#11 A local temperature recording form (PHILIP)

As I walks through our clinic for inspections, I met a Nurse busy recording the daily cold chain Refrigerator 'out side' Temperature. She shown it to me and I said to the Nurse - Yes, this is a example of the good record keeping.

The photo below was also taken when the same Nurse was responding to my question about: Vaccines Tally Sheet Record for the clinic.

#6 Temperature sensitive product being administered (KEHINDE)

#6 Temperature sensutive product been administered to a baby in one of our health facility in Oyo State Nigeria.

#10 - A health worker in Immunization Outreach (AUN)

RATANAKIRI, Cambodia: The outreach team of two male staff and one midwife from the health centre need to travel by motorbike, then boat to cross the river and again by motorbike or ox cart. The village is about 40 kilometers which take at least 2 hours travel and longer time, especially difficult during the rainy season.

Vaccines are kept in the vaccine carrier with conditioned ice packs. Vaccines are also kept in the plastic zipped lock. No Freeze Tag included in the vaccine carrier. The vaccine carrier is not well protected from sun light during transport.

#1 - A non-pharma example of measuring temperature (REZWAN)

This photo has been taken in my University department where they're constantly monitoring temperature and humidity of the room

This photo has been taken in my University department where they're constantly monitoring temperature and humidity of the room

#11: A local temperature recording form (KWAME)

Number 11:  A local temperature recording form

This is a temperature monitoring chart at Mhuju Health Centre in Northern Malawi. Temperature reading is done twice a day from a Fridge tag and charting done.

#14 Risks associated with transport and/or control measures introduced to detect/prevent and/or mitigate a risk (UMIT)

Dear All,

Though I have indicated that this posting is for the situation #14, it is not fully correct, because there is no "transport" involved what I will explain below. But I thought it would be a good example of "control measures" in our daily lives...

Where I live (Collonge-Bellerive) just across our apartment, there is a new construction of a two-story building with 3 levels of parking underground, and all these heavy machineries are pounding all day long, starting 7 am in the morning... It is good that they do not work on Saturday and Sunday. And I am so happy when it rains, at least we are not exposed to dust then...

I took this photo the other day, thinking that it will be a good example of control measures.

Here is a display at the entrance that serves a dual purpose: both to public and workers. 

First of all, it says "Entries prohibited to the general public". it is a warning sign, assuming that people will not enter reading this sign - so, it is preventive in nature, but of course it has a big hole in it. The sign is not too big and even with a big sign, you may not pay attention, and/or though you have read it you still can walk inside since there is no physical barrier that really prevents this. 

Secondly, it tells workers that the special personal protection is obligatory. So, we have a safety helmet, safety boots, and high-visibility vest on the sign. And you can see the worker on the machine wearing his helmet and high-visibility vest - though you cannot see it, he is also wearing his safety boots. Here, the sign again is a preventive measure. The helmet and the boots are also preventive in nature. The high-visibility vest is in detection nature at first (serves to others to see that there is a worker there), and by doing this it prevents any related unwanted situations. 

Keep in mind that no job is so important and no service is so urgent that we cannot take time to perform our work safely.

Cheers / UMIT

#4 An Example of a good temperature monitoring device in action (SHALINIE)

This is another temperature monitoring device in the cold room in Cebu City. The recording sheet shall be replaced weekly.

Sample monitoring sheet. These are kept in a folder at the cold room office for future references. The Pharmacist/cold room manager takes charge in replacing the monitoring sheet weekly.

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

Temperature monitoring devices used in primary TTSPs storage facility. The cold room temperature is displayed on the panel, drawn temperature chart recorder with digital display. Temperature is also recorded twice daily by designated staff.  Data of Labguard temperature monitoring system is monitored from the control room.

#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.