6 Best Practices for Refrigerated Vaccine Storage and Handling

JUNE 28, 2016
With flu season rapidly approaching, pharmacies will once again be filling their refrigerators full of lifesaving influenza vaccines to add to their already extensive vaccine inventory.
It’s crucial that the cold chain isn’t broken, so the efficacy of those vaccines isn’t put at risk. Unfortunately, a paper published in 2007 in Vaccine estimated that a shocking 14% to 35% of refrigerated vaccines are exposed to freezing at some point,1 and that doesn’t even encompass all excursions.
In light of this, here are some of the most commonly missed best practices for refrigerated vaccine storage and handling: 

1. Selecting a Thermometer
Make sure you’re using a thermometer that will accurately measure the temperature of the vaccine, not the ambient air. For this reason, food thermometers aren’t recommended; plus, they fluctuate rapidly when the door is opened. The probe of the thermometer should be suspended in glycol.
The thermometer should have a Certificate of Traceability, and you should have documentation that it has been calibrated. Also, remember that calibration doesn’t last forever, so be sure to send your thermometer off to be recalibrated before the due date, which is often put on a tag attached to it.2-3

2. Selecting a Refrigerator
Dorm-style refrigerators can’t be used for medications because they’ve been shown to be too unstable. Think about it: the freezer is inside the refrigerator and blowing air into the refrigerator compartment.
The CDC lists full-size freezer/refrigerators as “not preferred” but “acceptable,” as long as only the refrigerator compartment is used. However, in my experience, they don’t hold temperatures well either, partially because the freezer is still blowing cold air into the refrigerator.
Stand-alone refrigerators or medical refrigerators are best. After all, if you’re going to entrust $10,000 or more of product to your refrigerator, do you really want the cheapest one you can find? After you purchase a refrigerator, it will take several days for the temperatures to stabilize within the required range.2-4

3. Stabilizing the Temperature
Jugs of water act as a heat reservoir, absorbing excess heat when the door is opened and releasing it as the refrigerator cools off. From my experience, this can reduce the total temperature range a refrigerator is in by several degrees Fahrenheit. It’s also a CDC recommendation.
The jugs should be on the door, on the bottom (if you have salad drawers, remove them and put jugs of water in their place), and on the top. They should be labeled “Do not drink” because food and drink shouldn’t be kept in a vaccine refrigerator. If you actually go with a combination refrigerator/freezer, you have very little room left to store product because of the small size of the refrigerator compartment.3

Alex Evans, PharmD, BCGP
Alex Evans, PharmD, BCGP
Alex Evans, PharmD, CGP, works in community pharmacy in Jacksonville, Florida, and is preceptor at the University of Florida and Florida AM University. He graduated from the University of North Carolina-Greensboro with a BS in Biology and graduated from the University of North Carolina-Chapel Hill with a Doctor of Pharmacy degree. He has worked in both the community and long-term care settings. He can be reached at alex.evans.pharmd@gmail.com