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Nigel's surgery 17: Vaccine storage and fridges in GP practices
This has been updated and now includes information on data loggers, alarm systems and a link to the 'Green Book'.
We consider the safe storage of vaccines and medical fridges in practices under the safe key question.
This relates to key line of enquiry (KLOE) S4: How does the provider ensure the proper and safe use of medicines, where the service is responsible?
Public Health England (PHE) has published guidance about ordering, storing and handling vaccines.
- Public Health England. Immunisation against infectious disease (the Green Book), Chapter three: Storage, distribution and disposal of vaccines.
- Public Health England: Protocol for ordering, storing and handling vaccines
All staff involved in immunisation should follow the recommendations in this guidance This makes sure vaccines are stored and managed properly so immunisations are done safely, efficiently and effectively.
Vaccines may lose their effectiveness if they become too hot or too cold at any time. They naturally biodegrade over time and being stored outside the recommended temperature range, including during transport, may speed up loss of potency. This cannot be reversed. A vaccine may then fail to create the desired immune response and give protection. Vaccines cost the NHS around £200 million a year. Storing and transporting vaccines inappropriately causes wastage and unnecessary costs.
Management of vaccines
When ordering and taking delivery of vaccines, staff should:
- place orders every 2-4 weeks, according to need
- store vaccines promptly in a fridge after delivery, maintaining the ‘cold chain’ (stored between +2 to +8⁰C) at all stages
- rotate stock properly – the shortest expiry date used first
- place orders in time so there is an adequate supply for clinics.
Named, trained people need to be responsible for ordering, receipt and care of vaccines. However, all members of the primary care team should understand importance of good vaccine management.
The vaccine fridge
- Store vaccines and other medicines in a validated fridge specifically designed for pharmaceutical products. Do not use an ordinary domestic fridge.
- Only use it to store pharmaceutical products. Do not store food and clinical specimens alongside vaccines.
- Maintain the temperature between +2 and +8⁰C.Keep the vaccine fridge secure and accessible only to authorised practice staff. So keep it locked or in a locked room.
- Reduce the possibility of accidentally interrupting the electricity supply. For example, installing a switchless socket or clearly label the plug with a cautionary notice: ’Do not unplug/switch off’.
- Use a large enough fridge to allow enough space around the vaccine packages for air to circulate.
- Keep the fridge clean with no build-up of ice. Make sure that you:
- follow the manufacturer's servicing recommendations
- calibrate the temperature gauge
- include it in portable appliance testing.
- Keep vaccines in their original packaging.
The cold chain policy
This term describes the cold temperature conditions in which certain products need to be kept. It includes:
- transport vaccines from a recognised medical supplier in validated cool boxes
- all those involved in administering vaccines, as well as the practice manager, should:
- be trained on the importance of maintaining the cold chain
- understand what to do if there is a failure in the cold chain.
Observe the four Rs: Read, Record, Reset, React
Make sure that the person making the recording of the fridge temperature:
- does it at least once every day during the working week and signs the temperature record sheet
- records it in a standard fashion and on a standard form to include: current, maximum and minimum temperature readings
- acts immediately if the temperature falls outside +2 and +8⁰C
- resets the thermometer after each reading.
Ideally, use a second thermometer that is independent to the integral thermometer in the vaccine fridge. This:
- cross-checks the accuracy of the temperature
- monitors the temperature if the electricity supply to the vaccine fridge is interrupted.
If you do not use a second thermometer, calibrate the integral fridge thermometer as frequently as the manufacturer recommends.
You can use a data logger in the vaccine fridge, yet each working day you must still:
- read and record temperatures on the integral fridge thermometer (minimum, maximum and current)
- reset the min/max thermometer.
This will assure you the fridge contents have been stored correctly and are safe to use.
If you use a data logger and only check it weekly or monthly, you risk missing cold chain breaches. It is possible that you used vaccines that were stored outside the recommended temperature range. If you use an alarm system to alert that the fridge temperature is out of range, is it possible the alarm could turn itself off once it is back in range, without being investigated?
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.
Follow this schedule:
- every week: check fridge contents at least once
- every month: audit and record vaccine stock
PHE has also produced guidance on what to do if the cold chain is compromised or believed to be compromised.
If there is a known or suspected cold chain failure:
- the vaccines must remain in cold storage under quarantine
- contact the local screening and immunisation team at NHS England for advice
- do not use or discard vaccines until you have that advice.
- Last updated:
- 23 May 2019