#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