The vaccine accounting section of the Immunization Branch receives reports each month from more than 3,000 providers who administer state-supplied vaccine. The data from the reports are reviewed and used to monitor vaccine usage and expiration dates, inventory levels, and to tally the number of doses of vaccines administered.
The Legislature looks at the number of doses of vaccine administered to help determine our funding. In 2003, more than 7 million doses of state purchased vaccines were administered, which is reflected in reports received from over 3,000 providers each month.
Equipment | Personnel
Standard Operating Procedure | Ordering Vaccine
Receiving Orders | End-of-Month Inventory
Vaccines supplied by the state represent taxpayers' dollars, and each clinic that participates in the Texas Vaccines for Children Program (TVFC) must commit to protecting the vaccine so that we can continue to provide a safe, effective product to the children of Texas. The TVFC has the additional burden of proving to the Commissioner of Health, the state legislature, and the Centers for Disease Control and Prevention (as well as other organizations) that the vaccines are being used in a cost-effective manner.
There are three basic elements needed to assure that vaccines are handled properly: the right equipment, well-trained people, and standard operating procedures.
To be sure that vaccines are kept at the correct temperatures, you need a refrigerator, a freezer, and two thermometers, preferably with maximum-minimum temperature recording capability. An alarm system and a back-up generator also may be appropriate for larger clinics.
The refrigerator compartment should maintain temperatures between 2°-8°C (36°-46°F). Since it should never reach temperatures below 0°C (32°F), set the temperature mid-range, about 5°C (40°F) to provide the best safety margin.
The freezer compartment should maintain temperatures at or below -15°C (5°F). It should never reach temperatures above 0°C (32°F). You will get the most useful information about actual storage temperatures from maximum-minimum thermometers. You will want one for the refrigerator and one for the freezer.
High volume clinics may find separate refrigerators and freezers useful. But most clinics find a standard "kitchen" side-by-side or top-freezer unit to be sufficient. Frost-free freezers are acceptable. "Bar" units or dormitory-style units are not recommended, and state-supplied varicella vaccine should never be stored in one.
If your refrigerator is new or newly repaired, allow time to adjust it. Check the instructions carefully, before adjusting the temperature control settings, then make sure temperatures do not change overnight. Sometimes manufacturers recommend resetting the controls in summer and winter. If so, post instructions about this on the door.
Plug guards are an effective tool to prevent the accidental unplugging of equipment. The TVFC has purchased enough plug guards to serve all current public and private providers. As soon as they are received, they will be shipped to vaccine depots statewide, to be distributed with vaccine orders. Signs warning staff to not unplug the refrigerator are available from the Immunization Branch, Literature and Forms Section.
It is a good idea to identify sufficient, alternative space to store vaccines and maintain the "cold chain" during any period when your refrigerator is out of service.
It is important that vaccines be kept at the proper temperature at all times. Frequently opening the door interrupts the cold chain and can result in a cumulative loss of vaccine potency over time. Storing food, sodas, or patient specimens in the same refrigerator should be avoided.
Just because a refrigerator/freezer is plugged in and running does not mean that everything is fine and your vaccines are safe. No refrigerator is perfect and accidents will happen. Plugs get disconnected, power outages occur, and equipment can fail. So it is a good idea to take a few extra precautions to ensure the quality and effectiveness of your vaccines, not to mention the financial investment. Following are some basic tips:
- Check and record on a chart the internal temperatures. Think about the temperature; is it within the acceptable temperature range?
- Storing extra ice packs along the walls, back, and in the door racks of the freezer compartment helps keep a steady temperature during automatic defrosting cycles. It also provides additional reserves of cold in the event of a power failure.
- Storing a couple of large water bottles against the inside walls or in door racks of the refrigerator, helps maintain a stable temperature and again, provides extra reserves of cold in the event of a power failure.
- Never store vaccines in the doors because the temperatures are not as stable as in the body of the refrigerator or freezer.
- Stack vaccines with enough room for the air and the cold to circulate.
Be sure to look for vaccine shipments and open them as soon as possible after they arrive. Check a copy of your order against the packing sheet. If there are any discrepancies, contact your supplier immediately. Check the expiration dates on the vaccines you have received. Always use the shortest-dated vaccines first! Then place the vaccines in the appropriate storage compartment.
varicella vaccine must be kept at -15°C (5°F) and must be used within 30 minutes after reconstitution. It cannot be refrozen. If varicella has been thawed, but has not been reconstituted, the vaccine must be used within 72 hours as long as the vaccine is stored at 8°C (46°F) or colder.
MMR vaccine may either be stored frozen or refrigerated. MMR is sensitive to light and should not be left out in the light.
Other vaccines (DT, Td, DTaP, Hep A/B, IPV, and Hib) are stored in the refrigerator, and should never be frozen.
Diluents may be stored in the door of the refrigerator, and provide extra insulation much like bottles of water. It is preferred that diluents for MMR and varicella vaccines be stored cool, because warm diluent might inactivate those vaccines. Diluents should not be frozen, especially those containing adjuvant.
At the end of each month, count your inventory and pay special attention to the expiration dates of your vaccines. For any vaccine that will expire within 60 days, if you will be able to use it, no problem. If you will not be able to use it all, call your supplier immediately. In most cases, it can be moved to another clinic where it will be used before it expires.
Remember, the monthly form C-33, Monthly Vaccine Report Form (14KB, :04) is a vital tool to help you properly store and handle TVFC vaccines. Please do not simply record the information on the form--THINK about what the information means, and take appropriate action. Vaccines are money, and every dose wasted is like throwing money away. Negligent handling of TVFC vaccines may result in your clinic being billed for the dollar value of the vaccines lost.