Cold Chain Protocol - Vaccines and Biologics

Appendix 4: Algorithm to Assess Problems in Temperature Readings

Temperature reading is below the expected range
  1. Is the thermometer properly placed and working?
 No

Move the thermometer/probe to the centre of the middle shelf. Change battery, if necessary.
Yes
    
  1. Is the thermostat set to an appropriate setting?
 No

Adjust the thermostat to a warmer setting. Recheck the temperature of the refrigerator or freezer every half hour until the temperature stabilizes. Continue to monitor for several more hours.
Yes
    
  1. Has the ambient temperature of the room become warmer?
 Yes

Adjust the temperature of the room so that it is not too warm. A warm room will cause the refrigerator or freezer to work harder, producing a cooler environment inside the unit.
No
    
  1. Is there good air circulation outside of the refrigerator?
 No

Ensure the refrigerator or freezer is set up according to the recommended clearance requirements and that nothing is impairing the air exchange around the unit.
Yes
    
  1. Call a trained technician to check the unit.
  

 
Temperature reading is above the expected range
After ensuring that the refrigerator or freezer is plugged in, the outlet is working and/or the cord is functioning properly:
  1. Is there electrical power to the refrigerator?
No

Check the fuse box then contact the electric or hydro company in your area (if necessary).
Yes
    
  1. Is the door closed properly?
 No

Check the levelling legs, door seals, door latch and hinges. Call a technician to repair as necessary.
Yes
    
  1. Is the thermometer properly placed and working?
No

Move the thermometer/probe to the centre of the middle shelf. Change battery if necessary.
Yes
    
  1. Is the thermostat set to an appropriate setting?
 No

Adjust the thermostat to a colder setting. Recheck the thermometer every half hour until the temperature stabilizes. Continue to monitor for several more hours.
Yes
    
  1. Has the ambient temperature of the room become cooler?
 Yes

Adjust the temperature of the room so that it is not too cold. A cold room will cause a cool ambient temperature outside and a warm environment inside of the refrigerator or freezer.
No
    
  1. Is there good air circulation inside and outside of the unit?
 No

Rearrange vaccine trays to allow air to circulate around the vaccines. Ensure that nothing is impairing the air exchange around the unit.
Yes
    
  1. Call a trained technician to check the unit.
    

Adapted from the First Nations Inuit Health Branch, Health Canada and CDC Vaccine Storage and Handling Toolkit (2005), Resources Section, National Vaccine Storage and Handling Guidelines for Immunization Providers, Appendices.

Note: If a simple solution to a cold chain problem is not immediately identified (power disconnected, fridge door ajar, temperature probe misplacement, etc.) move vaccines and biologics to a back-up refrigerator or freezer or temporarily store in appropriate coolers.

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