufacturer, delivery truck, vaccine storage refrigerator, and person receiving an injection. If refrigerated and frozen vaccines stay within the correct temperature range at all times, you have maintained the "cold chain" and can be confident that the vaccine has not been damaged by storage at the wrong temperature.

Is the statement below True or False? If you have a small vaccine administration setting with limited space, a small dormitory or mini-bar refrigerator can be used to store frozen vaccines.

The answer is False. Refrigerators, such as dormitory or mini-bar types, that do not have a separate freezer do not keep consistent frozen temperatures. If you have limited space, there are small, high-quality commercial vaccine storage units available.

Is the statement below True or False? To keep them cold, vaccines boxes should be packed tightly into the vaccine storage unit.

The answer is False. Vaccine boxes should not be packed in the storage unit too tightly. Air must be able to circulate around the boxes to cool them. Packing a refrigerator too full can lead to subtle increases in temperature.

Vaccine has been delivered to the reception desk at your vaccine administration site. You place the box of vaccine on the primary vaccine coordinator's desk. Is the statement below True or False? You acted appropriately to maintain the cold chain.

The answer is False. Vaccine requires either refrigeration or freezing to maintain the cold chain. The primary vaccine coordinator's desk is at room temperature. Vaccine left on a desk may not be noticed right away and could be damaged by becoming too warm. In the next section of this module, we will discuss how vaccine should be handled on arrival at a vaccine administration site.

Click on Yes if the vaccinator has correctly safeguarded the vaccine after it was removed from the vaccine storage unit for administration to the client, or on No if the vaccine has not been correctly safeguarded. After adding diluent to a single dose vial of MMR vaccine and agitating it thoroughly, the vaccinator notes that the vaccine has turned yellow and discards the vial into a hazardous waste container.

The answer is No. MMR vaccine is expected to turn yellow after the diluent is added and the vaccine is agitated. This vaccine was wasted when it was discarded.

Click on Yes if the vaccinator has correctly safeguarded the vaccine after it was removed from the vaccine storage unit for administration to the client, or on No if the vaccine has not been correctly safeguarded. To reconstitute yellow fever vaccine, the vaccinator shakes the vial vigorously after injecting the diluent.

The answer is No. Some vaccines should not be shaken vigorously. For example, yellow fever vaccine should be allowed to sit for two minutes after the diluent is injected before it is swirled to mix. Vigorous shaking causes the vaccine to foam. It is important to read the manufacturer's product insert for specific directions on how to reconstitute any vaccine with which you are not familiar. Do NOT automatically shake every vaccine vial before drawing up the vaccine.

You are preparing to administer a vaccine and you notice that the vaccine's expiration date is November 30th. Today is November 30th. Is the statement below True or False? It is acceptable to administer the vaccine today, even though the expiration date on the vial is today's date.

The answer is True.

Click on Yes if the vaccinator has correctly safeguarded the vaccine after it was removed from the vaccine storage unit for administration to the client, or on No if the vaccine has not been correctly safeguarded. The vaccinator shakes a multidose vial of Td vaccine before withdrawing each dose, and then shakes each syringe before injecting the dose.

The answer is Yes. To make sure that the vaccine suspension is evenly distributed in the multidose vial, the vial should be shaken before each dose is drawn up. Before the dose is given to the client, the syringe should be shaken to make sure the vaccine is evenly suspended when it is injected.

Vaccine storage units must be kept within the proper temperature range.

The refrigerator should always be between 2° and 8°C (35° to 46°F), with the preferred set point at 4°C. The freezer always should be between -50°C and -15°C (-58°F and +5°F) .

The head of the chain of command is the "primary vaccine coordinator."

This person is responsible for ensuring that all vaccines are handled correctly and that procedures are documented. The primary vaccine coordinator is trained in routine and emergency procedures related to vaccine receiving, handling, storage, and shipping. If the vaccine storage area is locked, this is the person who should have the key.

different vaccines

•Store *zoster* vaccines in the freezer. •Some formulations of *varicella and MMRV* can also be stored in the freezer or refrigerator. Check the product insert as to storage requirements. •Store all other vaccines in the refrigerator NOTE: Zoster vaccine can be stored in the refrigerator for up to 72 hours prior to reconstitution.