TechNet-21 - Forum

This forum provides a place for members to ask questions, share experiences, coordinate activities, and discuss recent developments in immunization.
  1. Shahrzad Yavari
  2. Cold chain equipment
  3. Tuesday, 03 June 2014

Dear All,

I am a project coordinator for Nexleaf Analytics. We are a nonprofit organization dedicated to building low-cost technologies that create positive health, environmental and social impact. I have attached a Standard Operating Procedure (SOP) for fridge maintenance for your review. Additionally, I have also a little bit of the background about why we have created this SOP.

Nexleaf Analytics is currently deploying ColdTrace, our low-cost remote temperature monitoring device, in about 50 clinics in a district in Kenya and in about 100 sites in Mozambique. If a fridge experiences temperature excursions outside of the 2-8 degrees Celsius for a certain period of time, the ColdTrace sensor sends SMS alerts which notify clinic workers and Ministry of Health staff about vaccines reaching critical temperatures. Each level of the supply system can act on this information to help ensure vaccine safety. The goal of ColdTrace is to increase fridge up-time , improve the maintenance loop, and avoid vaccine wastage due to temperature excursions.

During my recent visits to Kenya and Mozambique, I learned the importance of creating a SOP for nurses that guides actions in three areas: (1) Preventive Fridge Maintenance; (2) What to do when they receive an SMS alert about a cold excursion: and (3) What to do when they receive an SMS alert about a hot excursion.

This SOP was also reviewed by the MOH maintenance departments in the two countries. This draft was slightly modified for Mozambique and translated in Portuguese. I would be more than happy to share that draft if anyone is interested.

I would greatly appreciate your feedback on this SOP as we are looking to make this SOP as comprehensive as possible. Thank you.

Attachments (1)
nassor Accepted Answer
Dear Shahrzad, When I was talking about using the term cool water packs instead of ice pack I was referring to the procedure of defrost during maintenance, the SOP guide the personnel to remove vaccines from the fridge to a cold box with ice packs. My point was to remember some of the vaccines are freeze sensitive and exposing them to low temperature may lead them to be damaged and loos potency. So, to avoid that, we should avoid the term ice packs and use cool water packs. Does that term apply to all the cold packs that are used in different fridge models?? I am Not sure about that. Regards Nassor
  1. more than a month ago
  2. Cold chain equipment
  3. # 1
Shahrzad Yavari Accepted Answer
Dear Gilles, Thank you for sharing this great SOP example with drawings! Using pictures is definitely an effective way to communicate information. I will keep that in mind as we develop the next version of our SOP.
  1. more than a month ago
  2. Cold chain equipment
  3. # 2
Shahrzad Yavari Accepted Answer
Dear Nassor, Thank you for your feedback regarding the cool water packs. Does that term apply to all the cold packs that are used in different fridge models?
  1. more than a month ago
  2. Cold chain equipment
  3. # 3
Gilles Ries Accepted Answer
Dear Sharzhad It is good and important to talk about PM. As you already mentioned, we face problems of funding to be effective on maintenance. Maintenance has to be done on very regular basis, and like John is saying, it is mostly about keeping the equipment clean. This is a task that should be executed by the users! Waiting for a qualified technician to keep equipments clean, is not the right way. Your attached maintenance plan is a good way forward. Even better in my eyes, is not to use text, but only drawings ( as you can see in my atachement ). We have used this SOP for our latest solar direct drive fridges that are right now being installed in Nigeria. Of course, such SOPs can be kept mor general, and adapted to compressor, solar or absorption technology. BR Gilles
Attachments (1)
  1. more than a month ago
  2. Cold chain equipment
  3. # 4
nassor Accepted Answer
Hi Shahrzad, My name is Nassor working with Maternal and Child Survival Program (MCSP) formal known as Maternal and Child Health Integrated Program (MCHIP) in Tanzania as Immunization Technical Advisor. I had a quick review of the SOP you shared, its real Good and capture everything that need to be done to maintain the refrigerator. Just one comment on the use of "ice pack" during defrost this may expose the vaccines to freezing temperature, I suggest to use the word "cool water packs" to avoid freezing of the vaccines during defrost of the Refrigerator. Although the SOP suggest to put the Temperature Monitoring Devices in the vaccine carrier that does not prevent extreme temperature but rather indicate the violation of temperature, therefore there is a need to change the word Ice Packs to Water Cool Packs to avoid exposure of vaccines to freezing temperature and also train responsible person on the differences between Ice Packs and Cool Water Packs. Regards Nassor
  1. more than a month ago
  2. Cold chain equipment
  3. # 5
Shahrzad Yavari Accepted Answer
Thank you both very much for your responses. In my conversations with the technicians in both countries, lack of funding for clinic visits (especially for the remote clinics) seemed to be the major reason that leads to delay in maintenance. Therefore, the technician at the MOH really emphasized on the importance of teaching Planned Preventive Maintenance (PPM) to clinic staff so they can fix common issues faster and without needing a technician. I also learned that the limited budget for maintenance is mostly spent on visiting close-by clinics versus remote clinics, and also on major issues (if the fridge has completely stopped working or needs a spare part). Therefore, we made the PPM SOP, which was used by the technician to train the nurses on training day on how PPM is done. We look forward to seeing if this SOP has been useful and I would be more than happy to share the results as we are monitoring the temperature plots over time.
  1. more than a month ago
  2. Cold chain equipment
  3. # 6
John Lloyd Accepted Answer
This table drafted several years ago; current discussions on Planned Preventive Maintenance (PPM) focus on the following issue. Electric compression refrigerators need very little PPM if they are powered by the grid. Most of the PPM task is cleaning and caring for the refrigerator that can be done by the user/storekeeper/healthworker without giving access to tools, nor authorisation to use tools. So PPM visits by technicians to healthy refrigerators are not indespensable - just 'nice to have'! On the other hand, if the electric compression refrigerator is powered by solar energy, PPM visits by technicians are justified due to complexity, vulnerability and reputation of solar driven refrigerators. So the user/storekeeper/health worker who is responsible for operating the refrigerator should be able to conduct routine PPM and to carry out some simple diagnostics. If the potential cause calls for a response without the need for tools, the user takes responsibility (unless a new refrigerator is required). If the potential cause requires repairs then a technician with tools should be called. If a replacement refrigerator is needed, either new or from stock, the technician may require support of the supervising manager.
  1. more than a month ago
  2. Cold chain equipment
  3. # 7
Oz Mansoor Accepted Answer
Thanks for sharing this nice job-aid to help address responses. Part of the challenge is that diagnosis of the cause for the fridge getting too hot or too cold may require a technician, but I think you nicely focus on those the health worker should be able to identify. However, need to emphasise that if they cannot identify cause, they need to get technician help. IN relation to diagnosis, you may find this sheet useful; - thanks to John Lloyd for the content! https://sites.google.com/site/vaccines30dtr/respond Perhaps of more practical importance in the field is that normal events can lead to short-term excursions that are of no importance. So, it would be important to not trigger an 'alarm' to the health worker too. The 30-day temp-recorder alarms set by WHO are relatively conservative, in that even when these are triggered vaccines are unlikely to have been damaged (except form the previous cumulative heat exposure in some cases). To my understanding, it is not possible to freeze a vaccine in an hour even if the temp falls below the -0.5C temp that triggers the 30DTR freeze alarm. So, to recommend a shake test if the temp goes below 2C makes no sense. Personally, I think that we should stop expecting health workers at the periphery to do the shake test. And rather than testing all vaccines it needs to be limited to freeze-sensitive ones; and perhaps only the one with the highest freezing point, as if that one is OK, others are likely to be so too!)
  1. more than a month ago
  2. Cold chain equipment
  3. # 8


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