#2 An example of a Good Warehouse keeping (SHALINIE)

This was taken this September 2016 at Cebu City Health Department Cold Room Facility. It shows a well spaced placement of the vaccines. It is arranged according to type of vaccines. The cold room staff also maintains cleanliness in the facility.

Hepatitis B vaccines are arranged in groups with label, Lot # and Expiration Date.

There are space in between PCV 13 vaccine supply to allow air circulation.

Cool water packs are laced on vacant spaces for packing of vaccines for delivery.

Although the cold room facility has its own temperature monitoring system with alarms, a Fridge Tag is placed on the vaccines to back up temperature monitoring.

#15 - A temperature violation (KWAME)

Number 15:  A temperature violation

This picture was taken in September 2016 at an outreach clinic during measles second dose post-introduction evaluation. At an outreach clinic, vaccines are put directly on top of a frozen ice pack. No condition of the ice packs  was done and no foam pad was used. Take note of the vial of tetanus toxoid vaccine,  a freeze sensitive vaccine.  At another clinic, the practice was different. Foam pad was in use.

#10 - A health worker in immunization outreach (KWAME)

Number 10: A health worker in immunization outreach 

This picture below  was taken in September 2016 during measles second dose post-introduction evaluation.  It shows a Health Surveillance assistant (HSA) at an outreach clinic in rural central Malawi giving a health talk to mothers before vaccination started. During immunisation clinics, other activities conducted include health talks, nutritional assessment, growth monitoring. In Malawi HSAs are the vaccinators and run the immunisation clinics. Some outreach clinics take place in  simple mud huts that are built by the communities especially in places where school classroom or churches are not available as alternative venues.

 

#6 A temperature sensitive product being administered to a child (SHALINIE)

#6 A temperature sensitive product being administered to a child

This picture is taken at Labangon Elementary school, Cebu City during the school based immunization for Grade 1 pupils. The nurse is giving MR vaccine to the child. Since this is a temperature sensitive product, vaccine carrier is brought to maintain the temperature requirement of the product.

#15 Temperature violation (HOA)

Every year, my institute have to order some reference agents from NIBSC for purpose establishment secondary standards and control quality vaccines.
This shipment was dispatched from NIBSC, England to Hanoi, Vietnam. They dispatched the parcel though DHL on Mon, Mar 7th. DHL sent the parcel pass though Germany, Thailand then Vietnam.
I received the parcel on Mar 18th (at 18.00). At that time, It had no dry ice and not in freezer. (Please see the photo).
I worried  about  condition during transportation of all the sample. I feedback to Dispatch Team Leader of NIBSC. He said that he need to consult with scientists about condition of products. Some of them could be shipped at room-temperature and so should be OK to use still. However some of them such as most of polio and influenza products must be -70degC all the time so they would have to be replaced.

After that he feedback to me that:

NIBSC would be replacing all the polio materials as they would not be fit for use.
Scientist has advised that the influenza antigens and antiserum reagents would be OK to use as long as they were not exposed to high temperatures.
However, if I feel quality was in doubt NIBSC could replace the influenza products as well. 

I were not sure about the quality of the influenza products so I required NIBSC replaced all polio and influenza products.

#11. A scanned image of a local temperature recording form (ARNULFO)

This is a scanned image ( as requested by Sir Umit) of a temperature monitoring chart (August 2016) of  10 cubic meter Cold Room No. 1, an intermediate vaccine store of the Department of Health-Regional Office VII, Cebu City, Philippines. The temperature limits of 2 degrees to 8 degrees Centigrade shaded in yellow is where the dots are mark corresponding to the reading of Fridge Tag 2. Twice a day recording of temperature and each dot is connected to plot a line graph, am - blue color / pm - red color. Exceeding this upper and lower boundary, corrective measures are done right away to prevent any negative effect to the vaccine stored.

The temperature monitoring tool calibration certificate date / due is indicated in the upper right hand corner. No break in  temperature monitoring even during Saturday, Sunday, and holiday.

The plotted line graph is the average temperature while the minimum / maximum temperature is in numerical. Alarm indication is also reflected and duly signed. Important notes is written in the  remarks portion for additional information.

#3. Heat Transfer (ARNULFO)

#3. An example of heat transfer with all different forms combine into one photograph

This photo was taken today using my iPhone.

One form of heat transfer is CONDUCTION, transfer of heat occurring at molecular level through contact. Aluminum frying pan is a good conductor of heat. This is why a towel is use in touching the handle of the frying pan because of the high conductivity of heat and the hand might get burn.

Another form of heat transfer is CONVECTION, transfer of heat from one place to another by the movement of fluids and air. Convection is the circular motion that happens when warmer air or liquid which has faster moving molecules, making it less dense rises, while the cooler air or liquid drops down. Convection in a frying pan (boiling of water) over a gas stove.

Last form of heat transfer is RADIATION, transfer of heat energy that is radiated or transmitted in the  form of  heat rays, light rays, and x-rays. The flame in the gas stove that makes the frying pan heat up and boils the water.

#6 A temperature sensitive product being administered to a child/person (NAGLAA)

These 2 photos from 2 different health facilities during immunization session. The photo shows health worker while administering Penta vaccine and OPV.

# 10 A health worker in immunization outreach (SHALINIE)

These pictures were taken on the second week of September 2016 during the follow up of defaulters in Barangay Banawa, Cebu City. Immunization at the health center is done every Wednesday. After the immunization session, Target Client List is checked for any defaulters. Every week the nurse go out to the community to follow up defaulters. Together with the Barangay Health Workers they go house to house and find these clients.

Pentavalen, OPV and Amv vaccines were given respectively by the health worker. It is very important that during the transport cold chain management is maintained. Vaccine carriers are brought to protect vaccines from heat. Just enough vaccines are brought to the community to avoid unnecessary exposure of other vaccines to potential extrme heat.

#7: Primary or intermediate vaccine storage facility showing vaccines in storage (NAGLAA)

Intermediate vaccine storage, Vaccines received from the primary vaccine store is received and stored in ice lined refrigerator.
The photo at right shows the ice lined refrigerator. photos at left show the vaccines in storage, Temperature is recorded twice daily using thermometer placed inside the refrigerator.

#4 Good temperature monitoring device in action (KEHINDE)

This temperature monitoring device known as beyond wireless was installed in most of our cold stores in Nigeria so as to be able to monitored the temperature of the inside the cold rooms and other equipment storing vaccine. The temperature monitoring is carried out by the device through an internet connectivity attached to this device and the officer in charge of the cold store can then monitor the temperature readings by logging to the beyond wireless web site http://p3.beyondwireless.co.za/ using the provided user name and password.

In case of temperature excursions, an SOP is attached to the device informing the officer in charge to know what to do see the below diagram 

The device had been successful installed in my State and it make use of probes that is connected from the device to the cold rooms (4) in numbers and also measure the ambient temperature of the environment where the cold room is installed.
The officer also make use of the manual temperature chart recording using the attached digital thermometers attached to each cold rooms to compare with the recording printed out from the beyond wireless site. See example of such manual recording below

#4: An example of a good temperature monitoring device in action (KWAME)

Number 4: An example of a good temperature monitoring device in action

Malawi is currently experiencing severe electricity power shortage. There is power rationing taking place the across and health facilities are not spared. Power outages take almost twelve hours.
Today I went for measles second dose post introduction evaluation field tour . At one health facility I inspected  a Vestfrost Defy chest refrigerator  that has a Fridge tag (FT). The FT had several alarms registered for temperatures above 8 degrees Celsius and each event was over  8 hours.  The fridge contains polio vaccine which is heat sensitive.

#4 An example of a good temperature monitoring device in action (DELALI)

This is a digital temperature recorder for one of our small clinics which use a medium-sized fridge to keep their vaccines and other cold chain products.
It gives the maximum and minimum temperatures inside the fridge as well as outside and serves as an appropriate temperature monitoring
The refrigerator holds vaccines used in the immunisation of babies. It also holds insulin products as well as ophthalmic products and other temperature sensitive products.

This is the temperature chart that is used to document and monitor the temperature readings. Readings are recorded from Monday's to Saturday's . Not on Sunday's and public holidays. Because the clinic is not open on those days.
Temperature readings are taken twice daily, with the maximum and minimum temperatures recorded by the Sister on duty.

#5 A refrigerated truck used outside the pharmaceutical cold chain (UMIT)

Dear All,

This space if for you to hunt the situations listed in the first posting. As I did in the posting on Temperature Violation, I am making a new one to showing an example of being more elaborative on the story behind the photograph. When you make your postings, please explain more, don't give just a couple of descriptive phrases what the photo shows. There is always a good story behind every single photograph...

Here we go...

Once in a while, on my way to the office, I stop in this Café Léo in Rive, Geneva to have a cup of tea with lemon. 

Rive is one of the busiest places in Geneva, a hub for many public transport bus lanes and connections as well as for some restaurants and a big shopping hall (with meat and mostly food shops) around. And every morning, many refrigerated trucks make their stops in the circle to offload the daily supplies, mostly vegetables and meat to these restos. 

As  you see in the map above, only within a perimeter of 50 meters, there are 10 locations that require temperature controlled distribution of food items. 

Here I see two refrigerated trucks... The Petit Forestier one parked before, and I watched the driver getting out, opening the back door of the truck, loading his trolley with supplies and going off to drop it to whatever resto. But he left the back door of the truck open. He came several times back for more loads... It took him around 8 minutes to distribute all he had to do with an open back door which exposes the inner space of the truck to heat up. Maybe he finds closing the heavy door each time a bit cumbersome. The thermodynamics of leaving the door open in a refrigerated truck deserves a different level of discussion in our discussion forum. I mean, how the thermodynamics work here and the inner space heats up? Does the cold air inside escapes out from the door, or the warm air enters the truck?

Though this is not a recommended practice, the impact on the products would be minimal and I only stop in this spot to have my lemon tea, which does not require any temperature controlled distribution supplies to have. It is CHF 3.80 which is 4 USD. Well, welcome to Geneva, things are expensive here... 

Wishing you a very good day...

UMIT

#9 Refrigerator with vaccines organized (Kwame)

Number 9: In 2010 Ice lined refrigerator  at a health facility  in Malawi with vaccine boxes well arranged. The vaccine boxes have spaces between then to allow air circulation. The boxes are placed in the fridge baskets and the vaccine vials are inside the box packages. The vaccines kept in this fridge are rota and PCV 13. A Fridge Tag is placed at the top of the boxes. This was the first time Fridge tags were introduced a few health facilities in Malawi. Before that dial and stem thermometers were in use. Now FTs are in use in over 80% of health facilities across Mlawi .

#15 A temperature violation (Naglaa)

Temperature violation  of heat sensitive product in health facility providing immunization service, These photos were taken in February 2013 during my mission to assess the health facilities. The first 2 photos  VVM grade 4 and the expiry 8/2013 of OPV.
The 3rd photo shows the thermometer reading is 12 .

#4: A good temperature monitoring (Hoa)

This is my institute's cold store. It has a temperature monitoring system automatically, camera system, warning in case of incidents, power cut, sending notifications to 5 people's phone.

#11 - A temperature recording form (Arnulfo)

As shown above photos, a temperature monitoring chart for the month of August 2016 posted in the cold room (1989 Toshiba model) wherein we record  the temperature twice a day (morning and afternoon) using Fridge-tag 2 temperature monitoring tool.

#15 - A temperature violation (Protect from freeze or beyond temperature violation... UMIT, New York)

Dear all,

In order to give a charge to the "scavenger hunt", I would like to do the first posting to set an example. In general, it should be you, who should be looking for the situations in the given list and post your photographs with short stories behind them, like the one below.

Here we go...

It was two years ago in January that the coldest air in almost 20 years was sweeping over the central U.S. toward the East Coast, threatening to topple temperature records, ignite energy demand and damage Great Plains winter wheat. That week, I was in New York. It was freezing cold - though I knew it was going to be cold, my sweater and heavy coat did not help much since there was also terrible wind all the time!..

On the 7th of January, walking in the 40E street, a pallet sitting on the pavement attracted my attention with a sign on it "Protect from freeze". I was in a rush for an appointment and just continued walking. In the afternoon, going back to my hotel from the same street, I was shocked to see the same pallet at the same spot, still waiting. This time, I made a photo, then took a screen shot of my iPhone showing the temperature.

Minus 16 deg C!.. I had no idea since when the pallet was left on the pavement, unattended like this, but was sure, whatever it contained, was sure frozen. This is what I call "temperature violation"...

Cheers UMIT